Inspection on 01/05/08 for Manor II

This inspection was carried out on 1st May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Manor II 08/01/09

Manor II 04/06/07

Manor II 09/11/06

Manor II 08/06/06

Manor II 30/09/05

Manor II 25/05/05

Manor II 24/01/05

Manor II 31/08/04

Manor II 23/06/04

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

CARE HOMES FOR OLDER PEOPLE Manor II 205-207 Hainault Road Leytonstone London E11 1EU Lead Inspector Peter Illes Unannounced Inspection 1st May 2008 09:00 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 II DS0000058844.V362622.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor II Address 205-207 Hainault Road Leytonstone London E11 1EU 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) 0208 539 0079 manager.manor2@aermid.com www.aermid.com Aermid Health Care Limited Bindu Tomy Care Home 17 Category(ies) of Dementia - over 65 years of age (17) registration, with number of places Manor II DS0000058844.V362622.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 the following gender: Either whose primary care needs on admission to the home are within the following category: 2. Dementia - Code DE(E) The maximum number of service users who can be accommodated is: 17 4th June 2007 Date of last inspection Brief Description of the Service: Manor II is a care home registered to provide care, support and accommodation for up to 17 older people with dementia type illnesses. The home is owned and operated by Aermid Health Care Limited. Accommodation provided is in single rooms, and all have en suite facilities except two, which are an adjacent to bathrooms/ toilets. There is a main lounge/ dining room, a smaller lounge and conservatory on the ground floor, and a stair lift to the first floor that contains further bedrooms, shower and toilet facilities. The home has a large pleasant rear garden. The home is situated in Leytonstone with good transport facilities to local shops and amenities. A stated aim of the home is to provide a caring and homely atmosphere, which respects the individuality, dignity and right to privacy of each resident. On the day of the inspection the range of fees for the home was between £450.00 and £550.00 per week. A copy of the Statement of Purpose, Service User Guide and last inspection report were available and can also be obtained on request. Manor II DS0000058844.V362622.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 1 star. This means the people who use this service experience adequate quality outcomes. The last key inspection took place on 4th June 2007 and a random inspection was then undertaken on 6th November 2007 to follow up progress the home was making with some of the requirements and recommendations made at the key inspection. The outcomes for residents from both of these inspections are included in this report. This unannounced key inspection took approximately eight and one half hours and was undertaken by the lead Inspector. Terms such as “we”, “our” and “us” are used where appropriate within this report to indicate that the inspection activity was undertaken on behalf of the Commission. The registered manager was on maternity leave at the time and the temporary manager, Ms Tina Rensch, was available and assisted throughout the inspection. There were sixteen residents living at the home at the time. One of the home’s bedrooms was being used as an office at the time and the home had no vacancies. The inspection activity included: meeting and speaking with most of the people living in the home although conversation was limited due to their needs; detailed discussion with the manager; discussion with the provider organisation’s chief operations manager who attended the home for the majority of the inspection; independent discussion with three care staff; independent discussion with the chef; independent discussion by telephone with a social worker from L.B. Waltham Forest and independent discussion with a contracts officer from L.B. of Redbridge. Further information was obtained from an Annual Quality Assurance Assessment (AQAA) submitted to us before the last key inspection, a tour of the premises and documentation kept at the home. What the service does well: What has improved since the last inspection? Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 6 By the random inspection in December 2007 improvements relating to requirements made at the last key inspection had been achieved in the following areas: a range of training that staff receive, including in the care of people with dementia, to better equip them to meet residents needs; assessment information when people first move to the home so that their needs can be addressed more effectively; safe administration of medication to maximise protection in this area; systems for recording complaints and improvements to the layout of the building. At this inspection improvements had also been made in the following areas: stopping a temporary arrangement to supply meals to another home; staffing levels to better meet people’s needs; further staff training including qualification training to better meet people’s needs; an additional safeguard to the records relating to people’s money and a change of location of the laundry facilities to further assist promote health and safety. A good practice recommendation about how assisting people to exercise more independence with their meals had also been acted on. A requirement about providing more personalised activities was still being worked on and is restated at this inspection. What they could do better: There are eleven new requirements made at this inspection and one carried over from the previous key inspection as more personalised activities are still needed for people living in the home. The eleven new requirements are in the following areas: obtaining more information on people past life experiences, wishes and preferences to help improve the care they receive now; making sure that records about risks people may face are better recorded to help staff minimise these; storage of medication to meet new regulations; how complaints are dealt with to make sure people are properly protected; four areas relating to the physical environment to further increase people’s comfort and safety; for the temporary manager to register with the Commission to formally verify that she has the necessary skills and knowledge; arrangements reviewed to ensure that one resident’s finances interests are further promoted and a health and safety issue relating to staff facilities. A good practice recommendation is also made regarding further staff training to help people living at the home make as many decisions for themselves as they are capable of. Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Manor II DS0000058844.V362622.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 II DS0000058844.V362622.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has up to date information about the services it provides so that people can know what to expect from the home. The needs of people seeking to live at the home are assessed although further information about people’s previous likes, dislikes and aspirations would assist staff in meeting the person’s needs more effectively. Once admitted, people’s needs are reviewed to help staff in continuing to meet their changing needs. EVIDENCE: The current registered manager is on maternity leave and another manager from within the provider organisation’s service is covering the post. The statement of purpose and service user guide were available in the entrance hall of the home and it was noted that these were satisfactory and had been updated to reflect the current management change. Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 10 The files of five people living in the home were inspected, some of whom had been admitted to the home since the last key inspection. These files contained a range of assessment information about the person including from the social workers or other professional that had referred them and other specialist assessment that was current at the time. All the files also included a record of a pre-admission assessment undertaken by the home before the person first arrived. At the last key inspection a requirement was made that during the initial preadmission assessment the religious, social/ cultural needs of the resident are identified. At the following random inspection this requirement was judged to have been met and at this inspection this information was seen on the files looked at. However, the overall assessment information on some people did not give very much detail about the previous life history of the person. This information is important for staff to know as it can give clues to help identify what was important to a person before the onset of their dementia and to help staff react appropriately to them. For example, if a person becomes agitated, upset or confused at times the more knowledge about the person the staff member has can help them respond to a particular situation more appropriately and can help contribute to and restore the person’s feeling of well being at the time. A requirement is made about this. We spoke to a social worker of one of the people that had been admitted to the home since the last inspection and who had undertaken a review of the person to see how they were settling in following that admission. The social worker stated that the home had been supportive to the person’s partner throughout the process, which the partner very much appreciated. The social worker went on to say that the resident appeared happy and comfortable and had settled in well. Evidence of reviews with placing authorities were also seen on other people’s files that were inspected. At the last key inspection a requirement was made that staff individually and collectively have the required skills, experience and training to deliver the service and care which the home offers to people with dementia. At the following random inspection this requirement was judged to have been met, including staff having undertaken training in meeting the needs of people with dementia. At this inspection staff were observed dealing with residents who at times were upset and/or agitated. Staff spoken to stated that the training received helped them feel more confident in dealing with such situations. The home does not provide intermediate care. Manor II DS0000058844.V362622.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs, including risks they may be vulnerable to, need to be better recorded in their care plans to ensure that staff are aware of these and so that protection to people in these areas is maximised. People are properly supported regarding their health care needs with access to a range of healthcare professionals. Satisfactory medication policies and procedures are in place to safeguard people living in the home although further action is now required to comply with a recent change in regulation relating to storage of medication. People are treated with respect and dignity by staff, which they and their relatives appreciate. EVIDENCE: The care plans for five people were inspected, which contained guidance for staff on meeting a range of identified needs. At the last key inspection a requirement was made that care plans are made more specific with regard to Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 12 the specialist needs of people with dementia and how these needs are to be met, and include End of Life choices and decisions. At the following random inspection a range of improvements were noted by the Inspector that undertook that inspection and the requirement was judged to be met at that time. At this inspection it was noted that an End of Life section had been added to the care plans seen. Although these gave guidance for staff on how to obtain the necessary information it was noted that this was still work in progress. Some of the plans seen contained information on the wishes of the person and/ or their representatives although the majority did not. We were told that this was work in hand that was being explored with relatives and other stakeholders at meetings, including review meetings, however progress on this seemed slow. A requirement is also made in the Choice of Home section of this report regarding the home obtaining life history information about residents, which will also contribute to the development of more comprehensive care plans. Care plans seen were being signed to indicate that staff were reviewing them monthly. A range of risk assessments were also seen that again contained a record to indicate that they were being reviewed monthly. These included risk assessments in relation to vulnerable skin, falls and the person’s moving and handling needs. However, these risk assessments were of varying quality. One moving and handling risk assessment seen contained minimal information and it was not clear as to whether the person needed the use of a hoist of other equipment. The risk assessment did not give clear information about how risks should be minimised when staff undertook moving and handling tasks with the person. The manager stated that no one at the home currently needed the use of a hoist but this was not reflected in some of the moving and handling risk assessments seen. The records on a nutritional risk assessment for another resident indicated that the person’s needs in this area had been reviewed monthly and had not changed for a number of months. However, the file also separately showed that the person had received specialist health professional input regarding their nutrition, how this should be managed and a separate specialist care plan was now in place regarding the person’s changed needs. It was disappointing to note that staff had appeared to record “no change” on the person’s nutrition risk assessment over a period of months when significant changes had obviously occurred. A requirement is made about this to ensure that clear and up to date information and guidance is available to staff about how to meet people’s needs including how to minimise identified risks. Evidence was seen that people living at the home are registered with a G.P. and evidence of appointments with G.P.’s were seen on people’s files inspected. Evidence was also seen that people are supported to attend appointments with relevant healthcare professionals including a dentist, optician, hospital outpatient appointments and the district nursing service. One person living at the home had a pressure ulcer at the time and evidence was seen that the person was being attended by the district nursing service regarding this. Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 13 At the last key inspection a good practice recommendation was made that a suitable alternative location be identified for the medicine trolley, office desk and associated records/ documents; so that these pieces of equipment impact to a lesser degree on residents’ communal space. At this inspection the medication trolley was being kept in a separate locked medication room. The home has a medication policy that was seen located in the medication trolley and indicated that the policy had been reviewed in November 2007. At the last key inspection a requirement was made that hand written entries on MAR charts must be signed and dated by the person making the entry, and include the source of the information. At the following random inspection this requirement was being complied with. Three people’s medication and medication administration record (MAR) charts, which included a photograph of the person, were inspected at this inspection and were accurate and up to date. Records of medication received into the home and medication disposed of were seen and were up to date. It was noted that two people were prescribed controlled drugs and that the administration of these were being recorded in a controlled drugs register by two staff and that an up to date count of the medication administered and of the medication remaining was in place. This controlled medication was kept in a separate locked cupboard on the wall in the medication room. The regulations regarding the safe storage of medication in registered care homes has recently changed and new professional guidance to care providers was issued by the Commission in January 2008. This can be found on CSCI Professional, the Commission’s website for care providers. The change in regulation includes that all registered care homes that administer controlled medication must now have a controlled drugs cupboard in place, the specification of which meets the regulations. It was not clear whether the cupboard being used to store the controlled drugs met the specifications of the new regulations and a requirement is made regarding this. Residents were appropriately dressed and appeared well cared for during the inspection, it was also noted that people’s preferred names were recorded on their files and staff were using these. One visitor spoken to stated that they were very happy with their person’s care. They went on to say that they visit the home at different times and that the care they see is always good. Staff were seen interacting with residents appropriately throughout the inspection. Manor II DS0000058844.V362622.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. More work is needed to ensure people living at the home enjoy a range of leisure and recreational activities so that their differing needs and preferences in this area can be properly addressed. Relatives and other visitors are made welcome at the home, which they and people living there appreciate. People are encouraged to exercise as much choice and control over their lives as they can to maximise their independence. They are also provided with a range of healthy and nutritious meals that they enjoy. EVIDENCE: At the last key inspection a requirement was made that activities are provided to meet the needs of the residents, according to their individual interests, specialist needs and capabilities. Staff must be employed in sufficient numbers so that people using the service are given the opportunity to take part in such activities both within the home and in the community. This requirement was not tested in detail at the following random inspection. Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 15 On the morning of this inspection staff led a singing session in the lounge that residents were joining in with and clearly enjoyed. Although no organised group activity was seen during the afternoon staff were interacting with residents individually which the residents seemed to appreciate. Relatives that were spoken to during the inspection stated that there were often activities being undertaken when they visited the home including, music, singing and quizzes. Residents files inspected had a record of daily activities that they had taken part in. However, the majority of entries seen in these records stated “watching television” or indicated that relatives had visited. The records did not include the purpose of watching television or the person’s reaction to what they had seen. It was noted that the television in the main lounge was on for the majority of the inspection but that it was not clear whether people were actively watching it. It appeared that some people could not see the television properly from where they were sitting. There were minimal records of other activities on the activity record on the files inspected. Staff spoken to independently stated that staffing levels had increased since the last key inspection although staff could still be very busy, especially at weekends when the cook was not on duty. One staff member also confirmed that a range of activities did take place in the home although indicated that it could be hard to motivate residents sometimes when activities were arranged. The provider organisation’s Chief Operational Manager and the home’s manager acknowledged that further work was still needed in this area. They also confirmed that the home was planning to employ an activities coordinator to work in conjunction with staff in this home and in another of the provider organisation’s homes located nearby to further promote the development of a more varied range of activities. Given that the home is providing a service to people with a diagnosis of dementia our judgement is that the above requirement is not being fully complied with and is therefore amended and restated. The registered persons must ensure that a varied and personalised range of social and leisure activities and opportunities are available for all residents, both inside and outside of the home and that clear records are kept of the activities that each resident is offered and the activities that they have taken part in. This is in order to meet people’s individual needs and preferences in a meaningful way with regard to activities provided by the home. We were told that the home had accommodated some respite residents since the last inspection and that some of these came from different ethnic minority communities. We were told that their cultural wishes and preferences, including diet, personal care and religion had been catered for. All the current residents at the home during this inspection were long stay and of white European ethnic origin. Their religious and cultural needs and preferences were recorded on their files and relatives and social workers spoken to stated that these were being met. A requirement is made in the Choice of Home section of this report regarding the home obtaining life history information about Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 16 residents, which could provide further evidence to assist identify more individual wishes and preferences to assist the home further in this area. The majority of the residents have some contact with relatives and friends. Residents and a visiting relative spoken to independently confirmed this. Evidence was also seen from the home’s visitors’ book that numbers of visitors, including relatives and friends, visit the home on a regular basis. The relative that was spoken to independently stated that they were always made welcome when they visited the home, that the staff were polite and friendly and that they were invariably offered a cup of tea. The manager confirmed that the home was not the appointee for any of the residents but did look after personal allowances for most of the residents. The personal allowance records and money looked after for one resident were sampled. This was satisfactory with an individual and up to date record of money held and spent, the person’s money kept in an individual wallet with the amount corresponding to the record and that all the residents’ individual wallets were kept locked in the office. It was noted that the home was holding a large amount of money in cash for one resident and a requirement is made regarding this in the Management and Administration section of this report. The home employs a chef for six days one week and for five days on alternate weeks. The home operates a five-week rolling menu that provided a range of healthy and nutritious meals with a choice of main meal. Residents are asked each day which choice they would like and an up to date record of this was seen. At the last key inspection a good practice recommendation was made that residents living with dementia may benefit from the use of, for example pictorial menus, finger foods, small nutritious snacks and more flexible eating times to maintain independence and exercise choice around food and eating. At this inspection pictorial menus were being used to help residents choose what they would like to eat. The chef confirmed that the home could meet the special dietary requirements of residents, including people from ethnic minority communities and gave examples for when this had occurred. The chef also confirmed that the home was providing appropriate meals for people with diabetes and for one resident that needed a soft diet. At the last random inspection the home was cooking and delivering meals to another of the provider organisation’s care homes situated nearby and it was judged at that time that this was not acceptable. We were told that this was a very temporary arrangement as the other home had recently admitted two residents following a period where that home had been closed for refurbishment. At this inspection it was seen that this arrangement was no longer in operation. Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has satisfactory procedures for dealing with concerns and complaints although was not able to demonstrate that a complaint made to the home had been properly investigated to ensure that residents’ and others were being properly protected. Residents are protected by the home’s safeguarding adults policy and procedures that the registered manager and staff are familiar with EVIDENCE: The home has a clear complaints procedure that was seen, including being displayed in the home. At the last key inspection a requirement had been made that all complaints made whether verbal or formal written; or expressions of concern or dissatisfaction, are recorded in the complaints log. This will ensure that any trends are identified and residents and their relatives can be confident that their complaints are listened to and will be acted upon. At this inspection it was noted that the home had introduced a “Concerns and Niggles” book, which was available in the entrance hall of the home, to assist with this. However, the only complaint or concern that had been recorded at the home since the last key inspection was in relation to a bruise on a resident Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 18 and it was not clear who had made the entry. The registered manager had recorded in the complaints book that the family of the person involved had been informed and that an accident report had been completed. The latter was confirmed by an entry in the accident book that was seen at this inspection although this still did not give very much detail about how the incident was dealt with. It was clear that the home’s complaints procedure had not been properly followed in this case, as there was no record of how the complaint was investigated or of a formal response under the complaints procedure to the person that had recorded the complaint and/ or to the family. The manager and the Chief Operating Officer were concerned about this although unable to provide any further information as neither of them were involved with the home on the date shown on the complaint record. A requirement is made that the home’s complaints procedure is followed in full whenever a complaint or concern is recorded and that an investigation must take place to ensure that the identified complaint was properly dealt with, any further action that is necessary is taken to conclude the investigation and that records are available for inspection records to evidence this. Relatives spoken to stated that they were confident that the home would take seriously and act on any concerns or complaints that they made. No complaints had been made to the Commission since the last inspection. The home had a satisfactory safeguarding adults procedure that was seen and also had a copy of the L.B. of Waltham Forest’s safeguarding adults procedure, the local authority in which the home is located. This procedure was seen on display in the entrance hall to the home. At the last key inspection a requirement was made that training in safeguarding adults is extended to all staff working in the home, including, ancillary staff to ensure that there is a proper response to any suspicion or allegation of abuse. At this inspection evidence was seen that ancillary staff as well as care staff had undertaken this training and the chef confirmed this. The manager and staff that were spoken to independently were able to describe appropriately the actions that would need to be taken if an allegation or disclosure of abuse was made. One safeguarding allegation had been made to L.B. of Waltham Forest since the last key inspection and evidence was seen that this had been properly dealt with under that authority’s procedures. No other safeguarding issues were recorded at the home or have been made to the Commission since the last key inspection. Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 & 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is well decorated, well furnished, well maintained and that generally meets their needs. However, improvements are needed to keeping residents safe when they are in the garden, to where equipment is stored in communal areas of the home and to maximising residents’ ability to keep their private possessions safe. The home was clean and tidy throughout and generally created a pleasant environment for people accommodated, staff and visitors. However, further work is needed to minimise risk to staff when using the basement. EVIDENCE: Accommodation provided is in single rooms, and all have en suite facilities except two, which are an adjacent to bathrooms/ toilets. There is a main Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 20 lounge/ dining room, a smaller lounge and conservatory on the ground floor, and a stair lift to the first floor that contains further bedrooms, shower and toilet facilities. The home has a large pleasant rear garden. At the last inspection requirements were made to ensure that the building better met the needs of people with dementia. These included to provide more appropriate signs and colour coordination and to move some items, including the medication trolley, staff desk, the home’s aquarium and to relocate the home’s laundry facilities, to more suitable locations. At this inspection these requirements were seen to have been complied with. During a tour of the building at this inspection a number of residents bedrooms were seen that were comfortable, well furnished and had been personalised to meet the persons wishes and preferences. At the last key inspection it was noted that all the bedrooms had call bells to summon assistance although the pull cord was missing from some of these and a requirement made about this. At this inspection there were pull cords to all the call bells seen and the manager stated that these were all in place throughout the home. It was noted during the tour of the building that residents did not have a lockable space in their rooms to keep personal possessions secure. It was also noted that although bedroom doors had locks none of the residents had a key to their room and there was no record of how this decision was made. A requirement is made that all residents have a lockable space available to them in their bedrooms to assist them keep their possessions safe, unless the reason for not doing so is explained in their care plan, including how this decision was made. The home must also offer residents a key to their bedroom unless the reason for not doing so is explained in their care plan, again, including how this decision was made. This is to ensure that the home can demonstrate that residents are being given as much control as they can manage regarding their day-to-day lives. The building was generally well decorated, well maintained and met the needs of people living in the home. It was noted that a communal bathroom and toilet were in need of repainting and the manager stated that arrangements for this work to be undertaken were in place by the home’s handy person. It was also noted that the first floor shower was not working and we were told that it had not been working for a number of weeks. A requirement is made regarding this. During the tour of the building it was also noted that a wheelchair was kept on each landing and a hoist was also kept in a communal area. A requirement is made that the home reviews where wheelchairs and the hoist are stored to minimise any possible health and safety hazard to residents and staff. The large rear garden was well kept and provides a pleasant environment for people to use when the weather is fine. However, it was noted that the fence on one side of this was in poor condition generally and was quite low. We were told that there have been occasions when residents had climbed this fence and Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 21 also that a resident attempted to climb the side gate on the other side of the building. A requirement is made that the garden area must be made more secure to better protect people with dementia who may try to leave the garden unsupervised. At the last key inspection two requirements were made about the location of the laundry facilities in the basement and the steep staircase that led to these facilities, which were deemed to be a health and safety hazard when the laundry facilities were being used. An immediate requirement notice was also issued at that time for a suitable lock to be placed on the entrance to the basement to better protect residents, as the door was not locked when staff were working in the basement. By the end of that inspection the immediate requirement notice had been complied with and at this inspection the two other requirements had been complied with including the laundry having been moved to the ground floor at this inspection. However, the basement is still used by staff to access the staff room and other staff facilities and the staircase remains a potential health and safety hazard. A requirement is made that a risk assessment is undertaken regarding staff using the staircase to the basement and any required action to minimise any potential risks is undertaken to maximise protection to staff when using these stairs. The relocated laundry facilities were seen to be satisfactory to meet the needs of the residents. The home had satisfactory infection control procedures that staff spoken to were aware of, was free from offensive smells and was clean and tidy throughout the inspection. Although a number of requirements have been made in this section of the report our overall judgement is that the environment of the home provides good outcomes for the current residents. Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A staff team with a range of qualifications and competencies, in sufficient numbers, support people living in the home. However, staff and people living at the home may also benefit from further staff training relating to recent legislation regarding people’s ability to give informed consent. People living at the home are protected by the home’s effective recruitment procedures. EVIDENCE: At the last inspection a requirement was made that staff are employed in sufficient numbers and mix as are appropriate for the health and welfare of residents. This was to include a review of the ancillary tasks being undertaken by care staff. This requirement had been complied with. At this inspection it was seen that staffing numbers working during the day time had been increased to three care staff working combined morning and afternoon shifts. Previously there had been two care staff on the morning shift and three on the afternoon shift. The home continues to have two waking staff at night. The home has also reviewed the domestic and laundry hours to better meet the needs of the residents. However, care staff spoken to independently stated that it could still be very busy for them on the days at the weekend when the Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 23 cook was not on duty. It is noted in the Daily Life and Social Activities section of this report that the registered provider is planning to employ an activities Coordinator to further enhance staff capacity to meet people’s needs. The home’s rota was seen and accurately reflected the staff on duty during this inspection. At the last key inspection a requirement was made that care staff employed to work in the home must receive training appropriate to the work they are to perform, including support to enrol and obtain further qualifications, for example national vocational qualifications. At this inspection evidence was seen that of the thirteen care staff employed six had achieved national vocational qualification (NVQ) level 2 in care and another four were working towards this. This meets the national minimum standard that at least 50 of care staff have achieved this qualification. The staff files of two staff appointed since the last random inspection were inspected. These files contained, an enhanced criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check, a clear application form, two references, proof of identity with a photograph and evidence of entitlement to work in the UK where appropriate. One of these staff members was spoken to independently and confirmed that the checks were taken out before they started work at the home. The manager and chief operations manager were clear about the importance of operating a robust recruitment procedure to maximise protection to residents. At the last key inspection a requirement was made that all staff working in the home receive comprehensive and accredited training in caring for people living with dementia. This was to ensure that staff are equipped with the relevant specialist skills and knowledge. At this inspection evidence was seen in individual staff training profiles seen that this had been complied with. Staff spoken to independently confirmed this and that they had found the training useful. Evidence was also seen from the training profiles that the provider organisation provides regular training for staff and recent training has included: infection control, fire safety, food hygiene and chemicals or substances harmful to health (COSHH). The home is registered to provide care to people that have a diagnosis of dementia. It was noted during the inspection that staff in the home have not received training on the practical implications of the Mental Capacity Act 2005, which came fully into effect on 1st October 2007. This legislation is particularly relevant for assessing whether people accommodated have the capacity to give consent or make decisions about a range of areas that affect their lives and how this should be evidenced in the documentation kept by the home. An example of this is referred to in the Environment section of this report regarding people having access to keys to lockable spaces in their bedrooms and to their bedroom door. A good practice recommendation is made that manager and staff should receive training on the Mental Capacity Act 2005 and Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 24 how this legislation should be practically implemented in the home for the benefit and protection of both residents and staff. Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. More robust input is needed by the provider organisation to ensure that residents’ benefit from a consistently well managed service when changes to existing management arrangements in the home are needed. People living in the home and other stakeholders are consulted regarding the quality of the service the home provides to help the ongoing development of the service. People’s financial interests are safeguarded while living in the home although further work is needed to ensure that the best interests of one resident is being maximised. Staff receive regular supervision to assist them meet the needs of people living in the home and to assist in their own development. The home has a range of effective health and safety procedures in place that helps to protect people living there, and others that work or visit the home. Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 26 EVIDENCE: The registered manager was on maternity leave at the time of this inspection. A manager from another of the provider organisation’s registered residential homes has been managing the home since March 2008 to cover for this maternity leave. The current manager has a range of care and management experience and presented as being knowledgeable about the needs of older people with a diagnosis of dementia. The manager acknowledged that she was still getting to know the residents and their families in more detail but stated that she was receiving excellent support from the staff and also from other managers within the provider organisation. Staff and other people spoken to throughout this inspection talked highly of the current manager and her management style. However, although the current manager is employed at the home on a temporary basis it is still necessary for the home to have a manager that is registered with the Commission to formally evidence that they have the required experience, knowledge and skills to do the job. A requirement is made regarding this. Although evidence was seen that the current manager is working hard there are particular issues identified in this report that we think are disappointing and originate from before the time that she arrived at the home. These include the need for more robust risk assessments to inform care plans and the need to be able to evidence that complaints are dealt with robustly. The provider organisation undertakes monthly-unannounced visits to the home as part of the quality monitoring arrangements that are required by legislation. We consider these visits to be especially important when there are temporary changes of manager, to help ensure continuity in the provider organisation’s management responsibility for the home and to support the current manager to settle into the home. Reports of these visits were sampled and indicated that key documentation was sampled during these visits as well as seeking feedback from residents, staff and any visitors. It is therefore disappointing that the shortfalls identified in risk assessments/ care plans and the way that the only complaint received at the home since the last inspection was recorded was not picked up during those visits. This was discussed with the chief operations manager and manager as part of the inspection feedback. The home does operate other effective quality assurance systems. Satisfaction surveys had been sent out by the current manager in April 2008 to residents, relatives and other stakeholders and those returned were sampled. Feedback was generally positive although some responses had indicated that more activities for residents would be welcome. The manager stated that the responses would be analysed and would contribute to the home’s overall objectives for 2008/ 09. We also spoke to a Contracts Officer from the L.B. of Redbridge that has residents placed at the home and the Contracts officer had recently undertaken a contract review at the home. He stated that the L.B. of Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 27 Redbridge was generally satisfied with the care of their residents at the home and for the Borough to continue to place people there. At the last key inspection a requirement was made that two members of staff sign all entries made in respect of residents’ financial transactions. This is to safeguard both residents and staff. At this inspection this requirement was being complied with. The manager confirmed that the home did not act as appointee for any resident. The records for residents’ personal allowances that the home holds were sampled and were generally satisfactory with money held safely and accurate records kept. It was noted however that the home was holding a significant amount of cash for one resident. A requirement is made that the home liaises with the placing authority and agrees how best to assist the resident manage their finances, including taking into account the best interests of the resident and the residents capacity to make decisions about their finances. The resident is currently not receiving any interest on the money held and this requirement is made both to protect the home and to promote the resident’s best interests. Evidence was seen from staff files inspected and from staff spoken to independently that staff receive formal recorded supervision and staff confirmed that they felt that this was helpful. At the last key inspection two requirements were made to promote residents’ and staff health and safety with regard to the use of the home’s laundry facilities, which were situated in the home’s basement at that time. These are described in the Environment section of this report and both had been complied with although a further risk assessment is required in the Environment section of this report as staff are still using the basement. A range of satisfactory health and safety documentation was seen during this inspection including: a current electrical installation certificate, a gas safety certificate, a portable appliance certificate and evidence that the home’s water supply had been inspected to minimise the risk of legionella. Evidence was seen of a fire officer’s visit to the home in February 2008 and a letter from the fire officer confirming that the home met the current requirements at that time. The home’s fire log was also satisfactory showing evidence of appropriate checks and fire drills. Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 2 2 X X 2 X 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 2 X 3 X 2 3 X 2 Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 OP3 OP7 Regulation 14, 15 Requirement The registered persons must ensure that as much information as possible is sought and recorded about the life history, life experiences and what has been important to residents with dementia during their lives. This is to assist staff in judging how to best meet the wishes and preferences of those people, who may not be able to tell staff about these areas when they are admitted to the home. The registered person must ensure that robust risk assessments, which are meaningfully reviewed on a regular basis, contribute to informing people’s care plans. This is to ensure that staff have clear and up to date information and guidance on how to minimise identified risks to maximise protection to people living in the home. The registered person must ensure that controlled drugs are stored in a controlled drugs cupboard that meets the current specification that is set out in DS0000058844.V362622.R01.S.doc Timescale for action 30/06/08 2. OP7 13(4) 31/05/08 3. OP9 13(2) 01/08/08 Manor II Version 5.2 Page 30 4. OP12 16(2)(n) 5. OP16 22(3)(4) 6. OP20 13(4) recently amended regulations re safe storage of medicines. This is to maximise protection to residents and staff. The registered persons must 30/06/08 ensure that a varied and personalised range of social and leisure activities and opportunities are available for all residents, both inside and outside of the home, and that clear records are kept of the activities that each resident is offered and the activities that they have taken part in. This is in order to meet people’s individual needs and preferences in a meaningful way with regard to activities provided by the home. (Previous timescale of 30/09/07 not met) 31/05/08 The registered persons must ensure that residents are properly protected by the home’s complaints procedure being followed in full whenever a complaint or concern is recorded and that an investigation must take place to ensure that an identified complaint was properly dealt with, any further action that is necessary is taken to conclude the investigation and that records are available for inspection records to evidence this. The registered persons must 31/05/08 review where wheelchairs and the hoist are stored to minimise any possible health and safety hazard to residents and staff. The registered persons must ensure that the garden area is made more secure to better protect people with dementia who may try to leave the garden DS0000058844.V362622.R01.S.doc 7. OP20 13(4) 31/05/08 Manor II Version 5.2 Page 31 8. OP21 23(2)(j) 9. OP24 16(2) 10. OP31 9 11. OP35 12(2) 12. OP38 23(3) unsupervised. The registered persons must ensure that the first floor shower is working properly to maximise the comfort and well being of residents. The registered persons must ensure that all residents have a lockable space available to them in their bedrooms to assist keep their possessions safe, unless the reason for not doing so is explained in their care plan, including how this decision was made. The home must also offer residents a key to their bedroom unless the reason for not doing so is explained in their care plan, again, including how this decision was made. This requirement is made to promote the dignity and independence of residents. The registered person must ensure that an application is received by the Commission to register a temporary manager for the home in the absence of the registered manager, to verify that the temporary manager has the required skills and knowledge to undertake the role. The registered persons must ensure that the home liaises with the placing authority for an identified resident and agrees how best to assist the resident manage their finances, including taking into account the best interests of the resident and the residents capacity to make decisions about their finances. This is to ensure that the resident’s financial interests are safeguarded. The registered persons must ensure that a risk assessment is undertaken regarding staff using DS0000058844.V362622.R01.S.doc 31/05/08 31/05/08 31/05/08 31/05/08 31/05/08 Manor II Version 5.2 Page 32 the staircase to the basement and any required action to minimise any potential risks identified is undertaken to maximise protection to staff when using these stairs. 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 OP30 Good Practice Recommendations A good practice recommendation is made that registered manager and staff should receive training on the Mental Capacity Act 2005 and how this legislation should be practically implemented in the home for the benefit and protection of both residents and staff. Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Manor II DS0000058844.V362622.R01.S.doc Version 5.2 Page 34 - 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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