Inspection on 12/03/09 for Manor House Residential Home

This inspection was carried out on 12th March 2009.

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

Extracts from inspection reports are licensed from CQC, this page was updated on 21/07/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Manor House Residential Home 21 Manor Road Torquay Devon TQ1 3JX Lead Inspector Rachel Proctor Unannounced Inspection 12th March 2009 10:30 DS0000072855.V374811.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor House Residential Home Address 21 Manor Road Torquay Devon TQ1 3JX 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) 01803 312759 Manor.house@hotmail.co.uk Mr Richard Conway Mr Richard Conway Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 14 New registration Date of last inspection Brief Description of the Service: Manor House offers accommodation with personal care to older people (65 ) both male and female. The home is registered to provide a service for up to 14 residents. Manor House has 14 single bedrooms 9 of which have en suite facilities. In terms of communal space, the home offers a T.V. lounge, quiet lounge and a dining room. It also has communal assisted bathrooms and toilets. To the rear of the building there is an accessible courtyard style garden with seating provided. A gate is available from the garden into the local park from the rear of the home. It is located in the St. Marychurch area of Torquay and offers level access to the local shopping precinct and has good public transport links to Torquay and Newton Abbot. The weekly cost of care at Manor House ranges between £301.00 and £367.00. To find out the current costs the home should be contacted. Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This was a key unannounced inspection, which took place on 12 March 2009. During the visit a tour of the home was completed. People living at the home and staff were spoken to and some records were inspected. Three of the people living at Manor House had their care followed as part of this inspection. Their records of care were seen and where possible people were spoken to about their experience of care. Information received from the home since the last inspection was reviewed, this included the AQAA (Annual Quality Assurance Assessment). This was received prior to the visit to the home. Some of the comments made during the inspection have been incorporated into this inspection report. All required core standards were inspected during the course of this inspection. The registered manager assisted throughout the inspection process. What the service does well: Manor House has a staff team that was well trained, experienced and committed to providing a quality service for the people living at Manor house. The people spoken with during the inspection said they were very happy at the home and were clearly relaxed. Examples were observed of sensitive care being delivered by the staff. One person said, “I am very well looked after, it couldn’t be better” and another remarked, “ The food is wonderful”. People were being treated with respect at all times and their privacy and dignity were clearly seen to be a priority for carers. All those spoken with were very positive about life at the Manor House. A wholesome diet was provided at the home with meals balanced and varied. People are consulted daily about what foods they would like to eat, and choice was always available. This should ensure people have a balance diet of food they enjoy eating. What has improved since the last inspection? This was the first inspection of a newly registered service following a change of ownership. Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 6 What they could do better: Plans of care had not been reviewed monthly or sooner to reflect changes in peoples individual care needs. This means staff will not have all the information they need to ensure people receive the care they need. The individual risk assessment in people’s plans of care had not been reviewed regularly to ensure they reflected the person’s current needs. By not keeping individuals risk assessments up to date people could be at risk of not receiving the care they need. The controlled drug record book had not been kept up-to-date. Controlled drugs no longer required by people had not been clearly recorded when they were returned to the pharmacy. By not keeping controlled drug record is upto-date people will be at risk of receiving medication they no longer require. The manager provided information on 23rd March 2009 that systems and practices had been updated to ensure a controlled drug medication records are kept in line with Requirements. The manager had not ensured that individual risk assessment for use of hot water baths, which exceed the recommended temperature, had been completed. This could put people at risk of scalding if their individual risks using hot water baths have not been assessed and actions put in place to reduce risk. The manager should consider regulating the hot water temperatures for the hot water baths people have access to. This will ensure the possible risk of scalding is reduced. The manager had not ensured that the freestanding mobile hoist had been serviced and was safe to use. By not ensuring hoists are regularly serviced and available for people who need them; people living at the home and the staff may be at risk of injury from unsafe hoists. The manager had not recorded fire equipment checks in the fire logbook. By not ensuring fire equipment tests are recorded after they have been carried out; people may be put at risk in the event of a fire if equipment fails. Copies of weekly menu had not been made easily available for people who chose to eat their meals in their own rooms. This will ensure they have the information they need to choose what they would like to eat. Although issues individual people had raised were being recorded in their plans of care evaluation. A separate complaints and concerns book or folder was not being kept to record issues that the staff team have addressed with individuals living at the home. By not doing this a clear over view of the issues raised by people will not be given. The manager had not ensured all the information required for staff files had been provided. Providing this will ensure recruitment continues to protect people living at Manor House. Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 7 Staff training and development plan based on their training needs and the needs of the individuals living at the home had not been completed. By not ensuring staff have training planed, which is relevant to the needs of the people living at Manor House; staff may not be able to continue to provide the good care for people they are doing at present. Not all relevant policies and procedures were available with in the home for staff use. This may mean staff do not have the information they need to protect peoples health and safety. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6. People using the 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 who live at Manor House are given sufficient information to make an informed choice about the home and its services. The assessment processes adopted by the manager should ensure people have their health and care needs met. Manor House does not provide intermediate care. EVIDENCE: As part of the new registration process the manager provided a new statement of purpose and service users guide for the service. He further advised that he was planning to introduce a client pack for each individual room. This would Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 10 contain a copy of the service users guide and other relevant information including the complaints procedure. This information provided people with details of the home and its services, which enable them to make an informed choice about the home. The manager advised that he was in the process of updating the care planning and assessment documentation for people living at the home. One person had been admitted to the home since the change of ownership. The manager had started to record some information in the new format. However the existing care planning system was still in use. Both assessments covered the activities of daily living for the individual and had a record of their personal choices and preferences. These included the time they like to go to bed and get up and, preferences for food and their interests. The AQAA (Annual Quality Assurance Assessment) provided prior to this inspection stated they do the following well. “Detailed pre assessments will be carried out on all potential new Service Users whilst in their current setting, this will ensure that every aspect of the individuals care can be met within Manor House. Life history letters will be sent to relatives. The information gathered will enable us to gain a greater picture of the Service User.” Two people living at Manor house said the manager has talked to me about what is important to me . “ they look after me well and the manager is very approachable. Manor house is not provide intermediate care. Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people had poor care plans and inadequate risk assessments, which had not been reviewed as needs, changed. Changes in people’s needs were reliant on staff remembering what to do without reference to written details. This puts people at risk. Medication practices are generally safe. However by not having a clear system for disposal and return of medication, people may be at risk of receiving medication they no longer require. Staff appeared to be skilled caring for people, they were polite and respectful to the people they care for. There was a genuine rapport between the staff and the people living at the home. People’s privacy and dignity was being upheld and they were being valued as individuals. Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 12 EVIDENCE: Three people had their care followed as part of this inspection. This involved speaking to the person where possible and visiting the room they occupied. Individual care plans; assessments and medication records were also viewed. All three had plans of care, which had been developed from their initial assessment of need. However no records of regular reviews were being kept in the existing care plans. Manual handling assessments did not appear to have been updated since the home changed hands. One person whose care was followed had deteriorated since their initial assessment was carried out. The manual handling assessments in the care plan did not reflect the current manual handling needs. The daily records for the person had recorded that the district nurses had been involved and provided pressure relief equipment to manage or reduce the risk of pressure sores. However no care plan had been formulated which related to management of pressure areas. None of the people whose care was followed had a record of a pressure sore risk assessment with the care plan. The manager advised that he and some of the senior staff would be attending training for management of pressure area care in the near future. One person whose care was followed was being cared for in their own room. They had been provided with the hospital style bed and pressure relief mattress. They care planning information did not include their pressure area management or a nutritional risk assessment. The last documented review of this persons care plan was on the 15th of June 2008. Manual handling assessment completed on the 3rd August 2007 indicated that this person needed two carer’s to transfer with the transfer sheet or use of a hoist. The manager advised that this person was now able to weight bare and no longer required the hoist. He also advised that the persons ability has fluctuated on a daily basis. On the day of the inspection the person was being cared for in bed. They did not appear to be able to alter the position in the bed themselves and relied on staff to help them move. One of the carers providing care for the person said they hadnt been very well that morning so they had stayed in bed. People living in a home looked well cared for. They were wearing clean clothes, and their hair looked tidy. Two of the carers spoken to during the inspection said, its important that the people we care for receive the attention they need. Four people living in the home who was spoken with during the inspection all said the staff are very kind and helpful. When the carers were asked about the needs of the people whose care was followed they were able to clearly say what they care needs were and how they should be met. However the information in the care plans was not up-to-date and didnt reflect current care needs. Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 13 Although risk assessments were in place these had not been reviewed regularly enough to ensure that they were still accurate. This included nutritional risk assessments and manual handling risk assessments. Risk assessments for the rooms included the use of hot water. One person whose care was followed had a care plan assessment, which stated they were confused and should not be left unattended for long periods. They were being cared for in en suite single room, which had a bath. This individual did not have a completed risk assessment for the use of the bath. The manager advised that the person had been risk assessed and the bath did not pose a risk to them. Medication records were checked for the three people whose care was followed. These had been signed and dated by the member of staff administering the medication. The manager advised that only senior staff who had received medication training took responsibility for managing peoples medication. He further advised that none of the current people living at Manor house were able to manage their own medication. Medication was being stored in a locked cupboard. The manager advised that there they had changed the supply pharmacy since he took over the home. Records of medication returns had not been fully completed. None of the current people living at Manor house were receiving any controlled drugs medication at the time of this inspection. A controlled/record book was available and had been completed. However where medication was no longer required no record of its return or disposal to the pharmacy had been recorded. One entry recorded since the new manager started indicated that there should have been a quantity of controlled drugs left. However these were not in a controlled drug cupboard. The manager advised that they had been returned to the pharmacy and the pharmacy returns book had been signed. However a copy of this record was not available at the home at the time of the inspection. Since the inspection the manager has provided information regarding how controlled drug medication has been managed. He has also provided a policy for staff to follow for medication no longer required. People living at home appeared to have a genuine rapport with the staff who are caring for them. Staff spoken to understood the needs of the individual people they were caring for. People living in the home who were asked said staff are always respectful and polite to them. The manager advised that the key worker for each individual person make sure that the person has their own clothes available to them at all times. People are able to see visitors or visiting professionals in the privacy of their own room. The shared rooms provided screening to ensure that personal privacy was not compromised. Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good arrangements for providing activities at the home that interest people. The home provides a healthy and nutritious diet for the people who live there. EVIDENCE: Many of the people living at Manor House are able to go out on their own and are encouraged to do so. Shops are available very near to the home. A park that situated at the back of the home was particularly popular; the surrounding area was level and does not pose any access issues for the people living at Manor House. The new manager advised that all the people living at Manor House are encouraged to make as many choices regarding daily living as possible. He also advised that Life history letters will be completed by relatives and or the person, which give insight in to previous activities, interests and hobbies. Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 15 The new manager had put a system in place to record people’s interests and activities they enjoyed. People asked said they had the opportunity to take part in activities if they wished. The activity book being kept had not been kept up to date with all the activities arranged. The manager advised that he had had several residents meeting to explore the opportunities in engaging people. These included the ongoing improvements, new interests and activities; where people at the home had been able to voice their views and say what was important to them. Two people asked said they had attended meeting with the new manager who had told them of his plans for the home. However a record of these meetings was not being kept. The manager also advised that he had purchased a computor terminal with internet acsess to enable people with relatives living abroad to communicate with them via email and web cam. On the day of the inspection a volunteer was helping out at the home. They were spending time with individual people living in the home. A visiting local vicar was also visiting the home to provide a morning service for those who wanted to attend. He advised that the new owner had asked him to visit the home when he took over. The home has an unrestricted visiting policy and procedure. The manager advised that visitors are always welcome. People spoken with said that they were supported to make their own decisions about matters that affected them. This was also confirmed from observations made during the inspection and the views expressed by others. A relaxed, homely atmosphere was apparent throughout the day of the inspection. People spoken with expressed a high degree of satisfaction with the way they were cared for at Manor House by the staff team. People had personalised their individual rooms with items of their choice. The manager advised that people are asked about their preferences for colour scheme when their rooms are to be decorated. One person asked confirmed that the manager had spoken to them about the colour scheme and carpet for their room. A menu was provided on the dining tables for the week. This showed the choice of meals for lunch and evening meal. However one person who had chosen to stay in their own room said they had not seen the menu. They also said they usually enjoyed the food provided. The managers advised that the homes menu was reviewed regularly to ensure that it reflects the likes of the people living there and relevant to the time of year. All meals are cooked in house with fresh local produce. Each mealtime has an option for main and desert. This was seen to be the case during the inspection when the lunchtime meal was shared with people living at the home. Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. People using the 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 has a robust complaints procedure that was displayed in the reception area. This should ensure people have confidence that any concerns they have will be dealt with sensitively by the homes staff team. The arrangements for the protection of vulnerable adults are satisfactory. EVIDENCE: The Commission has not received any complaints since the change of ownership for Manor House. The complaints policy has been up dated to reflect changes. However no complaints or concerns record was being kept at the home at the time of this inspection. The manager advised that any issues raised are dealt with as they occur and recorded in individual care plan evaluations. Two of the people living in the home spoken with were happy with the response they had to issues they had raised with the manager. The manager confirmed that staff received training for the protection of vulnerable adults. Reference information relating to adult protect was provided for staff in the home. Staff spoken with during the inspection were aware of the adult protection process and had clear policy’s to refer to. Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Manor house provides a pleasant homely environment for people living there. It is reasonably maintained and mostly well presented. By not ensuring risk assessments are completed for the use of hot water baths people could be put at risk of scalds. EVIDENCE: A tour of the home was completed with the manager and some people’s individual rooms were entered with their permission. One of the rooms entered had been redecorated and a new carpet fitted. The manager advised that each person’s room would be redecorated and refreshed after consultation with them. The manager confirmed that two individual rooms had been redecorated since he took over the home. The manager also advised that Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 18 separating out a small area of the dining room had created a lockable office area. This still left sufficient space for people to use the dining room if they wanted to at meal times. A small courtyard garden area was provided for people to use. The manager advised that he was planning to increase the flower boarders and encourage people who lived at the home to take part if they wanted to. This was accessible by a ramp from the rear door. Three people living in the home said they liked the individual room they had in the home. They also commented that they had been able to bring small personal possession to the home when they moved in. The lounge and dining room were pleasantly furnished and decorated. The dining room had table clothes and napkins. This made the dining room look inviting. The volunteer working in the home at the time of the inspection said that they usually helped to set the tables for meals when they were in the home. They said people had commented how nice the dining rooms looks. The lounge had domestic style chairs, which were suitable for people living at the home. One person was occupying a single room with an en-suite bathroom, which had a full bath. The water temperature in this bath had not been restricted to the recommended temperature. We noted that the water was too hot to hold a hand under. The manager confirmed that none of the baths had restricted water temperature. He also advised that all the current people living in the home had assistance when they used the bath. Staff were recording a record of bath water temperatures each time a person used the bath. However individual risk assessment for the use of unrestricted hot water in the baths had not been completed. All the communal areas and assisted bathrooms and toilets were fresh and clean during this inspection. The manager advised that redecoration of one bathroom and a new bathroom suite had been fitted. One of the individual rooms had a slight odour, which the manager was aware of. Other rooms entered were fresh and clean, pleasantly decorated and furnished. The home had a new bath hoist fitted and also had a free standing hoist, which one person was identied as needing in their plan of care. However the hoist available in the home did not have a record of service that showed it had been checked at least six monthly. The manager advised that they were not currently using the hoist as the person who had needed the hoist no longer required this. However one person was being cared for in bed and did not appear to be able to move independantly at the time of this inspection. The manager advised that their care needs fluctuated on a daily basis. Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 19 The kitchen had been refurbished since the change of ownership. The person using the kitchen said it was easy to work in and cupboards were easy to access. The manager advised that he was planning to increase the size of the kitchen and make the laundry easier to access. The laundry area was sited away from people’s individual rooms and food preparation areas. The manager advised that he was planning to improve the kitchen area and move the laundry area so it would be easier for staff to access. Glove and aprons were provided for staff use. An infection control policy was available for staff. Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. People using the 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 manager employs sufficient staff each shift who are supported to do their work. This should ensure people have their care needs met. The robust recruitment police and procedure should ensure people are protected from unsuitable staff. Staff report they felt well supported to do their work and stated they had access to training. However a training and development plan based on their training needs and the needs of the individuals they were caring for had not been provided. This may mean staff training does not reflect fully the needs of the people living at the home. EVIDENCE: The duty rota provided shows the number of staff on duty and in what capacity they are employed. This showed that more staff were on duty at peak times. The manager advised that staffing levels at the home would be adjusted if the needs of the people living there increased. The manager advised that since he took over the home a new senior carer had been appointed. Staff spoken with during the inspection said they were able to contact the manager or the new senior at any time if they were any issues at the home. The preinspection Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 21 information provided by the manager states, there are five full-time members of staff and six part-time members of staff. In addition to the care staff three other people are employed. These include a cleaner and a cook. The manager advised that all staff employed had either completed an NVQ (National Vocational Qualification) level 2 or above in care or were working towards this qualification. Preinspection information provided by the manager indicated that five of the eleven staff working at the home had already achieved their NVQ level 2 in care. The Staff spoken to confirmed that they had access to training help them do the jobs well. The manager advised that all vacancies are advertised through the local newspaper. And all new staff are required to provide two written references and gaps in employment are explored. He also confirmed that potential new staff are only confirmed in writing following a POVA 1st (Protection of Vulnerable Adults) and CRB (police check) have been satisfactorily completed. New staff will be employed using the homes code of conduct. Two staff files were checked during the inspection. These contain an application form, proof of identity and one written reference each. Evidence that both had a recent police check were available. The manager advised that he had worked with both of the new staff at his last job prior to them joining the home so had not requested a further written reference. None of the staff files seen had a recent photograph of the staff member. The manager advised that he was looking into possible providing a display board with all the staff photos, which would enable people living at the home and visitor to see who was on duty that day. How staff are supervised and supported was discussed with the manager. Not all staff had a record of supervision with the manager at the time of this inspection. However Staff spoken with during the inspection said they felt well supported to do the work. They also said the manager was approachable and listen to what they said. The manager advised that staff training and development programs were being developed. A record of staff development and training from previous owner/manager was not available at the home. The manager advised that he was looking at a new induction programme for staff, which was linked to the skills for care recommendation. Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the necessary skills and knowledge to lead his team and ensure the home is run in the best interests of the people who live there. However the health and safety of people living at Manor house could be compromised by the lack of clear health and safety policies for staff. Fire equipment tests had not been kept up to date this could mean people may be put at risk in the event of a fire. EVIDENCE: The Registered Manager has worked in the care home industry for several years. He also has experience managing other care homes. He has achieved Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 23 the Registered Managers Award and National Vocational Qualification at level 4 in Care. During this inspection he has provided evidence that shows he has both a good understanding of the needs of the people who are in his care. He showed his ability to provide the right training for the staff so that they deliver the correct care. He could demonstrate that the staffing levels he provides are sufficient to allow the correct level of care to be delivered top the people who live in the home who have a variety of needs. The manager advised that quality assurance questionnaires are sent out periodically to service users and relatives, GP and health professionals questionnaires will be sent out annually. Results are analysed and made available for people living at the home. People living at the home spoken with said the manager had discussed the changes he planned with them at the residents meeting he arranged. They also said he was approachable. A list of policies provided was given prior to the inspection. The manager advised that he was working through these to up date them as required. However it was noted that some policies were not provided. These included fire safety, Health and safety at work, food hygiene and Controll of Substancies Hazardose to Health (COSHH). The record of fire safty checks had not been completed fully since July 2008. The manager advised that he had checked these routinely but had not recorded this. The manager provided a new fire risk assessment completed in Febuary 2009 for inspection. Although there wasn’t a policy for COSHH, information relating to the chemicals used in the home was provided for staff. A policy for infection control was not provided and only three of the eleven staff had completed training. The lack of clear policys could mean that the health and safty of people living in the home and staff who work there are not fully protected. Records of money held for indivdual people were being kept by the manager. This included a record of money paid in and money taken out. Reciets were also being kept for expenditure on behalf of the person. The manager advised that people are encouraged to manage their own money if they are able to do this. Staff spoken to during the inspection said they felt supported to do their jobs, they also said the manager was approacahable and helpful to them. How staff were supervised was discussed with the manager. At present an informal supervision with staff takes place with out a written record. The manager advised that he was in the process of developing a supervision system for staff to provide written evidence that supervision takes place. Records of services for electical equipment and gas servicing were provided. The manager has provided the Commission with information( Regulation 37 Notices) about any untoward incidents or occurances at the home. Accident records being kept included actions taken at the time. Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 24 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 2 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 4 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 1 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 1 Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 25 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 (b) Requirement The registered person shall(b) keep the service users plan under review. Plans of care had not been reviewed monthly or sooner to reflect changes in peoples individual care needs. This means staff will not have the information they need to ensure people receive the care they need. 2 OP8 14(2) The registered person shall ensure that the assessment of the service uses needs is(a) kept under review; and (b) Revised at any time when it is necessary to do so having regard to any changes of circumstances. By not keeping individuals risk assessments up-to-date for manual handling, nutrition and pressure sore risk. People will be at risk of not receiving the care they need. 31/05/09 Timescale for action 31/05/09 Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 26 3 OP9 13(2) The registered person shall 12/03/09 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The controlled drug record book must be kept up-to-date. Controlled drugs no longer required by people must be clearly recorded when they returned to the pharmacy. By not keeping controlled drug record is up-to-date people will be at risk of receiving medication they no longer require. NB The manager provided information on 23rd March 2009 that systems and practices had been updated to ensure a controlled drug medication records are kept in line with Requirements. The Registered person shall ensure that: All parts of the home to which the service users have access are so far as reasonably practical free from hazards to their safety. People who have access to hot water baths, which exceed the recommended temperature must have individual written risk assessments completed, which are kept under review as the persons needs change The Registered person shall having regard for the number and needs of the service users ensure that(c) Equipment provided at the care home for use by service users or persons who work at the home is maintained in good working DS0000072855.V374811.R01.S.doc 4 OP21 13(4)(a) 30/06/09 5 OP22 23 (2)((C) 30/06/09 Manor House Residential Home Version 5.2 Page 27 6 OP38 23(4)(c) (v) order. By not ensuring hoists are regularly serviced and available for people who need them; people living at the home and the staff may be at risk of injury from unsafe hoists. The Registered person shall after consultation with the fire authority(4)Make adequate arrangements (v) For reviewing fire precautions, and testing fire equipment, at suitable intervals. By not ensuring fire equipment tests are recorded after they have been carried out; people may be put at risk in the event of a fire. 30/06/09 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 OP15 Good Practice Recommendations Copies of weekly menu should be made available for people who chose to eat their meals in their own rooms. This will ensure they have the information they need to choose what they would like to eat. The manager should keep a complaints and concerns book or folder to record issues that the staff team have addressed with individuals living at the home. The manager should consider regulating the hot water temperatures for the hot water baths people have access to. This will ensure the possible risk of scalding is reduced. The manager should ensure two written references are provided for all new staff. And provide a recent photograph for all staff. This will ensure recruitment practices continue to be safe. 2 3 4 OP16 OP21 OP29 Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 28 5 OP30 6 OP33 The manager should ensure that all staff have a training and development plan based on their training needs and the needs of the individuals living at the home. This will ensure people continue to be cared for by a knowledgeable staff team. All relevant policies and procedures should be available with in the home for staff use. This will ensure staff have the information they need to protect peoples health and safety. Manor House Residential Home DS0000072855.V374811.R01.S.doc Version 5.2 Page 29 Care Quality Commission South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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