Inspection on 27/11/07 for Manor House

This inspection was carried out on 27th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 21/11/06

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 Elaine Bruce Unannounced Inspection 27th November 2007 08:30 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.V350842.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.V350842.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 Position Vacant 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.V350842.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 21st November 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. Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key unannounced inspection at Manor House took place on the 27th November 2007 between the hours of 0830 and 1545. The inspector met with the people in the home, the staff and the owners. Records of care planning were inspected as were staff files and policies and procedures. The standard of the meals being provided was also looked at as were the medication arrangements for the home. The premises were also inspected in regard to key standards. Prior to the inspection the registered providers completed an Annual Quality Assurance Document. Three staff surveys were also received by the Commission for Social Care Inspection. These indicate that the staff at the home are pleased with the standard of care that they are delivering. One survey said: “we work well as a team, we always have positive feedback from outside agencies”. Manor House is delivering care to people with a mental illness and or dementia, some of whom have complicated care needs. During the course of the day the staff were noted to be kind and caring in their interactions with the people in the home. The registered providers are very involved in the running of the home and are committed to delivering a good standard of care. This inspection has identified that outcomes are assessed as generally “adequate” and could be improved to “good” with attention given to the areas identified in the report. The weekly cost of care at the home at this time ranges from: £349.01 to £420.00. On the day of the inspection there were three vacancies at the home. What the service does well: The Manor House offers care in a small, homely environment for older people who are mentally frail. The home is comfortable and safe and the staff kind and caring. The registered providers are very involved in the running of the home to also include hands on care at times. Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 6 The staff presented as a team and the people spoken to during the course of the day expressed positive comments about the kindness of the staff looking after them. Staff were noted to be attentive to the people in the home during the main meal of the day. People were also encouraged to make choices about what they wanted to eat and drink. What has improved since the last inspection? What they could do better: Improvements could be made to the Statement of Purpose and Service User Guide. These documents have not been reviewed since they were introduced. They are important documents that should reflect accurately the service that is being provided. Daily records could be improved to evidence how people are spending their time at the home. A nutritional screening document should be introduced to identify people at risk. Medication arrangements could be safer. At this time a system that is known as secondary dispensing is taking place at the home. This system has room for error and should be stopped to ensure that people are not being placed at risk. The complaints policy and procedures should be updated with the correct information on the Commission for Social Care Inspection so people can contact the organisation if they so wish. Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 7 The home has in place adult protection policies and procedures but it is appropriate that these are reviewed and updated if necessary and read by all the staff in the home. In addition it is essential that all staff receive external adult protection training. It is recognised that considerably improvements have been made to the environment over the 4 years that the registered providers have been in the home. It is anticipated that more improvements can be made. It is important that the registered provider gives attention to achieving the registered managers qualification as soon as is possible. 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. The summary of this inspection report can be made available in other formats on request. Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 8 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.V350842.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Important information on the home should be updated to ensure that people are fully aware of the services that the home is offering. The professional needs assessment means that peoples’ diverse needs are identified and planned for before they move into the home. EVIDENCE: The home has in place a statement of purpose document that is made available to family/representatives when making an enquiry to the home. The statement of purpose document has not been updated since The Care Standards Act and would benefit considerably from this. The inspection report of the 21st November also recommended that this document be reviewed. In Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 10 addition to the statement of purpose the service user guide and residents’ handbook would benefit from updating to ensure that these documents continue to reflect the services offered. The statement of purpose document is displayed on the notice board in the entrance of the home as is the most recent inspection report. Prospective people being admitted to the home are assessed prior to admission by the registered provider. Evidence was in place of a recent pre admission assessment having been undertaken of a new admission to the home. The registered provider gives a great deal of consideration to admissions to ensure that they will fit into the “homely” environment that is being offered at Manor House. Documentation was also in place (prior to admission) of external health and social care assessments. Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The present medication arrangements at the home could place people at risk. Improvements could be made to daily records to evidence that health and personal care needs are being met at all times. EVIDENCE: The home is using a recognised system for care planning and each person has in place a plan of care that is supported by daily records. The care plans are supplemented by good records that indicate when personal care delivery has taken place. Risk assessment documentation is also included in care planning. There is some evidence of the people and their representatives being involved in care planning but this could be improved as identified in the inspection report of the 21st November 2006. The daily records include good information on the intake of meals and the direct delivery of care but could be improved by including information on how a person is spending their time at the home. Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 12 More information is required in care planning on nutritional screening and the weighing of the people in the home. Each person is registered with a general practitioner and the home has good working relationships with local surgeries. Community nurses support the people in the home as required and good records are in place when this has taken place. The home is supplied with a monitored dosage system for medication administration from Boots pharmacy. The medication is stored appropriately in a locked cupboard in a room where staff have space and facilities to check the system. At this time the medication is being administered to the people in the home using what is known as a “secondary” dispensing system. Although two staff are checking the medication from the blister pack into the pots and then giving out the medication from the pots on a tray together there is still room for error within this system. Each person should be administered their medication from the blister pack to a pot and observed as taking it and then their medication administration record signed. This is not taking place at the home which can place people at risk. This has been discussed with the Pharmacy Inspector who has confirmed that this practice is not safe. The medication policy and procedure also requires updating from 2004. The registered provider advised that the staff have received medication training from the Pharmacy although there is no evidence that accredited medication training is taking place. The staff were observed during the course of the day to interact with the people in the home in a friendly, yet respectful and considerate manner. Three people spoken to during the course of the day confirmed that they are being well looked after. Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The daily records about the people in the home provide limited evidence that there are a range of activities within the home and community. Meals and meal times appear to be a positive occasion for the people in the home. EVIDENCE: As identified in the inspection report of the 21st November 2006 and at this inspection, the daily records do not show the recreational/social options and opportunities available to the people in the home. During the course of the inspection arrangements were being made for children to visit and sing to the people in the home from the local school over the Christmas period. Observation of the ladies in the home indicated that staff are spending one to one time painting their nails for example. The local vicar is a regular visitor to the home and is able to provide a service to meet the Church of England needs of any people in the home. The hairdresser also visits the home. Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 14 Observation of the daily life in the home indicates that the day is flexible to suit the needs of the individual for example the getting up time and the time for breakfast. There is a visitors’ book in the entrance of the home and daily records indicate when visiting has taken place. Visitors are able to call at any time, but they are encouraged to avoid periods when there are meals taking place. The main meal on the day of the inspection was cottage pie with green beans and potatoes followed by arctic roll or cheese and biscuits. The alternative meal to this was fish cakes. Records are in place with any alternatives to the main meal being documented. The main meal of the day is displayed on the chalk board in the dining room for the people in the home, and visitors to see. The cook explained an alternative to the main meal of the day is always provided. The dining room is light and pleasant but could be improved with a carpet rather than hard flooring. Staff were attentive to people during the meal time in ensuring they had choices around drinks for example and drinks were noted to be given during the course of the day. Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems for complaining indicate that the people in the home feel safe and listened to. However safeguarding procedures need to be developed further to include training and establishing that all the staff have understood the policies and procedures and how to implement them. EVIDENCE: The complaints procedure is displayed on the notice board of the home. It is recommended that an update be made to change the address and telephone number of the CSCI. A file is held on any complaints received and was available at the inspection. It was noted that the registered provider had responded well to concerns raised following a questionnaire audit last year. The adult protection policies and procedures are in a number of sources at this time and would benefit from being re-organised and updated to ensure that the policy is succinct and staff are fully up to date in reading it. All staff receive adult protection training at the home and there are plans for all staff to receive external training from Cornwall County Council. Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Ongoing internal and external maintenance and improvements are taking place at Manor House to the benefit of the people in the home. EVIDENCE: The home is situated in a rural position just outside the village of St Cleer. Limited car parking is available in the grounds of the home. Internally the home is made up of an older original building and an extension. Some of the communal areas within the home are a little dark compared to other areas, for example the lounge is very light and spacious and comfortable. The registered provider explained in detail the amount of work that they have undertaken in the 4 years that they have owned the home and the plans that Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 17 they still have to make further improvements. The majority of the windows have been replaced with double-glazed units with only a few more to replace. Bedrooms in the home are provided on the ground or first floor with a star lift available to the first floor. Corridors are narrow in some areas and upstairs there are four bedrooms and the communal lounge that are accessed by two steps with hand rails. All the bedrooms except one are singles. There are no en-suite bedrooms. Some attention could be given to touching up the paint work on door ways and corridors. Consideration should also be given to providing carpeting in areas where there is none at this time. The lack of carpet in the dining room and corridors adds to a feel of a lack of homeliness in these areas. The home was found to be clean on the day of the inspection. The cleaner was spoken to during the course of the day about her routine. The laundry is small but functional and fitted with modern, large washing machine and tumble dryer. Policies and procedures are in place for infection control. Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team at Manor House are competent, kind and caring. Recruitment procedures protect the people in the home. EVIDENCE: On the day of the inspection two care staff were on duty with a cook and a cleaner. In addition the registered providers are very involved in the running of the home on a daily basis. One of the registered providers takes responsibility for some care delivery during the month to keep a level of understanding on the needs of the people in the home. The registered providers provide on call support to the one waking night staff member if required. The staff on duty during the course of the day were observed to be sensitive to the needs of the people in the home and presented very much as a team. Recruitment procedures for staffing were found to be satisfactory to include completed application forms, two written references and an enhanced criminal bureau records check. Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 19 Training is taking place at the home and has recently included conflict management and the mental capacity act. Fire records indicated that fire drill training is up to date. Updating training for moving and handling and first aid is planned for the new year. There is an in-house induction undertaken by all new staff. The inspection report of the 21st November 2006 recommended the need to access information on the Skills for Care documentation which is still to take place. Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered providers are committed to delivering a good standard of care at Manor House. To achieve this outcome it is important that previous inspection report recommendations and the requirement of this report are addressed to meet the standards and regulations. EVIDENCE: The registered providers are very involved in the running of the home and are committed to raising standards and providing a good standard of care to the people living there. One of the registered providers is studying to obtain her NVQ 4 qualification, this is though nearly completed which will then move her Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 21 on to studying to obtain the registered managers award. It is recommended that priority is given to obtaining this qualification. It is also important that recommendations of inspection reports are addressed and any statutory requirements actioned. Staff survey forms (three) indicate that they feel supported by the management arrangements at the home The registered providers have used quality assurance questionnaires to obtain feedback from the people in the home and their representatives on the standard of care that they feel they are receiving. This last took place in 2006 with generally positive outcomes noted. It is appropriate for this to be done again. As identified in the inspection report of the 21st November 2006 it is appropriate that a summary of the quality assurance responses are available to the people in the home and their representatives. This could be done via the service user guide. The home is keeping records and managing the personal allowance of a small number of people in the home. Records are in place to evidence any transactions ie to chiropody/hairdresser, and balances kept in a bank account The home has in place policies and procedures for health and safety purposes. Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 22 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 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 3 Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 23 NO Are there any outstanding requirements from the last inspection? 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 OP9 Regulation 13(2) Requirement The registered person shall ensure that medication is given from the blister pack, into a pot direct to the person and then the medication record signed immediately avoiding any form of secondary dispensing. Timescale for action 31/12/07 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. Refer to Standard OP1 Good Practice Recommendations The registered providers should review and update the home’s Statement of Purpose and Service User Guide to ensure that the documents continue to reflect the services offered. The registered providers should review and encourage staff to improve the content of the recording in the daily records to include describing the residents’ lifestyle. The registered providers should implement into care planning a nutritional screening tool that identifies people DS0000048225.V350842.R01.S.doc Version 5.2 Page 24 2. OP7 3. OP8 Manor House who may be at risk, and provide evidence that people are being weighed. 4. 5. 6. OP16 The registered providers should update the complaints policy and procedure with the address and telephone number of the CSCI. The registered providers should update (and bring together) the adult protection policy and procedures and evidence that all the staff have read them. The registered provider should consider how to lighten internal areas to aid access around the home. In addition attention should be given to painting doorways where scuffed and providing carpet in all areas of the home. The registered provider should introduce a training programme which is compliant with the Skills for Care Documentation. The registered provider should aim to undertake and complete her studies to obtain the registered managers award qualification as a priority. The registered provider should carry out a review of the quality of care being delivered to the people in the home. The results of the audit should then be made available to all visitors to the home. OP18 OP19 7. 8. 9. OP30 OP31 OP33 Manor House DS0000048225.V350842.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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