Inspection on 10/10/05 for Manor House Nursing & Residential Home

This inspection was carried out on 10th October 2005.

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

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

Other inspections for this house

Manor House Nursing &... 05/04/07

Manor House Nursing &... 15/08/06

Manor House Nursing &... 14/02/06

Manor House Nursing &... 17/02/05

Manor House Nursing &... 06/08/04

Manor House Nursing &... 02/12/03

Manor House Nursing &... 04/08/03

Manor House Nursing &... 13/09/02

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

CARE HOMES FOR OLDER PEOPLE Manor House Nursing & Residential Home Moreton Road Upton Wirral CH49 4NZ Lead Inspector Les Hill Unannounced 10 October 2005 @ 09:00 am th 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 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 & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Manor House Nursing & Residential Home Address Moreton Road Upton Wirral CH49 4NZ 0151 677 0099 0151 604 0328 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes Limited Mrs Christine Varty Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 40 beds nursing care / 20 beds personal care in an overall total of 60 To admitt one named service user aged 57 years of age for the category of (TI) Date of last inspection 17/02/05 Brief Description of the Service: The Manor House is a large care home providing nursing and personal care for up to 59 residents over the age of 65 years. It is situated in extensive and well-maintained grounds that are fully accessible. Acommodation is provided on three floors with stair and passenger lift access to the first floor. Some rooms on the second floor are reached by a set of stairs and residents occupying these rooms need to be mobile. There are 59 single rooms of which 58 have full en-suite facilities. Communal areas are located around the home. Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of The Manor House took place on Monday 10th October 2005 and was carried out by two inspectors. It involved the examination of some records and a tour of the building. At the time of the inspection the home’s lift was out of order and residents were being supported in their own rooms. The inspection was undertaken as part of the Commission’s requirement to visit and report on each registered care home on two occasions each year. What the service does well: What has improved since the last inspection? Staff were signing the MAR sheets to confirm the administration of medicines. Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, 5 and 6 Residents have the information they need to make an informed choice about where to live. EVIDENCE: The home has a statement of purpose and service user guide that give full and detailed information about the home and the services provided. Both documents comply with Schedule 1 and Standard 1.2 of the National Minimum Standards, Care Homes for Older People and were available in the entrance to the home. Residents were issued with a contract/terms and conditions of residency that are maintained separately to the care files to maintain confidentiality. Inspectors examined the care files for four residents. The pre-admission assessment document was not located on these files but was given to the inspectors separately. The assessments were completed with full information and with the support of the prospective resident, their family and other professionals involved in their care and support. Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 9 The home has been providing care and support to older people for some time. The inspectors were satisfied from reading the care files and from discussion with the manager that The Manor House is able to provide appropriate services to meet the assessed needs of residents admitted to the home. Prospective residents and their relatives/friends are encouraged to visit the home and to spend time there before making a decision to move in. Most of the referrals are made by word of mouth and the home has developed a reputation for providing a high quality environment, hotel services and good standards of care. The home is not contracted to provide Intermediate Care. Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 and 11. Resident’s health, personal and social care needs were being met. Procedures to audit the disposal and the destruction of drugs need to be introduced to ensure safe practice. EVIDENCE: Care plans were in place on each of the care files examined during the inspection. They contained good information that was being used to plan the support required for individual residents and there was evidence to show that they were being reviewed. Risk assessments were in place where necessary and inspectors saw completed documents for two residents who needed the use of bed-rails. One of the assessments had been confirmed by the resident’s relatives but the other, still needed to be signed. The manager told the inspectors that the home receives good support from local GP’s two of whom attended to consult with their patient during the course of the inspection. The Tissue Viability Nurse, the Continence Adviser, Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 11 Physiotherapists, Chiropodists, Speech Therapists and CPN’s all support residents in the home when necessary. The manager reported that two of the residents have a pressure sore that is being managed through a wound care plan. The plans were viewed during the inspection and found to be in order. Photographs of the wounds are made to identify healing. The processes for administering medicines were examined. There was evidence to show that staff are signing to confirm medicines have been given and two staff signatures record when there is change to the prescribed dosage of medicine or when a new medicine is received between prescription renewal dates. However a check of the Controlled Drugs identified that confirmation of disposal could not be confirmed for one medicine discontinued in May 2005. Arrangements for the disposal of controlled drugs have changed recently and nursing homes are required to destroy any unused medicines in this category. The manager is required to ensure that safe policies and procedures are introduced to confirm the denaturisation of controlled drugs. Personal care is provided in resident’s bedrooms or in one of the communal toilets or bathrooms around the home. Locks are fitted to communal toilets and bathrooms that can be opened from the outside in the event of an emergency. Residents can meet with visitors in their own room or in one of the communal lounges. All of the residents in The Manor House are self-funding and expect high standards of care. The manager expects that her staff will provide care and support in privacy and will maintain the dignity of residents at all times. Policies and procedures are in place to ensure care and comfort is given to residents who are in the latter stages of their life: that they are treated with dignity and their wishes are respected. The home has an information leaflet that is given out to bereaved families and provides essential information about procedures to be followed and people who will need to be contacted. Counselling is available to staff who have been affected by a death in the home. Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. Residents are helped to exercise choice and control over their life. EVIDENCE: Routines are flexible throughout the home. An activities coordinator is in post and she arranges individual or group events. Information about activities is displayed on notice boards around the home and in resident’s bedrooms. Residents have expressed a wish for weekly Bingo sessions and there are also exercise groups, music appreciation sessions and entertainment provided by individuals and groups coming into the home. Some trips out have been organised and ministers of religion visit individual residents or arrange short services for groups of residents in the home. Visitors to the home are welcomed at any time and can meet with their relative in their own bedroom or in one of the communal rooms around the home. Visitors can also arrange to take a meal in the home for which there is a set charge. Breakfasts are usually served in resident’s bedrooms. Lunch and dinner are served in one of two large dining rooms (identified as restaurants) with waitress service. Care staff support residents who need help at mealtimes. Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 13 Tables in the dining rooms were laid out with tablecloths and napkins. A menu showing a choice of meal was available on each table. Examination of the menus at the home confirmed that a balanced diet was being offered and that a good range of foods was being prepared. The main meal of the day is served in the evening but the lunchtime menu offered a range of hot and cold meals. Special diets are catered for and the advice of the nutritionist is sought when required. The kitchens were clean and well ordered. Temperatures of fridges, freezers, hot and cold foods were being taken and recorded. On the day of this inspection the lift was broken and the lunchtime meal was being served to residents in their own room. Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 and 18. Resident’s complaints were being taken seriously and they were being protected from abuse. EVIDENCE: The home has policies and procedures in place to deal with complaints and these are provided in the statement of purpose and service user guide. They are also displayed in the home. Records inspected showed that two written complaints had been dealt with appropriately and within the stated time scales. Residents are listed on the Electoral Register and have the opportunity to vote in national and local elections. The home has policies and procedures in place to deal with suspected abuse. All staff are given training on the types of abuse that can occur and of the actions to be taken if abuse is suspected. The home has a copy of Wirral’s Adult Protection procedures to be followed in the event of an allegation of abuse being made. Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26. Residents live in a safe, comfortable, well-maintained environment that has the specialist equipment necessary to support their care needs and maximise their independence. EVIDENCE: The home is an original manor house that has been modernised and extended to provide accommodation for 60 older people. All areas of the home are decorated and furnished to a high standard. The home is set in extensive grounds that are well maintained. Supported living flats are located on the same site. Communal space in the home is well set out with decoration and domestic style furnishings that are of a good quality. The two dining rooms (restaurants) are located in the original manor house and are large pleasant rooms with high ornate ceilings. Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 16 The home has 59 bedrooms all of which are single occupancy although one can be used to accommodate a married couple or friends who choose to share. All of the bedrooms (except for one) have their own WC, wash hand-basin and bath. Bedrooms are well presented and have good wardrobe and drawer space. Residents can choose to bring treasured possessions and small items of furniture from home (fire regulations permitting) that can be used to personalise their own room. Additionally there are other bathrooms around the home that are equipped with specialist bathing equipment. The home has a range of specialist equipment fitted or available to support the needs of individual residents. With exception of a small number of bedrooms the home is fully accessible to wheelchairs and outside space has been developed for wheelchair users. Windows around the home provide natural light and ventilation. On the day of this inspection the home was warm and well lit. Hot water temperatures are controlled and are tested on a regular basis. The home was found to be clean and well maintained and there were no offensive odours noted. Policies and procedures are in place for infection control and the disposal of clinical waste. Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Residents are supported and protected by the numbers and skill mix of the staff and by the homes recruitment practices. EVIDENCE: The home employs 12 trained nurses, 33 care staff and 40 ancillary workers. Staff are deployed in sufficient numbers to meet the needs of the residents living at The Manor House. Agency workers and bank staff are used to cover staff vacancies through annual leave and sickness. Seventeen of the home’s care staff have an award at NVQ level 2 in care and some have moved on to level 3. Care staff are encouraged to take up NVQ training and staff without this award will be included in future programmes. BUPA Care Homes who own The Manor House is an equal opportunities employer and they have strict procedures for the recruitment and appointment of staff. The inspectors examined the files of three staff most recently appointed to the home. Each contained a completed application form and two references. There was evidence to confirm that CRB and POVA clearances had been obtained. New staff are required to undergo a probationary period of employment during which time their aptitude for the work is assessed. Staff records provided evidence of induction and ongoing training. Trained nurses are identified as “link” nurses for tissue viability and pain relief. All staff Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 18 are provided with training in adult protection matters and specialist training is provided as and when required. Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, and 35. The home is run in the best interests of residents. EVIDENCE: The manager of the home is a registered nurse with many years experience of managing care homes for older people. She has also completed an NVQ level 4 in management. During the course of the inspection it was clear that the manager had a good understanding of the needs of residents in the home and was fully up to date with their care arrangements and their individual expectations. The lift had broken down the day before this inspection, a Sunday, and she had come into the home to assist the staff in coping with the additional work that this had created. Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 20 BUPA has procedures in place to require monthly, quality audits of care procedures in the home. Additionally they undertake an annual quality assurance survey of the views of residents and their relatives. The manager planned to hold a cheese and wine event when the survey was completed to go over the results with residents and their families and discuss how the home would deal with any matters identified for review. A senior manager from the company undertakes the required monthly Regulation 26 visits and submits a copy of the report to CSCI. Records relating to the financial accounting of the company are available for inspection but were not viewed on this occasion. The Commission is not aware of any financial matters that are likely to affect the continued operation of the home. Residents or their relatives manage their own financial affairs and the home invoices them on a monthly basis for any expenditure that has been made on their behalf (e.g. hairdressing, chiropody). The home does manage smaller amounts of money for some residents to cover day-to-day purchases and records held in the home were found to be in order. Interest on any small amounts of savings is calculated and credited to the resident. All of the company’s policies and procedures relating to the management of a care home are maintained in The Manor House. Evidence confirmed that employment policies and procedures were being followed and that training was being provided for staff. Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 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 Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 x x x Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Requirement The manager must ensure that unused medicines are disposed of appropriately and that an audit trail is confirmed. Timescale for action 10/10/05 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 Good Practice Recommendations Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Liverpool Area Office 3rd Floor 10 Duke Street Liverpool, L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Manor House Nursing & Residential Home F52 F02 S20925 The Manor House V254373 101005 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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