Inspection on 02/03/09 for Manor House Nursing Home

This inspection was carried out on 2nd March 2009.

CSCI found this care home to be providing an Good 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 12/03/08

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Manor House Nursing Home Main Street Merton Nr Bicester Oxfordshire OX25 2NF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kate Harrison     Date: 0 2 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 23 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Manor House Nursing Home Main Street Merton Nr Bicester Oxfordshire OX25 2NF 01865331555 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): info@mhnh.com European Care (UK) Limited Name of registered manager (if applicable) Mr Krishna Prasad Adhikari Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 102. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home 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. Care Homes for Older People Page 4 of 23 care home 102 Over 65 0 0 102 102 Brief description of the care home 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 There are additional charges for hairdressing, chiropody (non diabetic service users), newspapers, toiletries and some outings. Care Homes for Older People Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was an unannounced Key inspection and was conducted by one inspector and our Expert by Experience over one day. It was a thorough look at how well the home is doing, and took into account detailed information provided by the home through the Annual Quality Assurance Assessment (the AQAA) and any other information we received about the service since the last inspection. This included information from the Health and Safety Executive about its recent inspection. We asked the views of people living in the home through our survey, and other people we met during our visit. We received 11 replies to our survey, mostly from close relatives of people living in the home. We saw documents and records about the care provided and discussed the running of the home with the temporary and deputy managers. We saw all areas of the home used by the people living there, we looked at how the home Care Homes for Older People Page 6 of 23 manages peoples medication, and we observed lunchtime in the dining room. We spoke to several people living in the home and to staff members about their experience of the home. We looked at how the home is meeting the standards set by the government, and in this report we make judgements about the standards of the service. The date of the last inspection of the home was 12 March 2008. The weekly fees range from GB pounds 676.75 to GB pounds 800. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 23 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before the home makes a decision to admit them, to make sure that the home is able to look after them properly. Evidence: The home does not provide intermediate care. The registered manager or the deputy manager usually visits the individual to carry out the pre-admission assessments. We saw the pre-admission assessment information for three people admitted recently, and noted that all the necessary information was available about the individuals needs for a decision about the homes suitability to be made. Care Homes for Older People Page 10 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have their health and personal care needs recognised and met, by a trained respectful care team. Evidence: We saw four care plans to check how the health and personal care needs of people living in the home were assessed and met. At our last inspection we made a requirement that the care preferences of the individuals admitted to the home should be recorded, so that the care plans contain enough detail for the care staff to look after individuals as they want to be cared for. We noted that most of the people have dementia and are not able to take part meaningfully in deciding how they want the home to care for them. Wherever possible the home gets information from family and representatives, and the information is recorded in the Getting to know you form. We noted that the detail about how people want to be cared for is included in the care plans, for example, about wearing hearing aids and glasses, about keeping areas clear to prevent falling, and about the particular music individuals liked to listen to. The managers are aware of the need to make the care plans more person centred, and are Care Homes for Older People Page 11 of 23 Evidence: working towards this aim. All the health and personal care needs of the individuals we checked were recorded and addressed. We noted that people get the equipment they need, and that they are supported to be independent. The care team is trained to look after people with dementia, and we noted that they treat people with respect and take time to talk with individuals. The care files need to be better organised, for example the care plans need to be easily assessible for the care staff and keeping them together in one plastic envelope is not useful. This issue is being addressed by the home. Risk assessments are carried out for health care issues, and these are regularly reviewed. The home is currently developing bathing risk assessments, to make sure that individuals are not scalded. We discussed the need to use an evidence based nutritional risk assessment and the deputy manager said that this would soon be addressed. People who responded to our survey about the care their relatives receive said: I feel she is in good hands, always receive willing help and advice, and we are very happy with the care. We looked at how the home manages medication. No one at the home manages their own medication, and the home has recently developed forms to record permission for the home to manage the medication of those who cannot manage their medication. The home receives prescribed medication weekly from the nearby pharmacy. Some of the medication is recorded when received, but the medication packaged in Dossette boxes was not recorded when received, as it needs to be, and the home has now started recording the receipt of the boxes. The home needs to get a copy of the Royal Pharmaceutical Societys guidance about managing medication in social care settings and use the information to update the medication policy and procedures. Care Homes for Older People Page 12 of 23 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is working towards providing more personalised activity for the people living in the home, and takes note of preferences in daily life, so that people can live as they want to. Evidence: The home employs four members of staff to manage the activities programme, two part time and two full time people. The coordinator has been away from the home for some time, and the provision of activities has suffered. We saw that no activities happened on the day of our visit, and the deputy manager explained that the coordinator had just returned to work and was developing the activities programme. A recommendation was made at our last inspection that ways of engaging people in activities be considered, and that details of peoples background and their preferences be obtained and included in their care plans. We saw that information is obtained about backgrounds and preferences are recorded, but that information is not yet translated into meaningful personalised activity for the majority of individuals. The home has two sensory rooms but these were both locked and not used during our visit. Information from our survey shows that relatives feel that the activities are not always suitable for individuals, unable to join in being one comment. Another was Care Homes for Older People Page 13 of 23 Evidence: about the lack of trips out of the home for individuals, even though the home has its own transport there are often problems preventing people going out regularly. The deputy manager explained that as the activities coordinator is now back at work that the home is looking at improving the provision of activities that are more suitable for people with dementia. Other plans include making the grounds more suitable for people to use as they want, such as for gardening and using the sensory garden and pond more to the benefit of people living in the home. The majority of people who responded to our survey said their relatives usually liked the meals provided. Some comments were about the lack of home made puddings on a regular basis. We noted that people were able to choose a meal at lunchtime by seeing the plated food, and were able to choose finger food if they preferred. At our last inspection we noted that water was not available for people to drink at lunchtime, and on this visit we saw that fruit squash or tea was available, but no water. We discussed this with the deputy manager, and she agreed to arrange for water to be available at meals in future. Visitors are welcome to the home and several were visiting relatives during our inspection. Several confirmed that the home keeps them up to date with how their relatives are getting on. Relatives meetings are held and people can join the Friends of Manor House Group. Care Homes for Older People Page 14 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home know that any complaints they or their relatives make will be taken seriously, and that the trained staff team know how to protect them from harm. Evidence: The complaints procedure is displayed in the home, and a record is kept of complaints received. People who responded to our survey said that they knew how to make a complaint, and we noted that complaints are investigated and responded to appropriately. We spoke to two visitors during our inspection who complained about clothes being mislaid. The deputy manager agreed to investigate this issue, and said that the home recognised there had been an issue with laundry, and had taken steps to address it. The home has recently updated the safeguarding procedure and this gives information to staff about how to respond to suspicions or allegations of abuse. Training is provided for all care staff about safeguarding the vulnerable people in their care. Care Homes for Older People Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes environment continues to improve inside and outside, so that it is becoming more suitable ffor the needs of the people living there. Evidence: There have been some improvements to the interior environment, including good signage suitable for the needs of the people living in the home. The managers are aware that the needs of the people living in the home should be considered when deciding on colour schemes and other updating, as these can have an impact on people with dementia. There are plans to continue redecorating and refurbishing the communal and private rooms in the home. A new conservatory has been provided and is in the process of being decorated. Some visitors said they appreciated the outside improvements to the grounds, but commented that it was taking some time to complete the work. There is a system in place to report and address maintenance issues to the maintenance manager. There are good facilities and arrangements in the laundry and a dedicated person, with training in infection control, is in charge of the operations. The majority of the care team have also received infection control training. The majority of people who responded to our survey said that the home is always fresh and clean. Care Homes for Older People Page 16 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of the people living in the home are met by enough safe, experienced and caring staff members. Evidence: At our last inspection a requirement was made that the recruitment procedures be more robust. We saw three staff files to check that all the necessary information is available to make sure that people living in the home are safe. We noted that all the information was available including Criminal Record Bureau checks for two of the individuals, but that only one reference was available for another individual. It was explained that a verbal reference was obtained, but although the written reference was promised it had not arrived. Since our inspection the missing reference has been requested. The home provides induction for all new staff members and has a training officer in post who is responsible for the homes staff training programme. We saw the training matrix, and noted that all the essential topics are included. The deputy manager confirmed that all the homes employees attend the training about caring for people with dementia. The AQAA shows that the home is not yet meeting the national minimum standard to have 50 of the homes carers with the National Vocational Qualification Level 2 in Care, and the deputy manager explained the present difficulties for the home. The staffing rota Care Homes for Older People Page 17 of 23 Evidence: shows that there is a mix of nurses and experienced staff available over the 24 hours, and the majority of relatives told us through our survey that there are always enough staff available to meet the needs of the people living in the home. People also praised the quality of the staff group, saying the staff are doing a wonderful job and nothing is too much trouble. AQAA shows that not yet meeting 50 trained carers. Training officer responsible for training proramme. Got copy of matrix shows good training programme in place including all mandatory subjects. Care Homes for Older People Page 18 of 23 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home responds well when shortcomings are pointed out, but needs to improve systems so that any shortcomings can be identified by the organisation. Evidence: The registered manager is qualified and experienced and has been at the home for several years. The AQAA was completed but lacked detail relating to the key standards and had not identified any issues discovered later by the Health and Safety Executive. The home carries out regular quality assurance surveys and we saw that one was carried out in January 2009, and the results are being analysed. Regular monitoring visits are also made unannounced to the home by a senior member of the organisation to assess the quality of the service. The home has procedures to manage any petty cash including keeping records of any transactions made on behalf of individuals living in the home. The Health and Safety Executive recently visited the home and made a number of requirements about the safety of the environment. The home has taken the outcome Care Homes for Older People Page 19 of 23 Evidence: seriously and is working to meet all the requirements. Improvement work includes the provision of new appropriate window restrictors, a bathing policy to make sure people are not scalded, and the provision of a new door by a stairway to help prevent falls. The home intends to meet all the requirements set by the Health and Safety Executive by the timescales set. The maintenance manager is responsible for the regular safety checks and recordings about the services and facilities. The home has made progress in improving the quality of the service, including meeting all the requirements made at our last inspection. The organisation is working to improve dementia care in the home and has made new appointments, including a business manager and a person responsible for excellence in dementia practice. Care Homes for Older People Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 22 of 23 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 23 of 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!