Inspection on 12/03/08 for Manor House Nursing Home

This inspection was carried out on 12th March 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 Nursing Home 02/03/09

Manor House Nursing Home 04/10/06

Manor House Nursing Home 06/02/06

Manor House Nursing Home 20/11/05

Manor House Nursing Home 08/02/05

Manor House Nursing Home 12/08/04

Manor House Nursing Home 26/02/04

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

CARE HOMES FOR OLDER PEOPLE Manor House Nursing Home Main Street Merton Nr Bicester Oxfordshire OX25 2NF Lead Inspector Marie Carvell Unannounced Inspection 9:50 11 & 12 March 2008 th th 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 Nursing Home DS0000042340.V358017.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 Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor House Nursing Home Address Main Street Merton Nr Bicester Oxfordshire OX25 2NF 020 7723 7071 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) info@mhnh.com www.europeancare.net European Care (UK) Limited Vacant post Care Home 102 Category(ies) of Dementia - over 65 years of age (102), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (102) Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Two unnamed residents under the age of 65 may be admitted to the home at any one time. The home has four named individuals who, on admission, were under the age of 65. The total number of service users to be accommodated at any one time must not exceed 102. 4th October 2006 Date of last inspection Brief Description of the Service: The Manor House Nursing Home is situated in a quiet rural location, within visiting distance of Oxford, Aylesbury and Banbury, and close to the market town of Bicester. It is easily accessible from the M40. It is set in over four acres of gardens and lawns, overlooking open countryside, with a small lake, pond and fountains. A landscaped enclosed courtyard has been created with a water feature. The original house is a 16th century manor house that has been considerably extended. The accommodation is provided on two floors and most rooms are single, en-suite. There are a few shared rooms. The home is divided up into four lodges, North, West, East, and Garden, each with its own complement of communal areas and staff. The Manor House Nursing Home is home to 102 frail older people, who require nursing care, and some require specialist care for various forms of dementia The fees for this home range from £676.75 to £800 per week. There are additional charges for hairdressing, chiropody (none diabetic service users), newspapers, toiletries and some outings. Manor House Nursing Home DS0000042340.V358017.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 1 star. This means the people who use this service experience adequate quality outcomes. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’ carried out over two days. The inspector arrived at the service at 9:50 and was in the service until 17:30 on the first day and from 10:15 until 17:30 on the second day. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the service and other people seen during the inspection or who responded to surveys that the Commission had sent out. Two relatives responded to surveys sent out. In addition one relative requested to speak to the inspector by telephone and one e-mail was received. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standards of the service. The inspector toured the building, examined records and met with service users individually and as a group. The inspector also spent time with the manager, deputy manager, nursing, care, ancillary staff and briefly with the Head of Dementia Development, who was visiting the home. In addition the inspector spent time observing how care was being delivered to service users and joined service users for lunch on the first day of the inspection. At the last inspection carried out in October 2006, one requirement and seven good practice recommendations were made; these are referred to in the body of the report. Feedback was given to the manager, deputy manager and senior administrator during the two days and at the end of the inspection on day two. What the service does well: All prospective service users and their representatives are provided with a copy of the home’s Service User Guide, Statement of Purpose and a ‘home pack’. The majority of current service users are funded by a health or local authority, who have a block contract with the home. A copy of the Care Management Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 6 needs assessment is provided to the home with supporting information from healthcare professionals. The manager or deputy manager then undertakes a pre- admission assessment to ensure that the home is able to meet the needs of the service user. Prospective service users and/or their representatives are encouraged to visit the allocated unit, before making a decision to move into the home. Service users being nursed in bed were observed to be comfortable and from discussion with nursing staff and written documentation, all nursing care needs were being well met. Records such as fluid balance charts and turning charts were well maintained. The medical needs of service users are met by one local, GP practice. From evidence seen and from discussion with management and nursing staff, the healthcare needs of service users are well met. Service users able to express a view confirmed that routines in the home are flexible such as being able to choose when to go to bed and when to get up in the morning. In discussion with staff most felt that the home was well managed and run in the best interests of the service users. Service users and relatives spoken to were positive about the manager and his management of the home. Procedures are in place for dealing with service users monies, financial records are well maintained and receipts obtained for all expenditures made on behalf of service users. What has improved since the last inspection? Two sensory rooms have been developed for use by service users. Since the last inspection a planned programme of redecoration and refurbishment is in progress. Work has commenced to upgrade all lounges and communal areas of the home. It was acknowledged that some areas of the home are shabby. The company is investing 4 of annual income for continues maintenance and decoration. The manager and deputy manager were appointed to their current positions in September 2007, when the previous registered manager resigned. Both have worked in the home for a number of years. The manager is a well qualified and experienced nurse and manager, having completed the Registered Managers Award. He is due to undertake his fit person interview with the Commission to complete his application to be registered manager of the home. Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 7 What they could do better: Care plans seen were not in sufficient detail regarding lifestyle choices or the preferences of the service user with regard to when care is to be provided and how. There appears to be an emphasis on group activities. Because very little information is recorded regarding service users life history, previous hobbies or interests, it is not clear how the service users emotional and social needs are meet on an individual basis. The home has its own vehicles for service user outings, this has been out of action for some time. Staff advised the inspector that service users do not have a choice of dishes at meal times and that information about special diets, food likes and dislikes is obtained at the time of admission and is passed to the catering team. Written information received from the manager prior to the inspection stated that all service users are provided with three full meals, based on their choice and likes and dislikes. This was not evidenced. Complaints from individuals are not always fully recorded. When they are logged, the records are incomplete, with timescales, outcomes and actions not being logged. One relative stated that complaints are not always addressed. Since the inspection the manager has written to the Commission to confirm that following the inspection the complaints procedure has been reviewed. Windows in one bedroom and partly in a second bedroom have frosted glass, the manager is unaware of the reasons for this and is to investigate the possibility of replacing the glass to allow for the bedrooms occupants to see out of the window. One unit in particular smelled strongly of stale urine and attempts are being made to address this problem. The manager was asked and agreed to move the wheeled bins to a more suitable site as at the time of the inspection five overflowing bins were place outside one of the ground floor lounges, used by service users. In addition it was observed that approximately 30 to 50 full clinical waste sacks were also sited on the ground within view of the lounge. Arrangements were made for the clinical waste to be removed the following morning and delivery of a number of clinical waste bins to be delivered. Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 8 A sample of eight staff files were examined and demonstrated that the home’s recruitment procedures, put service users at risk of possible harm. Formal staff supervision is to be arranged for all staff, following supervisory training for staff with supervisory responsibility. The manager is currently arranging this. 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 Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 9 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 Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 10 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): Standards 1 and 3. Standard 6 is not applicable, as the home does not provide intermediate care. Standard 1 was subject to a good practice recommendation at the last inspection. Quality in this outcome area is good. Service users and their relatives are provided with sufficient information about the home prior to admission to be able to make an informed choice as to whether the home can meet their needs. Service users are assessed before admission to ensure that their needs can be effectively met by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection a good practice recommendation was made that information should be provided to service users and their representatives about how to access inspection reports, made available following an inspection of the service. Copies of the most recent inspection reports are now displayed in the reception area of the home and visitors room. Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 11 All prospective service users and their representatives are provided with a copy of the home’s Service User Guide, Statement of Purpose and a ‘home pack’. The majority of current service users are funded by a health or local authority, who have a block contract with the home. A copy of the Care Management needs assessment is provided to the home with supporting information from healthcare professionals. The manager or deputy manager then undertakes a pre- admission assessment to ensure that the home is able to meet the needs of the service user. Prospective service users and/or their representatives are encouraged to visit the allocated unit, before making a decision to move into the home. From examination of a sample of service user records it was evidenced that health and social care professionals are involved in the admission process and supporting documentation was seen. All service users are admitted for a trial period of four to six weeks, followed by a review, before a decision is made to make the placement permanent. Comments recorded on surveys completed by relatives included ‘the home usually meets the needs of X’ and ‘when we had the first review meeting I was initially disappointed that the managers were both unable to attend as promised. However, at a subsequent meeting I raised several queries and comments which I am happy to see have generally been noted and actioned where necessary and where possible’. Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 12 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): Standards 7,8,9 and 10. Standards 7 and 10 were subject to good practice recommendations at the last inspection. Quality in this outcome area is adequate. Care plans need to contain sufficient information to demonstrate that all the needs of the service user are being met. Medication storage, administration and recordings were seen to be well maintained. Service users feel that they are treated with dignity and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From examination of a sample of service user’s files it was not always evidenced that the service user/representative is involved in the care planning process. Not all care plans were signed or dated. Care plans seen were not in sufficient detail regarding lifestyle choices or the preferences of the service Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 13 user with regard to when care is to be provided and how. At the last inspection a good practice recommendation was made that daily statement entries be more specific to the care needs/problems listed in the care plan. The information recorded is reviewed each month, however it was not clear that changes are communicated with the service user and/representative. Daily statement entries do not validate care plans and this needs to be developed further, this is particularly important as the home does not have a system of named nurse or key worker as it is considered important that all nursing and care staff have a detailed knowledge of all service users needs on the unit. Comments made on surveys completed by relatives included ‘I wonder with the bathing aspect if the staff perhaps need more training to be able to accomplish this task. I do appreciate what a sensitive and difficult area this is, obviously some of the nursing/care staff are better than others, as I’m sure will always be the case’. ‘I sometimes wonder if X is prompted to go to the toilet enough as I believe the main problem is that the bedroom is not en-suite and X does not know where the toilet is. This leads to accidents happening which means X has to be cleaned up, this causes agitation and aggressive behaviour, I wonder about the training the nursing/care staff have had to enable them to cope with these situations’. Service users being nursed in bed were observed to be comfortable and from discussion with nursing staff and written documentation, all nursing care needs were being well met. Records such as fluid balance charts and turning charts were well maintained. The medical needs of service users are met by one local, GP practice. From evidence seen and from discussion with management and nursing staff, the healthcare needs of service users are well met. Feedback received from one of the GPs included ‘we have been GPs to the Manor for 17 years. In general the quality of care is good with appropriate levels of concern and care for the patients. The staff work well with the GPs in the practice and we have efficient systems for dealing with questions and requests. The only difficulty we have is that of occasional staff where English is not their first language which can make communication more difficult. In general the home try to respond to any requests that we have made in terms of organisation of care’. Medication storage, administration and recordings were seen to be well maintained. None of the service users including service users’ administer their own medication. Risk assessments would be undertaken for any service user wishing to take responsibility for their own medication. The manager undertakes monthly medication audits. At the last inspection a good practice recommendation was made that hand written amendments to medication administration records, staff should not use abbreviations and should include instructions provided by the prescriber/pharmacist, such as maximum dose in any 24 hour period, staff to use the listed code letters consistently to indicate the reasons for omitting a prescribed medication dose. This has been actioned. Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 14 Staff were observed to interact with service users in a respectful and appropriate manner. Staff were observed addressing service users by their preferred term of address and in discussion were clear about the need to respect service users privacy and dignity. The right to privacy is not always addressed as some shared rooms do not have privacy screening and the inspector was made aware of two service users sitting in other service user’s bedrooms. During the inspection it was noted that all service users were appropriately dressed and well groomed. Attention had been given to ensuring that service users had dentures, spectacles and hearing aids in place. Comments made by a relative in conversation said that it was felt that ‘staff did their best under difficult circumstances and are always cheerful’. None of the service user files examined during the inspection contained information regarding the service user’s wishes regarding the arrangements to be made at the time of their death. This was discussed with the manager, who is planning to develop an end of life care plan for each service user involving the service user, if appropriate, relatives/representatives and medical staff. As in many other care homes, there is a wide range of racial, ethnic and faith backgrounds represented within the staff group compared with the current service users. From discussion with the manager, the inspector considers that the home is able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. However, there are indications that service users sometimes find that some staff cannot communicate satisfactorily because English is not their first language. Manor House Nursing Home DS0000042340.V358017.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): Standards 12,13,14 and 15. Quality in this outcome area is good. Varied ranges of activities are in place to meet the needs of the service users. Service users are provided with a nutritious and wholesome diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are two full time and one part time Activity Coordinators employed in the home. There is a varied programme of activities provided in the home and information about daily activities is displayed on notice boards in each of the four units. Each service user has a social activities log, which details activities undertaken each day. These are well maintained. However there appears to be an emphasis on group activities including the celebration of significant events such as Valentines Day, Easter, Halloween, Bonfire Night, Christmas and Birthdays. Because very little information is recorded regarding service users life history, previous hobbies or interests, it is not clear how the service users emotional and social needs are meet on an individual basis. The home has its Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 16 own vehicles for service user outings. A relative said that one minibus, which has been adapted to take wheelchairs, has been out of action for some time and has resulted in only those service users who are able to walk being able to enjoy trips out. The mornings of both inspection days, the television sets in each unit appeared to be the main form of entertainment for significant numbers of service users. The inspector observed a film show, during the afternoon of the second day on one of the units. On both days service users were seen to be aimlessly wandering around, with little to do. Comments made by relatives included ‘ It would be nice if X could be taken out in a minibus, but X uses a wheelchair and the bus with the lift is broken, I’ve been told it is going to be repaired, but nothing is happening’, ‘I have already suggested that more activities are planned and certainly in the part of the home X is in. The nursing/care staff should be doing more ‘ hands on’ activities to stimulate the residents rather than just being there and watching over them. Some of the staff do seem to be trying but I’m sure that some of them are not’. Since the last inspection, two sensory rooms have been developed for use by service users. Many of the service users have friends and family who are able to visit on a regular basis. Service users are encouraged to maintain contact, as far as possible, with the local community. Visitors confirmed that they are always made welcome. Relative meetings are held every three months and the inspector was informed that these meetings were well attended. Visitors are made welcome and are able to visit at any reasonable time. A hairdresser visits the home each week and religious ministers visit the home on a regular basis. The gardens provide a safe and pleasant outdoor space for service users to enjoy during the warmer weather. Service users able to express a view confirmed that routines in the home are flexible such as being able to choose when to go to bed and when to get up in the morning. The menus showed that service users are provided with a nutritious and wholesome diet. The inspector joined service users on one unit for lunch on day one of the inspection. The meal was attractively served and tasty. Staff advised the inspector that service users do not have a choice of dishes at meal times and that information about special diets, food likes and dislikes is obtained at the time of admission and is passed to the catering team. Written information received from the manager prior to the inspection stated that all service users are provided with three full meals, based on their choice and likes and dislikes. This was not evidenced from examination of a sample of service user files, which only stated ‘normal diet’. It was noted at lunchtime that one service user was eating a pureed meal, which was described by the service users as ‘alright’. Staff were unaware of why the service user was given a pureed meal and said that all meals are plated up from the main kitchen. The information recorded in the service users file stated that the service user Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 17 needed a ‘normal diet’. Drinking water was not available, although jugs of fruit cordial were offered to service users. Staff were observed to be attentive and assisting service users with their meals in a discrete manner. One service user did not eat any of her main course and only a small amount of dessert, staff were unable to offer an alternative meal. Each unit has a selection of snacks, which are offered to service users during the day. The manager is considering introducing ‘ Protected mealtimes’, which means that all nursing staff can be available in the dining room to assist with feeding service users and monitoring food intake rather than carrying out other tasks such as medication administration. Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 18 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): Standards 16 and 18. Quality in this outcome area is adequate. There is a comprehensive complaints procedure in place, However, not all complaints received by the home are recorded. Policies and procedures are in place to protect service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a comprehensive complaints procedure; this is displayed in the entrance hall. The policy of the home is that all complaints are recorded whether received verbally or in writing. Surveys completed confirmed that representatives were familiar with the home’s complaints procedure. Complaints from individuals are not always fully recorded. When they are logged, the records are incomplete, with timescales, outcomes and actions not being logged. One relative stated that complaints are not always addressed. Since the inspection the manager has written to the Commission to confirm that following the inspection the complaints procedure has been reviewed. Since the last inspection in October 2006, the Commission has received information concerning three complaints about this service. Two complaints were about the same issue. One complaint was referred to the service users care manager for action and the second and third complaint was addressed Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 19 satisfactorily by the management of the home. At the last inspection a good practice recommendation was made that all service users and their representatives are aware of the home’s complaints procedure. This has been actioned. All staff receive training in the home’s policies and procedures for protecting service users from abuse and the home’s whistle blowing policy. Training is provided to all new staff as part of their induction course and is then updated on a regular basis. The home has a copy of the Oxfordshire Safeguarding Adults procedures. One safeguarding adult referrals has been made in the last year. One safeguarding adults investigation has taken place. No referrals have been made for inclusion on the POVA (Protection of Vulnerable Adults) list. Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 20 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): Standards19, 20,21,22,23,24,25 and 26. Standards 19 and 26 were subject to good practice recommendations at the last inspection. Quality in this outcome area is good. The home is suitable for its stated aims and purpose. A programme of redecoration and refurbishment is currently in progress. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection a planned programme of redecoration and refurbishment is in progress. Work has commenced to upgrade all lounges and communal areas of the home. It was acknowledged that some areas of the home are shabby. The company is investing 4 of annual income for continues maintenance and decoration. At the last inspection a good practice recommendation was made that a armchair identified during the inspection be repaired or replaced. This has been addressed. Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 21 Hot water outlets in bedrooms and bathrooms are maintained at the recommended temperatures. All windows are fitted with window restrictors and radiators are covered. A call alarm system is fitted in all bedrooms, bathrooms and communal areas of the home. A possible security issue was discussed with the manager and as a result the Commission have been advised that enquiries are being made into obtaining a CCTV and intercom system for the reception area of the home. Most bedrooms have en-suite facilities. Service users are not always able to have the option of a single room immediately on admission. Not all shared bedrooms have privacy screening, and as a result little privacy is available when using the washbasin or en-suite toilet. It was noted that several shared bedrooms only have one call bell system installed. The manager has notified the Commission that an additional call bell system is to be installed in all shared bedrooms. Bedrooms are comfortably furnished and service users are encouraged to personalise their bedrooms with items of furniture and personal possessions. Windows in one bedroom and partly in a second bedroom have frosted glass, the manager is unaware of the reasons for this and is to investigate the possibility of replacing the glass to allow for the bedrooms occupants to see out of the window. Appropriate aids and adaptations are fitted in communal bathrooms and toilets. All areas of the home was seen to be clean, were carpets are in place these were seen to be clean and stain free. It is evident that the housekeeping team work hard to keep such as large home clean. One unit in particular smelled strongly of stale urine and attempts are being made to address this problem. The laundry is well equipped. All housekeeping and laundry staff have received training in COSHH, infection control and health and safety. Policies and procedures are in place. Staff are provided with protective clothing, such as disposable aprons and gloves for use when carrying out personal care to service users. At the last inspection a good practice recommendation was made that the laundry floor be repaired or resurfaced. This has been addressed. The manager was asked and agreed to move the wheeled bins to a more suitable site as at the time of the inspection five overflowing bins were place outside one of the ground floor lounges, used by service users. Staff told the inspector that when they had their meal/tea breaks in the lounge, they had to close the curtains. In addition it was observed that approximately 30 to 50 full clinical waste sacks were also sited on the ground within view of the lounge. Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 22 The manager who had been on leave prior to the inspection visit was unaware of this, due to a oversight when cancelling a contract with a company for the removal of clinical waste and the new contract commencing, a period of over a week, the inspector was advised. Arrangements were made for the clinical waste to be removed the following morning and delivery of a number of clinical waste bins to be delivered. Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 23 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): Standards 27,28,29 and 30. Standard 29 was subject to a good practice recommendation at the last inspection. Quality in this outcome area is poor. Recruitment procedures are not sufficiently robust to protect service users from possible harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From discussion with the manager and deputy manager, staff on duty and examination of duty rosters, staffing levels appear to be adequate to meet the needs of the service users. The home currently has vacancies for six full time care assistants and a full time housekeeper. In the last year twenty nine members of nursing/care staff have resigned for a variety of reasons. Exit interviews are conducted, if possible. Nine care staff are qualified to NVQ level II or above and seventeen care staff are working towards NVQ level II. All new staff now completes an induction programme that meets Skills for Care standards. Five members of staff are NVQ assessors. Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 24 The home has a training and development programme in place. All staff are expected to complete mandatory training, which includes training in dementia care for all grades of staff. Specialist training is provided to staff. A sample of eight staff files were examined and demonstrated that the home’s recruitment procedures, put service users at risk of possible harm. All files contained an application form, but not all were completed or gave a full employment history. One blank application form stated ‘ never worked in UK’. Some files only contained photocopies of reference letters addressed ‘ to whom it may concern’ and undated and no evidence of an interview having taken place. In two files it was noted that the registered nurse’s registration with the Nurses and Midwifery Council had lapsed. Fortunately these had been renewed by the registered nurse and could be validated following the manager been asked to check on the NMC website. Some staff have been employed and in post before Criminal Record Bureau Checks (CRB) being requested or Protection of Vulnerable Adult lists (POVA) being applied for. New staff are recruited overseas as well as locally, but does not follow the same recruitment procedures The staff files of two members of staff recruited since the last inspection evidenced that one had a completed application form, which did not give a full employment history. Two references had been requested and received. The member of staff was employed in the home providing personal care to service users without POVA first clearance being obtained. No evidence was recorded to evidence that an interview had taken place. The second staff file evidenced that the member of staff had not completed an application form, until after commencing duty as a care assistant. A telephone interview had taken place and photocopies of references ‘ to whom it may concern’ were obtained. A POVA first had been obtained prior to commencing duties in the home, however as the member of staff was from overseas the information recorded would only apply to the list maintained in the UK. It is understood that the recruitment of this individual was undertaken by an agency on behalf of the company human resources team. The manager was reminded that it is the responsibility of the registered persons to ensure the fitness of employees. Since the inspection the Commission has received written information that new employees will only commence work after written confirmation of CRB and POVA checks have been undertaken and in the future only written references to a named individual will be accepted. At the last inspection a good practice recommendation was made that staff files should be organised so that current information is easily located. This has been addressed. Many of the staff on duty have worked in the home for many years. Staff spoken to said that they enjoyed working in the home and felt that staff morale was slowly improving. Communication systems in the home appear to be well organised, with staff handovers taking place at the beginning of each shift. Staff meetings take place. Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 25 The home is currently in the process of recruiting a training officer to assist with the homes training process. The training officer will take responsibility for following the induction process and ongoing development training including training needs analysis and co-ordination under the direction of the management team. Team leaders, registered nurses and senior care assistants are to be given training to support with regards to mentoring of new staff. All grades of staff were observed to be professional in their approach to service users, throughout the two day inspection. Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 26 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): Standards 31,33,35,36 and 38. Standard 33 was subject to a good practice recommendation and standard 38 was subject to a requirement. Quality in this outcome area is good. The manager is working to improve outcomes for the people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager and deputy manager were appointed to their current positions in September 2007, when the previous registered manager resigned. Both have worked in the home for a number of years. The manager is a well qualified and experienced nurse and manager, having completed the Registered Managers Award. He is due to undertake his fit person interview with the Commission to Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 27 complete his application to be registered manager of the home. Both the manager and deputy manager are supernumery to the home’s staffing levels and are supported by two administrators. In discussion with staff most felt that the home was well managed and run in the best interests of the service users. Service users and relatives spoken to were positive about the manager and his management of the home. Procedures are in place for dealing with service users monies, financial records are well maintained and receipts obtained for all expenditures made on behalf of service users. Formal staff supervision is to be arranged for all staff, following supervisory training for staff with supervisory responsibility. The manager is currently arranging this. Policies and procedures are in place and are reviewed on a regular basis. The home has an annual business and development plan. Quality assurance processes are in place and it is evident that the views of service users, relatives and other stakeholders are sought on a regular basis. At the last inspection a good practice was made that the results of service user satisfaction surveys are published. The manager confirmed that this has been addressed. Reports written by a provider representative, following monthly visits to the home, were available for examination by the inspector. Time was spent with the maintenance manager and a sample of records relating to health, safety and welfare were examined and found to be up to date and well maintained. At the last inspection a requirement was made that suitable automatic door closures should be fitted following advice from the fire rescue service. This has been complied with. Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 28 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 2 2 3 Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 29 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 Requirement Care plans must be in sufficient detail to ensure that all staff are familiar with the specific care needs of each service user, when care is to be provided and how. Information recorded should include cross gender care preferences, emotional and social needs and end of life care. Timescale for action 29/04/08 2 OP16 22 All complaints received by the 15/04/08 home, in writing or verbally must be recorded in line with the home’s own complaints procedures. Recruitment procedures in the home must be more robust to protect service users from possible harm. 29/04/08 3 OP29 19 Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 30 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 OP12 Good Practice Recommendations That consideration is given to developing ways of engaging service users in activities and interests, so that everyone is offered chances for stimulation. Details of the service users background and preferences should be obtained and added to the care plan, to make sure that no important information is lost. 2 OP15 That consideration is given to providing service users with an alternate meal choice, based on their food preferences. This information should also be recorded on care plan documentation. It is strongly recommended that all staff receive training in dealing with and recording complaints. It is recommended that all staff are supervised and this meets the home’s supervision policy. Staff with supervisory responsibility undertake appropriate supervisory skills training. 3. 4. OP16 OP36 Manor House Nursing Home DS0000042340.V358017.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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