Inspection on 21/11/06 for Manor House

This inspection was carried out on 21st November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Manor House 14/01/10

Manor House 18/02/09

Manor House 27/11/07

Manor House 12/01/06

Manor House 11/08/05

Manor House 21/02/05

Manor House 13/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Manor House Higher Tremar Liskeard Cornwall PL14 5HJ Lead Inspector Alan Pitts Key Unannounced Inspection 21st November 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor House Address Higher Tremar Liskeard Cornwall PL14 5HJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01579 343534 Mrs Nichola Jayne Broadhurst Mr Robert Anthony Broadhurst Care Home 16 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (16) Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 16 adults aged over 65 years with a mental illness (MD(E)) Service users to include up to 6 adults aged over 65 years with Dementia (DE(E)) Total number of service users not to exceed a maximum of 16 Date of last inspection 12th January 2006 Brief Description of the Service: The Manor House is a privately owned older style house and, although only approximately five miles from the town of Liskeard, it is situated in a quiet moorland village. The home offers care and accommodation to up to 16 older people who have mental heath needs or dementia. Accommodation is in mainly single rooms, one of which is en suite. Rooms are available on the first and ground floors with a stair lift linking the two floors. Communal rooms and a small sun lounge are available on the ground floor with an additional large sitting room (that includes facilities to dine) on the first floor. The home has a garden at the rear, which service users can use in clement weather. The owners live in a property adjacent to the home. The range of fees charged is Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 21st November 2006 over a period of approximately 5.5 hours. Mr Alan Pitts carried out the inspection. The inspector met with residents, staff, and the owners, inspected documentation and toured the premises. Overall, the inspector found the home to offer a good level of service to the residents. The residents were observed to be comfortable, and relaxed in their interactions with each other and the staff. Comments received from residents and staff in respect of the home and the owners were positive. The home owners, Mr & Mrs Broadhurst, have daily involvement in the running of the home and the delivery of care to the residents. What the service does well: What has improved since the last inspection? What they could do better: The home could do more to ensure the involvement of the resident or their representative in the review of care plans, and to ensure that the daily records describe the lifestyle of the residents. A National Training Organisation Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 6 compliant induction programme must be introduced, and the staff informed of the General Social Care Council. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 The inspector judged the quality of service provided within this set of National Minimum Standards to be good. There is a Statement of Purpose and Service User Guide available. People are invited to visit the home and gain the necessary information before making decisions about seeking a placement. The home does not offer intermediate care. EVIDENCE: The home has a statement of purpose that is made available for all service users or their families/ representatives when making an enquiry. A copy of the Statement of Purpose is displayed on the notice board. The registered person was advised to review and date the Statement of Purpose and Service User Guide to ensure that these documents continue to reflect the services offered. Prospective residents are assessed prior to admission, as demonstrated by the care documentation of the most recent admission to the home. Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 9 The home does not provide intermediate care. Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The inspector judged the quality of service provided within this set of National Minimum Standards to be good. Residents have an individual care plan outlining their needs. Residents’ health needs are well catered for. Medication is stored and administered appropriately. Residents’ privacy and dignity were seen to be respected. EVIDENCE: Care plans have been reviewed since the last inspection; those inspected were clear and informative. There is a care plan for each resident. The care plans show regular and frequent reviews taking place, but the registered provider was advised that if the resident is unable to participate in the review of their care, then their representative should be invited to do so. The care documentation and discussions with the registered provider demonstrate that residents have access to other health care professionals as needed. The home has switched to the monitored dosage system for the administration of medication. Staff have had training in the safe handling of medication and Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 11 do not undertake its administration until they have been instructed. There is a medication policy in place. Policies are signed by staff to indicate that they have read them. Medicines are stored securely. Staff were observed to knock before entering residents’ rooms, and to interact with residents in a friendly, yet respectful and considerate manner. The residents spoken with confirmed that the home and the staff meet their needs. Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The inspector judged the quality of service provided within this set of National Minimum Standards to be good. More could be done to demonstrate the lifestyle experience of the residents. Contact with family and others is maintained, one visitor attended the home at the time of the inspection. The registered provider is committed to enabling the residents to have choice and control over their lives. Residents receive a balanced, varied diet. EVIDENCE: The inspector was advised that the residents being an elderly group, staff do spend time with them in arranging social stimulation and gentle activities to keep people mobile and orientated. Unfortunately there is a tendency for entries in the daily records to be generic in nature (e.g. “fine today”), rather than providing a brief description of the lifestyle of the resident. The daily records do not currently show the recreational/social options and opportunities available to the residents. This was discussed with the registered provider. There is a visitors’ book, and one resident had a visitor during the course of the inspection. Unfortunately the inspector did not manage to meet with the Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 13 visitor. Visitors are able to call at any time, but they are encouraged to avoid periods when there is maximum care activity. Discussions with the registered provider revealed a commitment to the welfare of the resident, including the promotion of choice and control over their lives. The majority of residents need help in managing their finances. The home prefers that a trusted relative or friend undertakes this, but the registered provider is appointee for one resident. The home will look after cash for a service user, documenting any thing that is bought and retaining receipts. The menu is a set one, but individual preferences are known and catered for. The record of meals is fully completed with any alternatives being recorded. Service users said the food was good. The dining room is a pleasant, sunny room and the tables were laid attractively with proper cloths and crockery. Meals were presented in a manner appropriate to people’s needs. Where people prefer to eat in their own room or the alternative sitting room, this is respected. The registered provider was advised that more could be done to promote choice at meal times. The registered provider undertook to ensure that the cook would inform residents of the menu for the day and also of the alternatives available. Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The inspector judged the quality of service provided within this set of National Minimum Standards to be good. The complaints procedure is displayed in the home with an invitation to anyone with a problem to discuss this as soon as possible with the registered persons. Staff are made aware of the issues and importance of the protection of vulnerable adults in order to safeguard residents. EVIDENCE: The complaints procedure is displayed in the home. It is unlikely that all the residents would be able to instigate this on their own behalf. The registered providers are however very knowledgeable about the residents, and were observed to quickly identify when a resident was displaying behaviour that indicated distress. The registered provider was advised to include the contact details for the local Adult Social Care office in the complaints procedure. Training records show that ‘No Secrets’ training has been provided. There is a whistle-blowing policy and an abuse policy. The registered provider was advised to introduce an Adult Protection procedure, which provides clear stepby-step instruction to staff as to the action to be taken in the event of an allegation of abuse (including relevant contact information). Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The inspector judged the quality of service provided within this set of National Minimum Standards to be good. The accommodation was in good order with on going maintenance to improve the overall standards and safety for residents. Residents’ rooms are arranged to suit a person’s needs and are personalised to varying degrees. The home was observed to be clean and free of undue odours. EVIDENCE: The inspector does not have the benefit of knowing the home at the time the current registered providers purchased it, but the inspector is advised that significant improvements have taken place over the past 3 years. All but a few windows have now been replaced with double-glazed units, and the remainder will be done in the near future. Residents’ rooms were decorated in a satisfactory manner and personalised to their liking. There is one double room, the remainder being single rooms. Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 16 Residents have a choice of communal rooms with two (plus dining room) on the ground floor and one upstairs. Equipment to promote independence and to assist staff was noted in the form of walking and toilet aids, lifting and bath hoists, and a new stair lift. There are some changes in floor level, though the registered provider is aware of this when assessing prospective residents. The accommodation is homely, and comfortable. One observation discussed with the registered provider was that internal parts of the building might be too dark. The registered provider should consider how to lighten internal areas to aid residents in their access around the premises, and also to promote their orientation (e.g. alternative lighting, use of light colours on walls and carpets). The home was seen to be clean throughout, and free from undue odours. The laundry is small, but functional, and fitted with modern, large washing machine and dryer. The kitchen is bright, clean, and orderly. There is an infection control policy in place. Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The inspector judged the quality of service provided within this set of National Minimum Standards to be good. The home benefits from a small, established staff team who have an in-depth knowledge of the residents and their care needs. There is ongoing training, and the home operates a robust employment procedure. EVIDENCE: The registered persons are closely involved with all aspects of the home and have got a good knowledge of the residents and the functioning of the home. The care team were observed to be sensitive to residents’ needs and to work well together. The registered person is clear in her thinking regarding residents and does not accept poor standards. The care staff are supported by domestic/housekeeping staff. The records show that there is ongoing training (manual handling, 1st Aid, adult protection), including NVQ training, though the number of NVQ qualified staff was not ascertained on this occasion. There is an in-house induction undertaken by all new staff. The registered provider was advised of the need to introduce a National Training Organisation compliant induction programme (www.skillsforcare.org). The registered provider was also advised to ensure that the staff have information about the General Social Care Council (www.gscc.org.uk). Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 The inspector judged the quality of service provided within this set of National Minimum Standards to be good. The registered providers maintain a daily involvement in the running of the home and the delivery of care. Residents’ interests are well served, and their financial interests are safeguarded. The health, safety, and welfare of the residents and staff is promoted and protected. EVIDENCE: Mrs Broadhurst has almost completed her NVQ Level 4 and the registered manager’s award. The registered providers appeared to be approachable and capable. Mrs Broadhurst is not afraid to confront and deal with contentious issues and has initiated changes in the work practice. Residents were observed to be at ease with the registered providers and staff, and able to ask questions Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 19 or make requests. Staff spoke positively about working in the home. The registered providers are in day-to-day control at the home. The registered providers have used quality assurance questionnaires to get feedback from residents’ representatives and other agencies. The registered providers were advised to make a summary of the quality assurance responses available to residents and their representatives (e.g. publishing in the Service User Guide). Mr Broadhurst is appointee for one resident. The practice in the home is to use the home’s float (petty cash) for residents’ personal purchases when necessary, and an invoice is then submitted to the resident or their representative. Financial records are supported by receipts, though as discussed this would be improved with the use of a duplicate book. The registration certificate and insurance policies were displayed. The accident records were seen. Fire training and equipment testing were current. A record of any incidents is kept and copies forwarded to Commission for Social Care Inspection. Certificates of training undertaken by staff were seen. The home has policy & procedural documents covering other aspects of the home’s practice, though the registered providers are considering using an external publisher to ensure that they have all the necessary documents. A Health & Safety policy was noted but not looked at on this occasion. Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP30 Regulation 8 Requirement The registered provider must introduce a National Training Organisation compliant induction programme (www.skillsforcare.org). The registered provider must ensure that the staff have information about the General Social Care Council (www.gscc.org.uk). Timescale for action 01/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP1 OP7 OP12 Good Practice Recommendations The registered providers should review and date the home’s Statement of Purpose and Service User Guide. The registered provider should ensure that if the resident is unable to participate in the review of their care, then their representative be invited to do so. The registered provider should ensure that the daily DS0000048225.V303559.R01.S.doc Version 5.2 Page 22 Manor House 4. 5. OP15 OP18 6. OP19 entries in the care documentation describe the residents’ lifestyle. The registered provider should ensure that the cook informs residents of the menu for the day and also of the alternatives available. The registered provider should introduce an Adult Protection procedure, which provides clear step-by-step instruction to staff as to the action to be taken in the event of an allegation of abuse (including relevant contact information). The registered provider should consider how to lighten internal areas to aid residents in their access around the premises, and also to promote their orientation (e.g. alternative lighting, use of light colours on walls and carpets). Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Manor House DS0000048225.V303559.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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