Inspection on 15/08/06 for Manor House Nursing & Residential Home

This inspection was carried out on 15th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 &... 14/02/06

Manor House Nursing &... 10/10/05

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 Key Unannounced Inspection 15th August 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 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 & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Manor House Nursing & Residential Home Address Moreton Road Upton Wirral CH49 4NZ 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) 0151 677 0099 0151 604 0328 BUPA Care Homes (BNH) 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 DS0000020925.V294154.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 40 beds nursing care / 20 beds personal care in an overall total of 60 To admit one named service user aged 57 years of age for the category of (TI) 14th February 2006 Date of last inspection Brief Description of the Service: The Manor House is a large care home providing nursing and personal care for up to 60 residents over the age of 65 years. It is situated in extensive and well-maintained grounds that are fully accessible. Accommodation 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. Information provided by the manager identifies that the fees are currently set at £700 - £720 per week. Individual residents requiring these services meet the costs of chiropody, hairdressing, physiotherapy and newspapers. Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken on Tuesday 15th August 2006 over a period of 4.5 hours. It involved the examination of some records, meeting with the registered manager and two staff, meeting with five residents and two visitors and a tour of the building. The registered manager had completed a pre-inspection questionnaire that gave information about the current status of the home. The inspection was carried out as part of the Commission’s responsibility to visit and report on each registered care home. What the service does well: What has improved since the last inspection? What they could do better: No requirements or recommendations have been made from this inspection. Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 Page 6 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 DS0000020925.V294154.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 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 the following standard(s): 1, 2, 3, 4, 5 and 6 Prospective residents have the information they need to make an informed choice about the home’s ability to meet their needs. 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 are available in the reception area of the Manor House. Privately funded residents are issued with a contract and statement of terms and conditions of residence. Other residents have a contract provided by the placing authority. All details of financial arrangements are kept separately to care files to maintain confidentiality. The inspector examined the care files for four residents. An assessment document was located on the files that gave full information about the resident and their needs. It also contained information about family make up, previous employments, interests and hobbies. The document had been completed in Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 Page 9 conjunction with the resident and/or their family/friends. The inspector was informed that BUPA are in the process of developing a new assessment document for use across all of its homes. Care and support for older people has been provided at The Manor House for some considerable time. From reading the care files, from discussions with the manager and her deputy, from meeting with residents and from records kept in the home, the inspector is satisfied that the manor House is able to provide appropriate services to meet the assessed needs of the people who live there. Prospective residents and their families are encouraged to visit the home and to spend some time there before making a decision to move in. The home will take emergency admissions and will provide respite care if a room is available. The Manor House 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 DS0000020925.V294154.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9, 10 and 11 Resident’s health, personal care and social care needs are being met. EVIDENCE: Care plans were in place on each of the care files seen during the inspection. They contained information that was being used to guide the day-to-day support for individual residents and there was evidence to show that they were being reviewed. The Manager told the inspector that they were developing the review arrangements to record the outcomes more clearly. Risk assessments were also in place. Separate assessments recorded the moving and handling, nutritional, continence and tissue viability needs of residents and there were documents to support the use of bed rails and the ability of residents to self medicate. The home has good links with local GP’s, district nurses, Community Psychiatric Nurses (CPN’s), the Continence Adviser and the Tissue Viability Nurse. A dentist and optician are available as necessary and the home has links with a chiropodist who provides a service for which there is an additional charge. The home has a contract with a Physiotherapist to provide Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 Page 11 rehabilitative support but residents can be supported by their own therapist or one provided by the hospitals. None of the residents currently accommodated in the home has a pressure sore. Wound plans are created when residents have a pressure sore or any other serious wound/skin damage and photographs are used to monitor the healing processes. Arrangements for managing prescribed medicines were examined and apart from some missing signatures on the medicine administration records (MAR) were in good order. The home has developed a procedure for the destruction of “Controlled Drugs” that conforms to good practice. The home has undergone an infection control inspection and was noted to have good practices in place across all areas of its operations. Personal care is provided in resident’s own rooms or in one of the bathrooms around the home. Locks are fitted to bathroom and toilet doors to assist privacy. All of the resident’s rooms have a door lock with a key but at the time of this inspection none of the residents had chosen to use them. Residents can meet with their visitors in their own room or in one of the communal lounges. Most 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 that their wishes are respected. The home has an information leaflet that is given 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 the death of a resident in the home. Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 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 the following 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 Organiser is in post and she arranges individual and group events. Information about the week’s activities is printed out and a copy is given to each resident in the home and displayed on the notice boards. The Activities Organiser spends her mornings in one-to-one contact time with individual residents and coffee is served in the lounge (though this doesn’t preclude residents taking the morning drink in their own room). Afternoons are usually spent engaged with group activities or with outside entertainers. Bingo, exercise sessions, Art classes and Sewing classes are all available. The home celebrates birthdays and other national events with parties and themed meals. Ministers of religion visit the home to support individuals or to hold services for groups of residents who choose to attend. Visitors to the home are welcomed at any time and can meet with residents in their own room or in one of the communal areas. They can also choose to take a meal in the home for which there is a set charge. Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 Page 13 Breakfast trays are made up and taken to resident’s bedrooms. Lunch and dinner are served in one of two restaurants with waitress service. Care staff assist residents who are unable to manage on their own. Tables in the restaurants are laid out with tablecloths and napkins. A menu listing a choice of foods is available on each table and residents decide what they wish to eat. Alternatives to the main menu options are provided where special dietary requirements are in place or where residents do not wish to take one of the meals on offer. The home provides a choice of sandwiches at suppertime. Environmental Health Officers inspected the home’s kitchens and hygiene practices prior to the CSCI inspection in February 2006. All of them complied with the requirements of Food Safety legislation. Residents who spoke with the inspector were complimentary about the meals provided in The Manor House. Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 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 the following standard(s): 16, 17 and 18 Resident’s complaints are taken seriously and they are protected from abuse through appropriate polices and procedures in the home. EVIDENCE: The home has policies and procedures in place to deal with complaints and these are included in the statement of purpose and service users guide. Compliment/Complaints forms are available in the entrance hallway to the Manor House. Records inspected showed that the manager had dealt with six minor complaints during the previous twelve months. All had been concluded to the satisfaction of the complainant, within the time scales set. Residents are listed on the Electoral Register and are given the opportunity to vote in local and national elections. The home has policies and procedures to deal with suspected incidents of abuse and “whistle blowing” arrangements in are place to support staff in raising any concerns. All staff are provided with training in the recognition of abuse and the actions to be taken if abuse is suspected. The home has a copy of Wirral’s Adult Protection Procedures. Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Residents live in a safe and well-maintained environment that has the specialist equipment necessary to support their care needs and maximise their independence. EVIDENCE: The home was originally a manor house that has been modernised and extended to provide accommodation for up to 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 owned and managed by a separate company are located on the same site. Communal space in the home is well set out with small sitting areas or larger communal spaces. A reading room is provide with library books and talking books that are changed regularly. Two restaurants are located in the old manor house and have high, ornately patterned ceilings. The Newer areas of the home have much lower ceilings, are more modern in design and can more easily accommodate the movement of residents and the use of specialist equipment. Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 Page 16 The problems that were being experienced through a lift breakdown during the CSCI inspection in February 2006 have been overcome. The home has 59 bedrooms all of which are single occupancy. However, one can be used to accommodate a married couple or friends who choose to share, thereby taking the home to its ceiling of 60 residents. All of the bedrooms, except for one, have their own WC wash hand-basin and bath. Bedrooms are well presented and have a good level of wardrobe and drawer space. Residents are encouraged to bring small items of furniture (fire precautions permitting) and treasured items to personalise their room. The home has some communal bathrooms that are fitted with specialist bathing equipment. A range of handrails, grab rails and hoists are provided around the home and specialist beds, mattresses and other equipment are provided as necessary. With the exception of a small number of bedrooms in the residential area the home is accessible to wheelchairs and outside space has been developed to provide level access. Windows around the home provide natural light and ventilation. On the day of this inspection the home was warm and well lit. Thermostatic valves control hot water delivered to resident’s rooms and bathrooms and the temperatures are tested on a regular basis. On the day of this inspection the home was found to be clean and well maintained and no offensive odours were present. Policies and procedures for the control of infections and for the disposal of clinical waste are in place. Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 29 Residents are supported and protected by the homes policies and procedures for the employment of staff and by staff training programmes. EVIDENCE: The home employs 14 trained nurses, 30 care staff and 40 ancillary workers. 3 trained nurses and 8 care staff are employed between 8:00am and 2:00pm, 2 trained nurses and 5 care staff are employed to work between 2:00pm and 8:00pm and 2 trained nurses and 4 care staff work through the night. The home’s manager is able to increase staffing levels for short periods of time if the needs of residents require higher levels of support. Increasing levels of dependency amongst the groups of residents being accommodated at The Manor House have been recognised by BUPA and they are keeping staffing levels under review. The home’s manager has worked to strengthen the team of trained nurses and avoid the use of agency nurses wherever possible. Twenty of the homes thirty care staff have an award at NVQ level 2 or above in care. A further four care staff are working to achieve this award. BUPA Care Homes is an equal opportunities employer and has strict procedures for the recruitment and appointment of staff. The inspector examined the files for four employees. Each contained all the necessary documentation and there Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 Page 18 was clear evidence that POVA and CRB clearances are being obtained. All new staff are required to undergo a period of probationary employment when their aptitude for the work is assessed. Staff records and a training matrix provided evidence of induction and ongoing training. Trained nurses are identified as “link” nurses for tissue viability and pain relief and cascade knowledge and training to colleagues. Basic training in moving and handling, fire safety, health and safety and food hygiene are provided at induction and updated on a regular basis. Specialist training is identified in supervision and is provided when required. The home’s manager identified that additional training has been provided in nutrition, “Personal best”, preferred pathways of care, understanding dementia and adult protection. BUPA will use distance-learning methods for all categories of staff where this is appropriate. Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 and 38 The home is run in the best interests of residents. EVIDENCE: The manager of The Manor House is a registered nurse with many years experience of managing care homes for older people. She has also completed an NVQ level 4 in the management of care. During the course of the inspection it was clear that the manager had a good understanding of the needs of each of the residents in the home and was fully up to date with their care arrangements and individual expectations. Residents who spoke with the inspector and referred to the manager were complimentary about her style of management and her personal commitment to their care. They also spoke positively about other staff in the home. One resident told the inspector she had never heard any member of staff raise their voice to any resident and that they were always kind and willing to help. Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 Page 20 Two relatives were complimentary about the home, the staff and the support that they had received. BUPA requires its managers to provide monthly returns of quality audits undertaken in the home. These range from reviews of care plans to sickness absence returns and checks on the management of medicines. Additionally the home organises an annual quality assurance questionnaire that is given to all residents and their relatives. Quarterly resident and relative meetings are held at which the manager and her staff discuss matters affecting the current and future care arrangements at the Manor House. She also presents feedback from the most recent resident/relative survey and the outcome form any CSCI report. She said that although invitations are been sent out to all residents and their relatives, attendance figures are often low. Nevertheless, minutes from the meeting are sent out inform those who attended and those who could not be there, of the matters that were discussed. A senior manager from BUPA visits the home on a monthly basis to complete the required Regulation 26 visits following which a report is prepared. Records relating to the financial accounting of the company are held at their head office and are available to CSCI. The Commission is not aware of any financial matters that would affect the continued operation of this home. The home does not manage the financial affairs of any of the residents. Expenditure for hairdressing or chiropody is billed to the resident or their family for payment. Staff will manage small amounts of money for those residents who request them to do so and detailed accounts of deposits and expenditure are maintained. All of the company’s polices and procedures for the management of a care home are available in The Manor House. The manager confirmed that the required checks are being made on electrical equipment and mechanical devices in the home. Fire safety equipment and hot water temperatures are tested routinely and appropriate certificates confirm the safety of gas and electrical appliances. The home’s lifts are checked and waste disposal arrangements are in place through contracts. Records relating to the care and support of residents and the employment of staff are kept locked in the home when not in use. Medicines are stored safely and appropriate records kept of their receipt and disposal. Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 4 4 3 3 4 4 4 4 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 4 4 4 3 3 3 4 4 Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 Page 22 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. Standard Regulation Requirement Timescale for action 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 OP27 Good Practice Recommendations The homeowner should review staffing levels at the home to ensure they remain appropriate for the levels of need in the resident group currently being supported. Manor House Nursing & Residential Home DS0000020925.V294154.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Liverpool Local Office 3rd Floor Campbell Square 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 DS0000020925.V294154.R01.S.doc Version 5.1 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. 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. 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