Inspection on 01/05/08 for Manor House Christian Rest Home

This inspection was carried out on 1st May 2008.

CSCI found this care home to be providing an Adequate service.

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 Christian Rest Home 08/05/07

Manor House Christian Rest Home 31/05/06

Manor House Christian Rest Home 28/11/05

Manor House Christian Rest Home 20/07/05

Manor House Christian Rest Home 06/01/05

Manor House Christian Rest Home 11/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Manor House Christian Rest Home Bacton Stowmarket Suffolk IP14 4LJ Lead Inspector Pauline Dean Unannounced Inspection 1st May 2008 11:30 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 Christian Rest Home DS0000024441.V363790.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 Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor House Christian Rest Home Address Bacton Stowmarket Suffolk IP14 4LJ 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) 01449 781447 01449 781447 info@manorhousebacton.co.uk Manor House Christian Trust Mrs Miranda Jane Jolly Mrs Miranda Jolly Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th May 2007 Brief Description of the Service: Manor House Christian Rest Home is a large 16th Century building situated in the centre of the village of Bacton, close to local amenities. It is surrounded by approximately three acres of grounds that include an orchard to the rear of the property. There is a large farm to one side of the home and a GP surgery to the other side. The building is privately owned and leased by the Manor House Christian Trust for the purpose of providing residential accommodation for older people, within a Christian community. The Trust are somewhat restricted as to any adaptations they can make to the property as it is a listed building and formal negotiation is required before any permission will be given to make any changes. The Trust are responsible for the upkeep and maintenance of the property. The home offers accommodation and care for up to sixteen older people, the majority of whom are practicing Christians. However, local people who do not follow the Christian faith would not be precluded from living at the home. The current range of fees, as at the site visit were said to be £355 .00 per week (Suffolk County Placement Fee) to £435.00 per week (Private Fee). Hairdressing, chiropody, newspapers and toiletries are at extra cost. Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection of the Manor House Christian Rest Home took place on 1st May 2008 over an eight-hour period. The inspection involved checking information received by Commission for Social Care Inspection (CSCI) since the last key inspection in May 2007. At the site inspection, records and documents were inspected and the inspector spoke to the registered manager, care staff and the people living at the home. The deputy manager was spoken to on the following day by telephone. When the manager went off duty, two senior care staff assisted the inspector with the inspection. In addition the Annual Quality Assurance Assessment (AQAA) completed in November 2007 was considered as part of the inspection process and a tour of the premises was completed. Surveys were sent to the home prior to the inspection. A total of ten surveys for the residents, five for relatives and three for healthcare professionals were sent to the home and at the time of the inspection one survey had been completed and returned by a resident and one had been completed and returned by a relative. Their comments are reflected in this report. During the inspection three people who live at the care home, three care staff and a cook were spoken with. What the service does well: The home was bright and welcoming on the day of the inspection. There was a relaxed and friendly atmosphere in the home. Care planning and record keeping for those residents who had resided at the home for some time were in good order. The ‘Resident Support Plan’ covered all aspects of health, personal and social care needs and was seen to be reviewed regularly. People living in the home spoke of being able to make choices around what they wished to eat, what they wished to do and where they liked to spend their time. Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 6 Care staff were seen to support and encourage residents in these activities; they were seen to take a keen interest in what residents enjoyed and encouraged and prompted individuals to follow their own preferences such as knitting, attending prayer and church services and group entertainment. There was an awareness of the importance of keeping residents stimulated and interested. What has improved since the last inspection? What they could do better: Whilst care-planning practices for the majority of residents was in good order, the home does need to review practices relating to holding information for new residents. Whilst initial assessments and an interim care plan were found in the manager’s office, when this was locked, this information was not available for care staff and therefore they did not have sufficient information to know how to care for the individual. The management of medication administration and record keeping still requires attention. An Immediate Requirement was given to the home following this inspection. This was with regard to medication storage and administration. A response was received within the prescribed timescale and a medication trolley and a Controlled Drug cabinet were said to be fitted and brought into use. Both the Complaints Procedure and the Adult Protection Procedure require revision and updating and further work is required on the quality assurance and quality monitoring system in place to analysis and action the findings. Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 7 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 Christian Rest Home DS0000024441.V363790.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 Christian Rest Home DS0000024441.V363790.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): 3 & 6. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who come to live at the home can be confident that their needs will be fully assessed and these will be met. EVIDENCE: Care planning documents for three residents were sampled and inspected at the inspection. The care plan of the most recent admission to the home was seen. It is the practice of the home to hold two care plan files, one in the manager’s office, which is kept locked away when they or the deputy manager are off duty and a second file in the staff room. At the start of the inspection, the manager was present and they were able to leave with us the office care-planning file. This file detailed the admission process of the most recent admission to the home and it was seen to hold an Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 10 assessment, which had been completed prior to admission. Additional assessments covering moving and handling had been completed just before the person had moved into the home and risk assessments around activities had been completed on the day after admission. These were seen to contain relevant and detailed information. Unfortunately, this information had not been copied or transferred over to the staff care plan file. In this ‘working’ care plan used by care staff there was no admission or assessment information and a ‘Resident Support Plan’ (Care Plan) was not found on the file. This proved particularly difficult when a doctor was called out to the resident in the evening and no previous medical history could be found. The home does need to review their current practices to ensure that full detailed information is available at all times to enable care staff to care for resident’s health, personal and social care needs. In the one survey completed by a resident and returned to the Commission for Social Care Inspection (CSCI), the resident said that they had received enough information about the home before they moved in to make a decision if it was the right place for them and they had received a contract. In the Annual Quality Assurance Assessment (AQAA) Manor House stated that they ensure that all prospective residents receive ‘full information about the home prior to admission’ and ‘we make sure they are all assessed so we can cater for their needs.’ Manor House does not provide intermediate care. Manor House Christian Rest Home DS0000024441.V363790.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 & 10. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Overall, people who live at the home can be assured that their care needs will be met through their individual plan of care, although they cannot be assured that their medication will be administered in a safe and secure way. EVIDENCE: Three care plans were sampled and inspected at the inspection. The two care plans for residents who had lived at Manor House for sometime were found to have a detailed ‘Resident Support Plan’. Alongside this there were evidence of an Interim Care Plan, which had been created on admission to the home. The Support Plan covered all aspects of health, personal and social care needs. Headings such as personal care, communication, mobility, diet and nutrition, health care conditions, behaviours and consideration for religious and medical Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 12 condition were considered in this document. Risk assessments around mobility, falls, toileting, personal care and activities were detailed in this document to ensure that staff are aware of how to care for each individual. A ‘Client Risk Assessment’ summary sheet had been completed for one of the two residents, but not for the other. When raised with a senior carer, they acknowledged that this had been an oversight and was usually completed to summarise risk assessments in place and care needs. Monthly reviews were documented on each of the two files and changes made to care as required, ensuring staff would be aware of current needs. It was noted however that there was no care plan in place for the most recently admitted resident even though they had been admitted in February 2008. Whilst the details of medication and emergency contact details were known to staff they did not have access to a plan identifying the residents needs and how these should be met. Furthermore none of the care plan files sampled and inspected had photographs of individual residents to identify and personalise the care plan document. Within the AQAA it was stated that Manor House provides ‘individual plans of care which are put together from a full assessment. These are very in depth and updated and reviewed on a monthly basis.’ Whilst it is acknowledged that this was the situation for two out of the three care plans sampled it was not the case for the most recent admission to the care home. Records of health care visits were seen in the daily records completed for each resident. These were sampled and seen to evidence visits from opticians, chiropodists, practice and district nurses and GPs. Residents are registered with the GP surgery adjacent to the home and regular visits to the home are made by a GP from that surgery. Two residents spoken to at the inspection said that should they need a doctor, the home would request a visit from the GP. A third resident in the survey form said that they always receive the medical support they need and in the AQAA it was said ‘All health care needs are fully met; we are in constant touch with the GP surgery and practice and district nurses.’ They went on to say that nutritional screening is undertaken and resident’s weights are checked monthly. Both a staff member and a resident confirmed this. A record book with the recordings of these monthly weighing was seen and the inspector was told that residents weights are monitored. The Policy on Medication held in the Policies and Procedures file found in the staff room was last reviewed in January 2007. It was found to need updating to reflect current arrangements with regard to a change of dispensing chemist. Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 13 At the site visit medication administration, storage and record keeping was sampled and inspected. A senior carer assisted with this aspect of the inspection. They had a good understanding of the processes and procedures involved in medication administration. Medication records and medicines were sampled and inspected for three residents and the home was seen to use a blister pack system receiving their medication from the pharmacy at the GP Surgery. Whilst a new medication trolley was seen in the manager’s office and the inspector was told that a Controlled Drug cabinet has been purchased, neither had been brought into use. Medication continued to be transported from a locked cupboard in the medication room via a plastic box around the home. As was stated at the last inspection, this system may not always be safe, as there is a risk that there will be circumstances when the box is left unattended (and therefore not fully secure) and it could be detrimental to the health and safety as there will be circumstances when the box is left unattended and it could be detrimental to the health and safety of care staff (moving and handling) carrying this large box around the home. On the day of the inspection the home was holding Tamazepam in 10mg tablets. Records were kept of administration through the Controlled Drug Register. This drug is required to be stored in a Controlled Drug cabinet, which complies with the Misuse of Drugs (Safe Custody) Regulations 1973. They were being held in a wooden cupboard in the medication room and were being transported around the home with other blister packed medication in the large plastic box. This is concerning with regard to the health and welfare of residents at the care home. An Immediate Requirement was made at the end of the inspection regarding the management and storage of medication including Controlled Drugs and the provider has responded promptly identifying action to be take to address concerns. To reduce the quantity of medicines being carried around the home, the home had adopted the practice of sharing medication between two or three residents. This was evident in liquid medicines Lactulose, Gaviscon Advance Sugar Free and Peptac Liquid. Records detailed that Lactulose had been received for five residents, whilst only two bottles were in the cupboard and in use and records relating to Gaviscon detailed that two residents had received delivery of this medicines this month, but only one bottle was in use. Furthermore two residents were said to have received a bottle of Peptac Liquid and only one bottle was in use. Medicines supplied for individual residents are the property of the named person. The Medicines Act 1968 clearly defines that medicines must only be administered to the person for whom they have been prescribed, labelled and Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 14 supplied. Prescribed medicines obtained in this manner may not at any time be used for other residents. This concern was raised with the deputy manager the day after the inspection and the need to conduct an immediate review of medication held and recorded was highlighted, for it was evident that the record keeping completed on receipt of medication was clearly not accurate and not giving a clear picture of medicines received into the home. This is concerning for the health and welfare of the residents at the care home. Furthermore an additional unopened bottle of Lactulose was found in the medicine cupboard. This was not needed any longer and the deputy manager said that it was being held waiting disposal. They were advised of the need to separate all medications awaiting collection and disposal to ensure that other residents do not use them. Record keeping relating to administration of medication was seen to be clear with staff initialling and records of refusals etc. completed using the correct coding. Small passport sized photographs of residents were held on the Medication Administration Record (MAR) sheet folder. Daily recordings of the fridge temperature used for storing medication was seen and noted. A record was kept of taking the room temperature of the medication room although no temperature was noted only the fact that it had been completed. It was not clear as to why this record was kept this way. Within the AQAA it was stated that ‘All staff are trained to give out medication correctly so service users are protected by the home’s policy’. It went on to say that the home has ‘ a good system for giving our medication.’ These are statements, which do not bear a resemblance to what was found on the day of the inspection. Residents spoken said that care staff treat them with respect and they listen to what they say. During the inspection staff were seen chatting and joking with residents and as we went around the home they were seen to knock on bedroom doors waiting for them to be answered before entering. Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 15 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 & 15. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home can expect to be given choices about how they spend their time, visiting arrangements and meals. EVIDENCE: Within care planning records there was some evidence of residents being able to exercise their choice with regard to leisure and social activities, routines of daily living, food and meals taken, personal and social relationships and religious observance. As a Christian care home services and prayer meetings are held daily. Three residents said that they could attend as they wished and two residents said that they enjoy going to the local church each week. The home continues to have strong links with the local community and has developed activities and social events using local people. Residents spoke of a local musician who plays their squeezebox and on the day of the inspection Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 16 there was musical entertainment in the main lounge. Information about activities in the home is noted on the large wipe board in the main lounge. Some records were seen in individual care plans of the likes and dislikes of residents with regard to social and leisure activities and there was some evidence in the daily records of what individuals had been doing during the day. Not only were group activities noted, but also individual activities such as watching television in the television lounge, knitting squares for blankets and chatting with each other were seen. Three residents in the lounge told the inspector of both individual and group activities they enjoy doing and when not occupied they are happy to sit in the lounge watching the wild life in the garden or in the fine weather sitting out in the summer house in the garden. During the inspection, visitors were seen visiting residents. They were able to meet with them in their room or in the communal areas of the home. Two residents said that visitors are always made very welcome and they often engage in conversation with other residents other than their relative. Within the bedrooms there was evidence of personal possessions. Many of the residents had small pieces of furniture, pictures, photographs and ornaments in their rooms. One resident spoke about being able to bring their possessions into the home and being able to chose the colour of their room to go with their belongings. In survey work conducted by the Commission one person who had completed the survey said that they always liked the meals served. Three residents spoken to said that the ‘food was always good’ and that there was always a choice. They told the inspector that the home has three cooks plus catering assistants. The cook on duty on the day of the inspection said that try to offer a varied and wholesome menu, with the residents enjoying ‘old fashion’ cooking. At least two choices are offered for lunch each day and four desserts are offered each day. They said that the home is currently looking to revise and develop their menus and the home’s cooks are in the process of collating new menus. Fresh, frozen, dried and tinned food supplies were seen in the home with supplies purchased from wholesalers, supermarkets and local suppliers. This meant that the home had a good variety of food supplies in the home. Temperature checks and records are kept of the four freezers and two fridges in use and daily records are kept. A recommendation was made that these appliances are numbered to ensure that records are clear as to which temperature relates to which appliance, for it was evident that different staff undertake this duty and it was not clear which fridge or freezer temperature was being recorded and noted. Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 17 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 & 18. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home should expect their concerns to be taken seriously by the care home. EVIDENCE: A copy of the home’s complaints procedure was found in a Policy File in the staff room. This was found to need updating to show the updated details of the Commission. This policy was dated as being amended in September 2004 and therefore does require an annual review and revision. As stated in the AQAA a copy of the Complaints Procedure was to be found on display in the front hall. One resident who had completed a survey said that they did know how to make a complaint and a staff member in their survey said that they did know what to do should a resident or relative raise a concern. One resident spoken to said that they would speak to the manager or deputy manager should they have any concerns. A policy detailing the arrangements in place for the management of residents’ money and valuables was in place. This had been updated in December 2006. Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 18 It was brief and did not fully reflect the full details of the current arrangements for holding residents’ money, i.e. both the manager and deputy manager have access to resident’s money and records, which is kept in the manager’s office. A Protection of Vulnerable Adults (POVA) Policy was found on file in the Policies file in the staff room. This had been reviewed in June 2007. Whilst this policy reflected good practice and it did outline how to raise an alert within the home it was found to require a review and revision for details relating to the Commission for Social Care Inspection (CSCI)’s details for they were out of date and incorrect. As well as the policy, additional information was seen on display in the staff room, which related to the Elder Abuse campaign and contact details of useful agencies were to be found. One member of staff spoken to during the inspection said that if they had any concerns they would not hesitate to refer this to the manager, or in their absence one of the senior care staff. A resident said that if they did not feel safe, they would speak with their family and would make their concerns known to the manager. They said that they felt reassured, as the manager was readily available during the day when they were on duty. In their absence the deputy manager or one of the senior staff could be approached. Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 19 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 & 26. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at Manor House have homely, comfortable and safe surroundings, which are kept clean and tidy. EVIDENCE: A tour of the premises was conducted at this inspection. Bedroom accommodation comprised of two double bedrooms with the remainder being single bedrooms. The bedrooms were seen to vary in size and shape and residents had been able bring in small pieces of furniture and some personal belongings. One resident in their survey said that the home is always fresh and clean and this was found to be the situation on the inspection. Three residents spoken to Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 20 on the inspection said that they have been able to choose their rooms and they were pleased to be able to personalise them with some of their own belongings. Communal areas of the lounges (2), front hall and the dining room were homely and light. Pictures and photographs of residents and staff were seen around the home. Some decoration and refurbishment had taken place since the last inspection, namely new flooring and bath panelling had been fitted in one of the two bathrooms and a new carpet had been fitted in a lounge. There is access to the home’s gardens from the main lounge via patio doors. A maintenance log is kept of work required and work completed. Records were seen of tasks logged and completed such as a repair to a tumble dryer, which was completed in April 2008. Manor House has a passenger lift located in the front hall to the first floor of the home. This gives direct access to this level, but does not give direct access to all interim levels for there are steps up and down on this floor. In addition there is a chair lift on a back staircase and this is accessed and used by residents. Some toilet doors operate on a swing door basis and this can mean that if the door is not locked properly, it is possible for the door to open outwards whilst the cubicle is occupied. Within the AQAA this problem was acknowledged and it was said that residents are shown how to operate the locks on these doors. At the inspection no problems were observed. Within the laundry and airing room there were two washers and two dryers. Laundry is completed by care staff during the day and at night the ironing is completed. Appropriate systems are in place to ensure infection control and protective gloves and aprons were seen to be available and in use. The commode pot washer is now in working order. It was out of action at the last inspection. Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 21 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 & 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home can expect to be supported by sufficient staff with skills and knowledge to meet their needs. They can be assured that appropriate recruitment practice has been followed to safeguard their welfare. EVIDENCE: On the day of the inspection, there were fourteen residents. The registered manager was on duty in the morning leaving at 13:00 hours. In addition three care staff were on duty throughout the day until 18:00 hours when two care staff were on duty until 22:00 hours when two night awake carers come on duty. In addition, during the day there was either a Cook or kitchen assistant on duty and cleaning staff. From discussion with the manager, care staff and two residents this was said to be sufficient to meet the needs of the residents. This was seen to be the situation during the day of the inspection, for call bells were answered in a reasonable length of time and carers were able to sit and chat with residents during the day. This was obviously enjoyed by residents who joked and chatted with them. Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 22 Within the AQAA it was stated that all staff are offered National Vocational Qualification (NVQ) training. The manager confirmed this and three care staff members. One carer was appreciative of the training offered and recognised the importance of the training provided. The manager said that the home has developed a training and development programme for care staff with a training company, which included NVQ training. Within the AQAA it was said that the home has twenty permanent care staff of which seven have a NVQ Level 2 or above and a further three care staff are working towards a NVQ Level 2. On these files, evidence was seen of both in-house induction training and Skills for Care induction training. One carer confirmed that they had completed this training and they were aware that this would be linked in with their planned NVQ training. Thought had also been given to the development of a training and development plan for each individual for consideration had been given to their recent completed training such as First Aid and a note had been made when this was due for renewal. No evidence was found of either medication training or training in safeguarding adults. The staff recruitment files of two new care staff that had joined the home since the last inspection was sampled and inspected. These files were found to in good order with application forms containing employment history, a minimum of two references, documentation relating to identification and evidence of both Protection of Vulnerable Adults (POVA) 1st checks and Enhanced Criminal Record Bureau (CRB) disclosures. Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35, 36 & 38. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home should be assured of good management with an ongoing quality and monitoring system in place and health and safety systems to ensure that the people living in the home are protected. EVIDENCE: The registered manager had worked at Manor House for a number of years and they said that whilst there had been some changes they had a good staff team. A senior carer also spoke of an established ‘good staff team.’ From speaking to the manager, carers and residents it was seen that the manager has a ‘hands on’ role in the home. Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 24 As with all care staff the home’s manager said that they had a training and development programme in place for themselves and they accessed all refresher training as other care staff. Three residents spoken to at the inspection said that the manager and deputy manager were approachable and always ready to listen to them should they need to speak with them. They said that when the manager is on duty they would walk around the home and have a chat with them. The manager said that they conduct a quality assurance survey each July. A copy of the questionnaire was seen and this was seen to cover Catering and Food, Personal Care and Support, Daily Living, Premises and Management. The manager said that evidence of the last survey was to be found on the individual care planning files. However, none of the six care plan files sampled in the staff office had copies of these documents. The only quality assurance questionnaire seen on a file related to the person’s admission, the environment and their bedroom in the home. Whilst the response was positive from the new resident and their relative, it was not possible to see what discussion; consideration or action had been taken. The home should look to ways in which they can assure that resident’s interests are listened to and recorded to ensure that they are meeting their needs. All three residents spoken to at the inspection were very positive regarding the care they received at Manor House. One said the ‘Staff are lovely here’ and another said the ‘Food was very good.’ Records and money and valuables held on behalf of residents were sampled and inspected. The money and records held for three residents were inspected and they were found to be in good order. Both the manager and deputy manager of the home have the responsibility for managing this task and the manager completes a monthly audit. There is a supervision and appraisal system in place for staff, with senior care staff conducting the supervision of care staff. Records were seen of three supervisions sessions conducted alternate months – September 2007, November 2007 and January 2008. The manager said that the employee is asked to complete a supervision form prior to the supervision and this is then considered and discussed. Whilst it was signed as discussed and seen, the senior carer had added no records of the discussion or action taken. The manager stated in the AQAA that they have regular supervision sessions conducted by one of the Trustees to ensure that they are supported and managed appropriately. Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 25 Evidence was seen of some basic training courses to ensure that there are safe working practices within the home. On the staff files sampled there was evidence of First Aid, Basic Food Hygiene, a two-day Manual Handling training course and training in risk assessments in the last year. The home’s manager continues to have limited control over budgets. The Trustees manage budgets relating to the environment and training. In the AQAA it was stated that funds are now available for these areas as needed and it was stated that ‘all training is kept up to date’. Care staff spoken to said that training was made available as they needed it reference to preferred training courses was noted in supervision notes e.g. Afterlife Care and NVQ training. When asked in the AQAA what the home could do better, the manager highlighted ‘medication training for those that need it’. Notifications as required by the Care Homes Regulations 2001 – Regulation 37 were discussed and matters around confidentiality were considered with the manager. A recent notification was discussed and the manager agreed to update the Commission for Social Care Inspection (CSCI) with full details as they become available. As stated earlier in this report some updating and reviews of Policies and Procedures is required, for of those sampled (4) all required updating and revision. See ‘Complaints and Protection’ Section. This is to ensure that the people living at the home receive the care they need and should be expected. Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 26 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 X 3 Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 Schedule 3(1)(b), (2) Requirement People living in the home must be assured that all of their care needs will be set out in an individual care plan, including resident’s recently admitted to the home. This must cover all aspects of their health, personal and social care needs. Timescale for action 26/06/08 2. OP9 13(2)(4), 17(1)(a) Schedule 3(3)(i) People living in the home must 26/06/08 be assured that all care staff adhere to appropriate policies and procedures for the receipt of medication and the recording, storage, handling and disposal of medicines which safeguards their welfare and well-being. People living in the home must be assured that medicines prescribed for individual’s remains for property of that individual and is not used as stock medication in the home. 05/06/08 3. OP9 13(2) Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 28 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 OP3 OP33 OP16 Good Practice Recommendations People living in the home should be assured that care staff have information to care for residents at all times. People living in the home should be assured that their opinions would be heard, listened to acted upon. People living in the home should be assured that they are safeguarded by an updated complaints procedure with the latest Commission for Social Care Inspection (CSCI) contact details. People living in the home should be assured that they are safeguarded by an updated adult protection procedure with the latest Commission for Social Care Inspection (CSCI) contact details. 4. OP18 Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Manor House Christian Rest Home DS0000024441.V363790.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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