Inspection on 04/06/07 for Manor II

This inspection was carried out on 4th June 2007.

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

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

Other inspections for this house

Manor II 08/01/09

Manor II 01/05/08

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 Ms Gwen Lording Unannounced Inspection 10:00 4 & 14th June 2007 th 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.V340077.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.V340077.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.V340077.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 9th November 2006 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 is in single rooms, and all have en suite facilities except one, which has an adjacent bathroom/ toilet. There is a lounge/ dining room and conservatory on the ground floor, and a stair lift to the first floor. The home is situated in Leyton with good transport facilities to local shops and amenities. 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.V340077.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by the lead inspector, Gwen Lording that took place over one and a half days, 4th June and 14th June 2007. The registered manager was available throughout the visits and for the feedback at the end of the inspection days. This was a key inspection in the inspection programme for 2007/2008. Discussion took place with the manager, several members of care staff and the cook. Care staff were asked about the care that residents receive, and were also observed carrying out their duties. At the time of the inspection there were eleven permanent residents and one resident on a two-week period of respite care. The inspector also spoke to a number of residents and one visiting relative. Where possible residents were asked to give their views on the service and their experience of living in the home. A tour of the premises, including the laundry and main kitchen was undertaken. A sample of residents’ files were case tracked, together with the examination of other staff and home records. This included medication administration, staff rotas, training schedules, activity programmes, maintenance records, menus, complaints, fire safety, accident/ incident records and staff recruitment files. Information was also taken from an Annual Quality Assurance Assessment (AQAA), which was completed and returned by the manager. This is a new self-assessment process, which all providers are required to complete once a year. Additional information relevant to this inspection was also obtained from monthly Regulation 26 reports and Regulation 37, notifications of events. As part of the inspection the views were sought of several local authorities that currently have residents placed in the home, and are commented on in this report. An Immediate Requirement Notice (IRN) was issued with regard to the fitting of a suitable lock to the door leading to the basement laundry facilities. A subsequent follow up visit to the home confirmed that the IRN had been complied with. The inspector had a discussion with the manager and people living in the home about how they wished to be referred to during the inspection and in the report. They expressed a preference to be referred to as ‘resident’. This is reflected accordingly in the report. The inspector would like to thank the residents and staff for their input during the inspection. Manor II DS0000058844.V340077.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Consideration must be given to the environment to best utilise the layout and design to meet the specialist needs of people living with dementia. For example, through the use of décor, visual clues such as colour, signage and the use of familiar things from a person’s previous setting, such as photographs. All staff working in the home must undertake comprehensive, accredited training in caring for people living with dementia, so as to equip them with the relevant skills and specialist knowledge. More work is needed around developing care plans that are more specific with regard to meeting the specialist needs of people with dementia. Manor II DS0000058844.V340077.R01.S.doc Version 5.2 Page 7 The manager was provided with a copy of the Commission’s good practice guidance on Dementia Care Within Care Homes, which includes environmental considerations, approaches to care, effective communication and the promotion of positive practice and the training and development of staff. The registered providers must ensure that staff are employed in sufficient numbers and mix as are appropriate for the health and welfare of residents. This will include a review of the ancillary tasks currently being undertaken by care staff. The registered persons, together with the staff team, should consider how the service could be further developed, so as to achieve good and excellent quality outcomes, as set out in the Commission’s Key Lines of Regulatory Assessment (KLORA’s). Support from the parent organisation in progressing such developments and improvements is vital to ensuring an increased quality if life for people living in the home 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.V340077.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.V340077.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): Standards 2, 3 & 4 People using the service experience adequate outcomes in this area. We have made this judgement using all available evidence including a visit to this service. A pre-admission assessment is undertaken for all prospective residents and care plans are drawn up from the information in this assessment. However, there was limited information recorded as to the specialist dementia care needs of residents. More detail around the individual needs of people living with dementia must be obtained and recorded so that staff understand and are able to meet such needs. The home does not offer intermediate care. EVIDENCE: Individual records are kept for each resident and a number of files were examined, including the records of the most recently admitted resident. All records inspected have assessment information recorded and the information had been used to continue assessment following admission to the home and Manor II DS0000058844.V340077.R01.S.doc Version 5.2 Page 10 develop written care plans. The records showed that residents, where possible, and their relatives/ representatives are involved in the process. Where appropriate, information provided by the placing authority was also included. All resident receive a contract/ statement of terms and conditions which sets out the fees. All records examined had assessment information recorded around the personal and physical care needs of the residents and the inspector was satisfied that such needs were being adequately met and understood. However, very little information was recorded as to the specialist care needs of people living with dementia. More detail needs to be obtained around a person’s existing abilities, such as making a cup of tea, washing up and other ordinary activities of daily life. This should then enable the staff to provide the right level of care to assist the resident to continue to live as full a life as possible, and for as long as possible. This is important element of the assessment process as the home offers to provide a specialist service for people living with dementia. At the initial pre-admission assessment the religion, ethnicity and social/ cultural needs of the individual are being identified to a limited degree. This area needs expanding so that staff understand and are able to meet such individual needs. The majority of the care staff have not received adequate and appropriate training to meet and understand the needs of people living with dementia. Such training would equip all staff with the relevant skills and knowledge required to ensure good quality provision for people admitted to the home, and ensure that their specialist needs will be met. The manager advised that training in dementia care has been identified as a future training need for all staff. The manager was provided with a copy of the Commission’s ‘Policy and Guidance on Provision of Fees Information by Care Homes’. This sets out what information care home providers need to include in the Service User Guide regarding fees and terms and conditions, and is in a format that is easy to understand. Manor II DS0000058844.V340077.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): Standards 7, 8, 9, 10 & 11 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. Residents’ health and personal care needs are set out in individual care plans. The care plans are generally detailed but need to be more specific with regards to the recording of outcomes for residents around the cultural, religious and social care needs of the individual; and the specialist needs of people living with dementia. There are clear medication policies and procedures to follow. However, there are some inconsistencies in the management of medication, which may result in unsafe practices. EVIDENCE: Individual care plans were available for each resident and a total of five residents were case tracked and their care plans and related documentation inspected. The records for these residents were found to be generally detailed, but need to be more specific with regard to the recording of outcomes around Manor II DS0000058844.V340077.R01.S.doc Version 5.2 Page 12 the cultural, religious and social care needs of residents. For example residents religion is recorded but there was no evidence on the care plans as to the impact of a persons religion on the method and type of care provided. Staff need to have knowledge of what a person’s religion means in terms of care and activities. There was very limited information on meeting the specialist care needs of people living with dementia. The quality of care, which is experienced by someone with dementia, can be improved by the way staff use and understand care plans. A comprehensive care plan can only enhance the care experience of a resident living with dementia. The majority of care plans seen tended to plan care in terms of risk, dependency or disability. The assumption that people with dementia cannot do much can lead to dependence of care staff to do tasks that the individual could actually be doing themselves. It is therefore essential that comprehensive care plans be developed, with the assistance of relatives/ friends, to ensure that staff provide the correct level of care. However, one care plan did contain a lot of detail about the level of support needed by one resident to enable her to maintain a level of independence around her personal care needs. This level of detail must be developed in all care plans and throughout all elements of an individuals care. The documentation/ health records relating to wound management; management of diabetes and the most recently admitted resident, were examined. The records for these residents were found to be detailed and being adequately maintained. The District Nursing Service visits the resident with a heel wound and her notes are incorporated into the individual’s care plan. The manager has purchased a blood glucose monitoring machine for a resident with diabetes. This will enable her to monitor the resident’s baseline blood sugar levels and monitor them accordingly with the input/ advice of other health care professionals when required. There was evidence that care plans were being reviewed at least monthly. Records indicated that residents are seen by other health professionals such as optician, dentist, optician, district nurse and GP. There was no evidence in the files of “End of Life” care plans and the importance of developing these was discussed with the manager. Risk assessments are routinely undertaken on admission around nutrition, manual handling, continence, falls and pressure sore prevention; and are reviewed on a regular basis. Records are maintained of nutrition, including weight gain or loss with appropriate action being taken where necessary There are policies and procedures for the handling and recording of medicines. An audit was undertaken of the management of medicines and a random sample of Medication Administration Record (MAR) charts were examined. The following issue was discussed with the manager: Manor II DS0000058844.V340077.R01.S.doc Version 5.2 Page 13 • Hand written entries on MAR charts must be signed and dated by the person making the entry. The entry must also include the source of the information. e.g. GP, registered nurse. Staff talked about and were observed to treat residents in a respectful and sensitive manner. They were seen to be very gentle when undertaking moving and handling tasks and offered explanation and reassurance throughout the activity. They understood the need to promote dignity through practices such as the way they addressed residents and were observed knocking on bedroom and bathroom doors before entering. The inspector spoke to the visiting relative of one resident. Whilst she had expressed concerns about the way the home had previously been managed, she said: “ I am now very satisfied with the care of my husband and I have no concerns. The staff look after him very well”. Manor II DS0000058844.V340077.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): Standards 12, 13, 14 & 15 People using the service experience adequate quality outcomes in this area. This judgement has been made using all available evidence including a visit to this service. Whilst there is a range of general activities, any planned activities are subject to care staff being available to arrange and facilitate such activities. This restricts residents’ choice and does not afford them the opportunity to take part in activities of their choice, and according to their individual interests and capabilities. The meals in the home are well presented and there is always a choice of meal. Residents with dementia may benefit from the use of, for example picture menus, finger foods, small nutritious snacks and more flexible eating times to maintain independence, exercise choice around food and eating and still provide a healthy balanced diet. Visiting times are flexible and people are made to feel welcome in the home so that residents are able to maintain contact with their family and friends as they wish. Manor II DS0000058844.V340077.R01.S.doc Version 5.2 Page 15 EVIDENCE: The home does not employ an activities co-ordinator and care staff are responsible for facilitating and arranging any activities. However, care staff are also involved in undertaking cleaning and laundry tasks. On the day of the visit staff were engaging with some residents, for example playing a board game, looking at pictures in a magazine and talking to a resident. But staff were having to balance this with attending to individuals personal care needs, as well as cleaning and laundry tasks. The registered persons must ensure that activities are provided to meet the needs of the residents, according to their individual interests and capabilities, and that staff are 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. It is acknowledged that some improvements have been made since the last inspection. Additional staff are rostered to undertake the cooking on alternate weekends when the cook is not on duty. One resident is supported to access the local community on a daily basis and this is in line with his particular wishes and interests. However, it is a requirement that the registered providers undertake an urgent review of the staffing levels and roles and responsibilities of care staff to ensure that staff are employed in sufficient numbers and skill mix as is appropriate for the health and welfare of residents. A visit was made to the kitchen and the inspector was able to discuss the storage, preparation of food and menus with the cook. She was fully aware of those residents requiring special diets, for example diabetic diet. She demonstrated a good knowledge and understanding of the importance of well balanced and well presented meals. Fresh fruit is provided each day, which is cut up and served for residents to help themselves to; and is also available on request. Menus were inspected and found to be balanced and a choice is offered each day. Each morning care staff ask residents what they would like from the choices available. Residents living with dementia may benefit from the use of, for example pictorial menus; more finger foods, such as the prepared fruits; small nutritious snacks; and more flexible eating times to maintain independence and exercise choice around food and eating. This area does need to be developed through the provision of pictorial menus or other methods such as making available to residents before the actual mealtime, small portions of the meals so that they can see, smell or touch the food and thereby make a more informed choice. The taking of meals should be an enjoyable experience for all residents, and the manager’s attention is drawn to the Commission’s recent report ‘Highlight of the Day’, that is about food and nutrition within care homes. Manor II DS0000058844.V340077.R01.S.doc Version 5.2 Page 16 The inspector was able to observe the lunchtime meal being served. Meals are served in the lounge/ dining room; the conservatory or residents may choose to eat in their rooms. Some residents remained in their lounge chairs and ate off small tables placed in front of them; though it was not clear if this was through choice. There was a nice atmosphere throughout the meal. Residents were offered a choice of drinks and the meal was pleasantly served to residents by care staff. Staff were on hand to assist individuals when necessary and staff were observed to be offering assistance appropriately and residents were not being rushed. Visiting times are flexible and one visitor commented: “The staff make me feel very welcome – I am always offered a cup of tea to sit and enjoy with my husband”. Manor II DS0000058844.V340077.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): Standards 16 & 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. All complaints made whether verbal or formal written must be recorded to ensure that any trends are identified and that residents and their relatives can feel confident that their complaints are listened to and will be acted upon. Care staff have received training in safeguarding adults. However, this must be extended to include all staff working in the home to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a written complaints policy and procedure and the complaints log inspected indicated that no complaints had been received since the last inspection. In discussion with the manager and inspection of the complaint record maintained, it was evident that only formal written, or serious complaints are being logged. The inspector discussed with her as to what constituted a “complaint” to be logged. This must include verbal complaints via telephone or face to face, and expressions of concern or dissatisfaction with any element of the service. Whilst case tracking the care of residents it was noted that verbal expressions of concern were being reported on in residents ‘Daily Progress Reports’. However, such concerns must also be recorded in the complaints record. This will enable the manager to review the number and nature of complaints made and should be used as part of the home’s quality Manor II DS0000058844.V340077.R01.S.doc Version 5.2 Page 18 assurance procedures in order to improve the service. One visiting relative spoken to said: “I would speak to the manager or one of the girls (care staff”)”. All care staff working in the home have received training in safeguarding adults and this is included in the induction training for all new staff. The manager must ensure that this training is extended to include all staff working in the home, for example ancillary and maintenance staff. This will ensure that there is an understanding and proper response by all staff, to any suspicion or allegation of abuse. Care staff spoken to during the inspection were aware of the action to be taken if they concerns about the safety and welfare of residents. Manor II DS0000058844.V340077.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): Standards 19, 20, 22, 23, 24, 25 & 26 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The physical environment must be improved so as to meet the specialist needs of people living in the home. People with dementia have particular needs with regard to the layout of communal space and associated signage and décor. The design and layout of the physical environment is crucial to aid their orientation and remaining capacity. The registered providers must ensure that there are written policies/ procedures and arrangements in place for the safe working practices of staff in line with all relevant legislation. This will ensure that the health, safety and welfare of staff is promoted and protected. Manor II DS0000058844.V340077.R01.S.doc Version 5.2 Page 20 EVIDENCE: The building was toured by the inspector, accompanied by the manager, at the start of the visit and all areas were visited again later during the day. Some bedrooms were seen either by invitation of the resident, whilst others were seen because the doors were open or being cleaned. All of the bedrooms seen were personalised and were reflective of the occupant’s interests, culture and religion. There is a call alarm system fitted to each bedroom but not all alarms have pull cords attached. The manager has experienced difficulties in obtaining replacement pull cords from the original service manufacturers. However, she has been able to identify another manufacturer to provide replacement pull cords that are compatible with the current alarm system. In the interim the manager is required to identify and put effective systems in place to ensure that residents are able to summon assistance from staff, were such alarms are not accessible to them. There were no offensive odours and generally the home was clean and tidy. The standard of the furnishings and fittings are generally being maintained to an adequate standard. The signage and décor were not appropriate to the needs of residents living with dementia and this needs to be further developed. Toilets had some signage but this was inconsistent and there was no use of colour on the doors of bathrooms/ toilets and en suites to aid identification. As the ability of people living with dementia to communicate with words decreases, the use of non-verbal cues and the environment are important in enabling them to cope better with daily life and aids to their orientation. The home is registered to accommodate people with dementia. Therefore the general environment must reflect good practice guidance on dementia care within care homes. Consideration must be given to utilising the existing design and layout of the home to meet the specialist needs of people living with dementia. For example, through the use of visual cues such as colour and signage. There were no appropriate pictures in the corridors or communal areas. The manager must give consideration to ensuring that there are items of interest for residents throughout the home. These can also be used as points of discussion with residents living with dementia. The physical environment has an enormous impact upon on how the strengths and skills of people living with dementia are supported or not. Changes mentioned above, if implemented, can help to support people living with dementia, and help to maximise independence and minimise confusion In one corner of the main lounge/ dining room there is an aquarium, which could provide residents with a very interesting focal point. However, it is partly obscured by the medicine trolley, which is anchored to the wall adjacent to the aquarium. Next to this is an office desk which staff appeared to be using for Manor II DS0000058844.V340077.R01.S.doc Version 5.2 Page 21 writing reports and storing other home records. Whilst it is acknowledged that space within the home is very limited, the current location of the medicine trolley and the office desk are significantly impinging on the residents’ communal space. It is strongly recommended that a suitable alternative location be identified for these pieces of equipment, that impacts to a lesser degree on residents communal space. The laundry facilities are situated in the basement. At the last inspection a requirement was made for the visible damp problem in this area to be investigated and any required works to be undertaken. This requirement has been complied with. Access to the laundry facilities is by way of a steep wooden staircase with only a short handrail at the bottom end of the staircase and the inspector found it difficult to negotiate this staircase safely. In addition to the hazard and risks associated with negotiating the steep staircase, staff are also required to carry heavy loads of laundry. These are totally unacceptable working practices for staff and the registered providers must, as a matter of some urgency, review these current arrangements. In the interim it is a requirement that the registered providers undertake a risk assessment to ensure safe working practices for staff accessing the laundry facilities. A written policy must also be provided detailing the organisation and arrangements for maintaining safe working practices, in line with relevant legislation. This includes the Health & Safety at Work Act 1974; Management of Health & Safety at Work Regulations 1999; and Workplace (Health, Safety and Welfare) Regulations 1992. In addition it was noted that the door leading to the laundry facilities in the basement was not secure when occupied. This was a potential hazard for residents safety as the door opens onto the steep flight of stairs. An Immediate Requirement Notice was issued for the registered providers to fit a suitable locking facility to the laundry door to ensure the safety of residents. This requirement was subsequently followed up the following day and a keypad had been fitted to the door. There is currently one resident in the home that smokes. The manager has received information and is fully aware of the recent legislation regarding smoking in care homes, which comes into effect on the 1st July 2007. The registered providers must ensure that the smoking environment complies fully with the Health Act 2006, Smoke-free (Premises & Enforcement) Regulations 2006; this is to ensure the health of residents. The manager may also wish to make reference to the Royal College of Nursing (RCN) recent best practice guidance for staff and managers on Protecting Community Staff from exposure to second-hand smoke. This will ensure that there are adequate systems in pace for the protection of staff working in the home. Manor II DS0000058844.V340077.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): Standards 27, 28, 29 & 30 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 home employs staff in sufficient numbers to meet the personal care needs of the residents. However, care staff are not sufficiently trained or skilled to understand and effectively meet the needs of people living with dementia. The staff team is reasonably effective but could be more so with an increased number of ancillary staff and the addition of an activities co-ordinator. EVIDENCE: The levels of care staff were sufficient to meet the personal care needs of residents. Generally the inspector was satisfied that the home has an effective staff team, but has concerns around the ability of this team to always be effective as they should because of the lack of ancillary staff and an activities co-ordinator. The home does not employ a designated person to undertake activities or laundry duties and a domestic is only employed three days a week. Cleaning and laundry tasks are mostly done by care staff and this is to the detriment of time spent with the residents on an individual and group basis. Only a limited number of staff working in the home have received training in dementia awareness. All staff must receive comprehensive and accredited training in caring for people living with dementia, so as to equip them with the Manor II DS0000058844.V340077.R01.S.doc Version 5.2 Page 23 relevant skills and knowledge to ensure good quality care provision to residents. This must be considered to be a priority training need for all staff. Aermid Health Care Limited; as an organisation, employs a workforce from diverse cultures and backgrounds. It was apparent at the time of the inspection that the ethnicity of the staff team was different to that of the people living in the home. It is important therefore that the manager ensures that staff working in the home receive the necessary training in equality issues and valuing diversity, so that the religious, cultural and other needs of the residents can be understood and appropriately met. Throughout the inspection all staff were observed interacting with residents and were seen to be kind, caring and respectful in their approach and attitudes. From viewing staff records and talking to staff, it was evident that arrangements are now in place for staff to receive regular supervision. Information taken from the AQAA completed by the manager states that only 25 of care staff are qualified to National Vocational Level 2 (NVQ or above. However, this low number is reflective of recent staff turnover. The manager is aware of the need for more care staff to be working towards this qualification and is confident that an increase can be achieved. This is one of the improvements detailed in the AQAA that is planned for the service within the next twelve months. A record is now maintained of staff training and records showed that staff have undertaken training in essential areas such as fire safety, manual handling and safeguarding adults. A random sample of the files of the three most recently appointed staff were examined. These were found to be in good order with necessary references, Criminal Records Bureau (CRB) disclosures, and application forms duly completed. Manor II DS0000058844.V340077.R01.S.doc Version 5.2 Page 24 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): Standards 31, 33, 35 & 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 home has had a number of acting managers, which has not provided consistency for residents and staff. There is now a registered manager in post and her management style is to create an open, positive and inclusive atmosphere and this will be to the benefit of the residents. EVIDENCE: The current manager has only been in post since March this year and she was registered with the Commission in late May 2007. She has an understanding of what improvements are needed and the key areas in which the home needs Manor II DS0000058844.V340077.R01.S.doc Version 5.2 Page 25 to further develop. She is improving and developing systems that monitor practice and compliance and is aware that more work is required in this area. Support from the parent organisation in progressing this work is vital to ensuring an increased quality of life for people living in the home. Staff spoken to during the inspection were very supportive of the new manager. The home has had a number of acting managers, which has not provided consistency for residents and staff. The current registered manager holds a registered nursing qualification and is being supported by the organisation to undertake relevant management training. She has also had some training in dementia care, but must undertake further accredited training in this key area to ensure that she is knowledgeable and competent in the specialist care of people living with dementia. The responsible individual undertakes Regulation 26 monitoring visits on a monthly basis to monitor and report on the quality of the service being provided in the home. A copy of the report is sent to the Commission. Currently the manager does not act as an appointed agent for any resident. Residents, financial affairs are managed by their relatives/ representatives. The home has responsibility for the personal allowance of several residents. Secure facilities are provided for the safekeeping of money and valuables held on behalf of residents. A written record is maintained of all transactions however; the manager must ensure that all entries are signed by two members of staff to provide safeguards for both residents and staff. A discussion took place with the manager around the recently introduced Mental Capacity Act 2005, which became effective for those people who do not have family and friends from April 2007, and for everybody from October 2007. It is important that this is discussed with people living in the home, staff and relatives, and that the organisation ensures that staff undertake adequate and appropriate training in this important area. A wide range of records were looked at including, fire safety, emergency lighting, accident/ incident records, hoist maintenance and portable appliance testing (PAT). These records were found to be detailed, up to date and accurate. Manor II DS0000058844.V340077.R01.S.doc Version 5.2 Page 26 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 X 3 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 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 2 2 2 3 2 3 2 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 2 3 2 2 Manor II DS0000058844.V340077.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 OP4 Regulation 12, 14 & 18 Requirement Timescale for action 30/09/07 2. OP4 14 3. OP7 OP11 12 & 15 4. OP9 13 The registered providers must ensure that staff individually and collectively have the required skills, experience and training to deliver the service and care which the home offers to provide to people living with dementia. The registered providers must 31/07/07 ensure that during the initial preadmission assessment the religious, social/ cultural needs of the resident are identified. The registered providers must 31/08/07 ensure that care plans are more specific with regard to the specialist needs of people with dementia and how these needs are to be met, and include End of Life choices and decisions. The registered providers must 04/06/07 ensure that: • All hand written entries on MAR charts must be signed and dated by the person making the entry, and include the source of the information. The registered persons must DS0000058844.V340077.R01.S.doc 5. Manor II OP12 OP27 16(2)(n) 30/09/07 Version 5.2 Page 28 18(1)(a) 6. OP16 22 7. OP18 12 & 18 8. OP19 OP20 OP24 23 9. OP22 23 10. OP27 18(1)(a) ensure 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. The registered providers must ensure 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. The registered persons must ensure that the training in safeguarding adults is extended to all staff working in the home, including, ancillary staff. This will ensure that there is a proper response to any suspicion or allegation of abuse. The registered providers must ensure that the existing layout and design of the home reflects good practice guidance on dementia care within care homes, to ensure that the specialist needs of the residents in the home are being met. The registered providers must ensure that there are effective systems in place for residents to summon assistance from staff, whilst the current alarm system is being made fully operational throughout the home. The registered providers must ensure that staff are employed in sufficient numbers and mix as DS0000058844.V340077.R01.S.doc 04/06/07 30/09/07 30/09/07 04/06/07 31/07/07 Manor II Version 5.2 Page 29 11. OP28 18(1)(c) (i)(ii) 12. OP27 OP30 OP31 18 13. OP35 OP37 16 & 17 Schedule 3 14. OP38 16 & 23 15. OP38 16 & 23 are appropriate for the health and welfare of residents. This will include a review of the ancillary tasks currently being undertaken by care staff. The registered persons must ensure that care staff employed to work in the home receive training appropriate to the work they are to perform, including support to enrol and obtain further qualifications, for example NVQ’s. The registered providers must ensure that all staff working in the home receive comprehensive and accredited training in caring for people living with dementia. This will ensure that staff are equipped with the relevant specialist skills and knowledge. The registered providers must ensure that all entries made in respect of residents financial transactions are signed by two members of staff. This will provide safeguards for both residents and staff. The registered providers must review the access to and location of the laundry facilities to ensure that the health and safety of staff using these facilities are promoted and protected. The registered providers must undertake a risk assessment to ensure safe working practices are in operation for staff accessing the laundry facilities. A written policy must be also be provided detailing the organisation and arrangements for safe working practices, in line with all relevant and current legislation. 30/09/07 30/09/07 04/06/07 31/07/07 31/07/07 Manor II DS0000058844.V340077.R01.S.doc Version 5.2 Page 30 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 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. It is strongly recommended 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. 2. OP19 Manor II DS0000058844.V340077.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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.V340077.R01.S.doc Version 5.2 Page 32 - 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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