Inspection on 08/06/06 for Manor II

This inspection was carried out on 8th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 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 01/05/08

Manor II 04/06/07

Manor II 09/11/06

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 Kristen Judd Unannounced Inspection 8th June 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Manor II DS0000058844.V292239.R01.S.doc Version 5.1 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 www.aermid.com Aermid Health Care Limited Mrs Ruta Starkute-Nahani Care Home 20 Category(ies) of Dementia - over 65 years of age (20) registration, with number of places Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th September 2005 Brief Description of the Service: Manor II is registered to provide care for up to 20 elderly people with dementia, both male and female. At the time of inspection there were 11 residents in the care home. Accommodation comprises 14 single bedrooms and three doubles, a lounge, dining room and conservatory, which is also the designated smoking area. The home is situated in Leyton with good transport facilities to local shops and amenities. Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced took place from 9.30 am to 8.00pm. This inspection follows up requirements from the unannounced inspection held on.30th September 2005 The inspector spoke with service users, staff and the acting manager who joined the inspection at 11.30 am .A tour of the environment was undertaken and samples of records were examined. There have been 23 requirements and 3 recommendations made following this inspection. An unannounced inspection gives the Commission an opportunity to assess the home against the National Minimum Standards applicable to the service without the home having notice of the visit. A number of requirements were made at the last inspection 7 of which have not been met and have been restated in this report with a new timescale for compliance. Unmet requirements impact on the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. Verbal feedback was given to the acting manager. The inspector wishes to thank the staff and service users for facilitating this unannounced inspection. A feedback card was left for completion. What the service does well: What has improved since the last inspection? What they could do better: Assessment and care planning must improve so that staff know what to do for each resident to meet their individual needs. General recording is also a concern. Risk assessments must be accurate and clearly indicate to staff how Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 6 to minimise risk and provide clear guidance when dealing with challenging behaviour. There are concerns with regard to competency of staff. Given the content and concerns raised in this report the registered person must maintain a thorough system for monitoring and improving the quality of care provided in the care home as a matter if urgency. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3 ,4 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service user guide for the home requires further clarification to provide accurate, up-to-date information for prospective residents or their representatives about the services provided. The contracts must be agreed and signed by all service users. EVIDENCE: The service user guide was examined however as stated in the previous inspection many of the documents are now being separately produced and are available in the home this means that the service user’s guide does not include all the information such as the qualifications and experience of the proprietor, registered manager and the experience of staff; this information is within the statement of purpose. The document also does not include a summary of the complaints procedure or service users’ views of the home and the terms and conditions of the home. These are important issues for service users. The document does make Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 9 reference to these issues however the National Minimum Standards clearly state that this information must be included in the guide. Individual records are kept for each of the residents; records for the service user who was admitted on 27/5/06 were inspected. This was a privately funded placement and as such the pre admission assessment should be comprehensive and contain all elements of standard three of the National Minimum Standards. Through the tracking of care it was noted that the admission form contained some basic information however there was concern at the lack of information that was missing for example the resident profile was blank. Information with regard to mental condition and cognitive skills only stated ‘confused Alzheimer’s’. The file contained an in complete care plan, no risk assessment and no evidence of a signed contract in place. A second service users file who was admitted on 1/11/05 indicated concerns regarding appetite however the pre admission assessment lack information on other issues such as mental health and personal care needs. Another service user who was admitted on 7/12/05 file was examined as there had been concerns about this being an inappropriate placement. The inspector noted that there was little information to support a comprehensive assessment prior to admission. Although information from the previous placement clearly indicated that there had been serious behavioural issues and that the service users was very demanding. There was no evidence that these issues were discussed to demonstrate how the service users needs were to be met. One the day of inspection there was a new admission, the service users family were given a contract to sign. The inspector spoke with the family and it was clear that they did not wish to sign the contract without being able to fully read and comprehend the document. They were about to leave the home when it was brought to their attention that the document needed signing. It is recommended that service users and their families be given blank documentation prior to admission to allow time to comprehend such an important document. The home does not provide intermediate care. If, at a future date, the registered provider should wish to provide such care, consideration would need to be given to staffing levels, appropriate staff training and the provision of dedicated space for this purpose. Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,&10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans cover basic needs and require further improvement to provide a comprehensive and consistent document. Risk assessments must be in place and adhered to with clear strategies in place so that service users and staff are not put at any undue risk. It was the inspectors view was that medication was not being accurately administered; the current practise and lack of adequate recording puts service users at risk. EVIDENCE: There are care plans in place for service users, which contained information to enable staff to meet some of the needs of service users. The plans indicate the assessed needs and the action required. The inspector was informed that the care plan format was in the process of being further developed to make accessing of information clearer. The inspector raised concern at the inconsistencies in the care planning and information available on service users files. For example a service user with challenging behaviour recorded under mental health condition as ‘good very alert’ and emotional condition ‘stable no concerns’ however information Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 11 provided by the previous placement stated ‘Mrs. X has a history of disruption which manifests itself in having absolutely no regard to other feelings’ There was in-depth information provided by the previous placement about the service user, how she responds to others, behaviour and reacting to stressful situations. None of this crucial information was transferred to the service users care plan. The inspector tracked the incident records and found several incidents had occurred in recent months. It is regrettable that further tracking failed to evidence any evidence of evaluation following incidents and there was no indication that the care plans or risk assessments being updated following physical incidents involving staff. Such information is crucial for the service to revise its guidelines and develop strategies for staff working with the service users. It was the inspector’s view that the care plans generally lacked a focus on the strengths of the service uses. When working with service users with dementia this is crucial to enable staff to develop a holistic package of care. Inconsistencies were noted in recordings, they were not all up to date and did not accurately reflect the service user needs or the care provided. For example one care plan was cross-referenced with information provided by the local authority. Relevant information such as medical and mental health was not transferred to the care plan .The service user also had a history of suffering from depression, anxiety and moods swings such information should be taken into account when developing a plan of care. This service user due to poor appetite was prescribed a food supplement daily. This information was not entered on to the care plan. A requirement was made in the previous inspection with regard to recording instructions given from health professional this therefore remains and outstanding issue. Through the tracking of care it was clear that the service user had suffered a weight loss of six kilos over six months. However the care plan indicated only two evaluations/reviews one in January 2006 and one in April 2006, which reflected no change. The evaluations must accurately reflect any changes in service users needs and service users must be updated to reflect those needs. Additionally inaccuracies were noted in issues such as the dietary needs of the service user, which indicated that West Indian food to be served at least three times a day. The inspector queried that this should read weekly. On discussion with staff the inspector was informed that cultural meal for this service user are actually served weekly. Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 12 The inspector cross-referenced aspects of the care plans with risk assessments. There was evidence of basic issues being assessed such as moving and handling. However consistencies were noted in the assessments. Through the cross referencing and tracking of care errors were noted such as indicating that that a service user mental state was ‘ comatosed’ however mobility ‘ independent’. Such assessments contradict each other. The same form indicated that the service user was prone to wandering however the form was part completed and not signed or dated. There are further concerns with regard to the risk assessments, they did not relate to the individual behaviours of service users and failed to identify evident risks and those risks that were identified had insufficient strategies in place to minimise harm. This could potentially put staff and service users safety and wellbeing at risk. This therefore remains an outstanding issue. The inspector acknowledges that the organisation is in the process if updating the documentation used to record service users care and needs. Medication is received in blister packs. The inspector checked a random selection of medication supplies service users. One service had no prescribed ‘ Amisulphide’ medication available for four days. Another service user medication records indicated that there was no medication available for two days although the inspector was informed that staff were unaware that extra medication stocks were in the home in another storage cupboard. Prescribed medication that is not available will seriously affect the wellbeing of the service user if not administered in accordance with prescription. Another check was conducted for one service user who was prescribed ‘paracetomol’, the medication stocks were deemed incorrect. A further five random checks were conducted all of which could not be deemed correct as accurate records regarding quantities were not available. On arrival at the care home the inspector noted a service user using the toilet with the door wide open by the main communal area. The inspector spoke with staff and requested that they deal with the situation. The inspector entered the main lounge area returning to hallway some minutes later to find the staff member standing watching the service user with the door still open. The inspector spoke with staff again and suggested a screen be used. The inspector was informed that the service user was frightened to close the door and there were no screens in the home. Following further discussion a female staff member went into the toilet and closed the door. The inspector spoke with the staff member in question and was concerned at the lack of comprehension regarding this situation and the concerns that the inspector had. There were issues raised regarding privacy and dignity at the previous inspection. Staff must become aware of such issues and respond appropriately. Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There was a lack of evidence to show that activities occur on a regular basis. EVIDENCE: Staff take responsibility at present to arrange and facilitate activities in the home. This means that activities can only be offered once staff have finished relevant tasks such as personal care. There were no activities undertaken on the day of inspection. There was also limited evidence on the daily recordings that indicated that any activities were undertaken on a regular basis. The inspector has concerns with regard to staffing levels, which are commented on further later in this report. One of the concerns are that due to staffing levels service users are not given sufficient choice with regard to certain aspects of the day for example what time to get ready for bed. Any limitations or service user choice should be recorded on the service user individual care plan and this should include evidence of the consultation with the service user or a representative. The inspector raised concern following discussion with the acting manager and staff with regard to finding time to undertake activities. There is a budget Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 14 however this is limited and would only fund an outside entertainment once a month. During the inspection the inspector found the noise level extremely high. There was music playing and the television on in the conservatory area and another television in the dinning area. The inspector highlighted this and the two televisions were turned off and old time music put on. The service users all began to sing along and clearly enjoyed this. Later in the day during lunch time the inspector noted that once again there were two televisions on with different channels and the music was on. Staff should be aware that when people need to concentrate on skills such as feeding themselves, activities or simply interacting with others the environment should be calm and peaceful. Apart from the unsettling experience of excessively loud noise service users would not be able to hear verbal prompts from staff. There have been no relative meetings since the previous inspection. The inspector did not have the opportunity to meet with any relatives for feedback on the service provision. At the time of inspection there was no evidence of any community contact this area should be developed. As stated in this report there are issues with regard to staffing levels and as such this will put limitations on service users being given the opportunity to access the community with staff support. The registered person should develop this area in line with service user wishes. Through the discussion with the acting manager the inspector was satisfied that service users are encouraged to deal with their own finances if appropriate or with support by family. Through observations seen during the inspection it was clear that service users are entitled to bring personal possessions with them to personal their own rooms. Menus seen reflected that the breakfast, lunch and evening meals provided were healthy and appetising. The cook was on holiday at the time of inspection, the Head of Care was filling this post. There was evidence of fresh fruit and vegetables. The inspector saw the food storage facilities; fresh, frozen and dry stocks were appropriately stored. Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is a poor. This judgement has been made using available evidence including a visit to this service. There are serious concerns with regard to ensuring the protection of vulnerable adults. EVIDENCE: There are policies and procedures in place for all aspects of complaint handling that states that any complaint will be acknowledged within two days and that any complaint will be investigated, within timescales indicated. The policy also provides guidance for staff if a verbal complaint is received. There is information about how to complain on display in the home. The registered manager is responsible to investigate complaints and concerns that service users, relatives or staff may have. The complaints log was seen however there have been no complaints received since the previous inspection. The acting manager provided the inspector with a copy of the Abuse policy however point four states that the registered manager will ‘decide how the situation should be investigated and what further action is required’. The inspector is concerned that the policy is misleading as government guidance calls for a multi-agency approach in response to allegations of abuse led by the host authority [the local authority within the boundaries of which the home is situated]. It is the responsibility of the host authority to call a multi-agency strategy meeting at which the decision is made as to which agency should carry out the investigation. It is a requirement that the policy and procedure is amended to bring it in line with the above guidance. Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 16 There has been a recently been an allegation made which has been investigated and was unsubstantiated however this allegation was not reported in line with correct Adult Protection procedures. The incident occurred on the 13th May 2006 the acting manager was not on duty and did not return to the home until 17th May 2006. The acting manager was advised of incident on the 17th May 2006, but staff had done nothing in her absence. Additionally the acting manager met with the service user to establish the nature of the incident. The interview took place in a public area with other service users and staff present. This is deemed poor practice. At this stage the host authority or the Commission for Social Care Inspection had not been informed of the allegation. The inspector was informed that all staff had received training on Protection of Vulnerable Adults. However the inspector is concerned with regard to the level of competencies and understanding of the procedure. The inspector spoke with one staff member who had difficulty in responding appropriately. The inspector raised concern with the acting manager, as it was not evident that staff spoken to could comprehend what Adult Protection was even though he had attended training. Service users finances were seen which were being recorded accurately and were deemed correct. Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was well maintained, clean and well furnished. EVIDENCE: The home is situated in a quiet residential area of Waltham Forest and is within easy access of transport links and the local community. The home is within walking distance of some local amenities; there is a garden area and parking available. A tour of the premises was conducted with the acting manager. There is a large conservatory attached to the dining area, which is the main communal area an additional lounge at the front of the house although the inspector was informed that this area is rarely used. Communal areas are comfortably furnished and decorated. At the time of this inspection there were eleven service users placed which provides adequate private and communal areas however as stated in previous Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 18 inspection reports this will need to be monitored to ensure that the home remains suitable for the aims and objectives of the service. There is a concern that there are only two-assisted bathrooms/shower; while this is adequate for the present number of service users this could become a concern if the numbers increase above sixteen service users. The first floor laundry equipment was being moved to the basement and the inspector was informed that this area was to be turned into a walk-in shower. All of the individual rooms seen had been personalised and were comfortable. All of the communal areas and service users bedrooms were of adequate cleanliness and hygiene. There was evidence of appropriate aids and adaptations available for service users including mobility aids and hoists with accompanying slings. The bathrooms have suitable equipment to meet the need of service users. There is a call system throughout the home. There is no lift however there is a chair lift fitted to one of the staircases. There is a laundry facility in the basement. On the day of the inspection the home was clean and free from offensive odours throughout. Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 &30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There have been issues raised with regard to competencies of staff. The homes recruitment process was insufficiently robust. This could mean that unsuitable staff have been recruited to provide care for service users. There are concerns in the report, which suggests that staff levels need to be reviewed to ensure that service users are given choice and that all their individual needs are met. EVIDENCE: As stated in this report the inspector has raised concern with regard to staff competencies for example lack of basic knowledge of adult protection, and ensuring the privacy and dignity of service users is maintained. The inspector examined a file of one particular staff to establish previous experience and training in working with other people. However the staff member had no previous work experience or qualifications in care. A very basic induction checklist had been completed however there was no evidence that the formal induction programme had been completed even though the staff member had been in post since February 2006. The staff member had received only one supervision session in four months. The inspector also raised concern, as the references received did not correspond to the employment history on the application form. Additionally one of the references did not correspond with the reference details on the application form. The inspector was informed that the staff member was on a student visa however copies of this were not available at the time of inspection. Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 20 Through discussion with staff it became apparent that staff are expected to attend training in there own time and do not receive payment for the time. The National Minimum Standards clearly state that staff should receive a minimum three paid days annually. At the time of inspection there were eleven service users in the placement. The inspector was informed that there is two staff on duty between 8.00am and 4.00pm with three staff on duty between 4.00pm and 8.00pm. There are two waking night. In addition there is a cook and domestic support. The inspector was informed that one staff member has National Vocational Qualification Level 2(NVQ) and that eight of the staff team were on the course. This does not currently meet the standard however it demonstrates that staff are activity undertaking the qualification. This will be further assessed at the next inspection. During the inspection there was a situation where the acting manager and the inspector heard a staff member shouting loudly at a service user. The acting manager and inspector proceeded to the top of the first stairway to ascertain the situation. A service user was partway up the stairs with a staff member shouting for her to come down. The language and tone was totally unacceptable. One further investigation it transpired that the service user had wandered out of the communal area and went up stairs unassisted. The service user suffers dementia and is unsteady on her feet. Staff did not know how long she had been missing. One discussion it was clear that unless all the service users are in one area staff find it difficult to monitor movements. The inspector was informed that when the service user left the communal area while one staff was giving medication, and was serving service user with drinks and the third was in the conservatory. As the inspector was conducting the tour of the environment after teatime it was noted that there are three sets of bedtime clothing in the bathroom. The inspector also noted service users were already for bed sitting in the lounge area, the inspector spoke with staff with the acting managers present who stated that service user got ready for bed prior to the night staff coming on duty as there are three staff on duty between 4.00 and 8.00pm.The clothes are gathered together to get service users ready for bed downstairs to save time. This is concerning as it does not provide service users with any choice as to what time they get ready for bed or whether they would like such personal care to be conducted in their own bedrooms. There have also been issues raised in the report with regard the lack of activities being undertaken due to the staff not having the time. Given that this is a home that is registered for dementia the organisation must ensure that staffing levels are maintained at such a level that enable all of the service Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 21 users needs to be met appropriately. Evidence of regular staff meetings was seen although the last one was in March 2006. Relevant issues were discussed such as training issues; the importance of updating care plans (this issue has been raised within this report) laundry issues and staff changing shifts. Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33,34,35,36,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The content of this report, which includes unmet requirements from the last inspection, reflects poorly on the conduct and management within the organisation. EVIDENCE: The registered manager was not present at the time of inspection. The acting manager joined the inspection mid morning from her annual leave and was extremely helpful in facilitating this unannounced inspection. The inspector examined service users monies and petty cash records. Through discussion with the acting manager the inspector was extremely concerned regarding the current arrangements for the manager to access cash on a dayto-day. The acting manager ran in to debit in April 2006, May 2006 and funded the petty cash from her own funds. This appears to be caused by the system in place for managers requesting money and the time that it takes the Head Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 23 office to process. Although the inspector was satisfied that service users do not go with out this is unacceptable practise. The inspector checked monies held in relation to the four service users, all were deemed correct at the time of inspection. Through case tracking inconsistencies with recording were noted and changes in assessed care needs were not transferred to other documentation such as individual care plans and risk assessments. There was evidence of poor recordings for example the inspector tracked the care of one case as the care plan indicated that food take was to be recorded and monitored. Recordings were poor and did accurately reflect actual intake. There are many more examples of poor recording throughout this report. Records regarding incidents were seen however as stated this information did not trigger the care plan being updated or a risk assessment being developed. The inspector as previously stated tracked several incidents, which involved a service user being physically aggressive towards staff. The Commission for Social Care Inspection should have been notified of these incidents. A sample of supervision records was seen during the inspection, one of which was not in line with regulation. The inspector was concerned as this was a relatively new employee with no experience or induction and as such need close monitoring. Standard 37 has scored ‘1’ because, as identified in relevant standards, not all records required were available, up to date or accurate. In particular: Service user Care Plans. Risk Assessments Supervision records Medication Notifications The inspector saw some evidence of certificates and other documentation that was in place to ensure health, safety and welfare of service users and staff. Portable Appliance Test 2/3/06. Fire extinguishers were last checked 6/6/06 Insurance certificate seen was valid until 29/7/06 Stair lift was serviced 15/4/06 Hoists 11/1/06 Electricity 4/6/05 valid for three years. Fire Alarm and emergency lights 6/6/06 Gas was last checked 17/12/05 valid for one year. Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 24 Monthly visits are made to the home and reports were seen for the previous three months. A service user questionnaire survey was completed in January 2006 however there was no evaluation of the outcomes. The inspector raised concern, as it was not clear who had completed the documentation on behalf of some of the services users. If service users require assistance this should be from an independent person so that any issues/concerns raised can be anonymous. During this inspection concerns were noted with the skills and competencies of particular members of staff. Given the content and concerns raised in this report the registered person must maintain a thorough system for monitoring and improving the quality of care provided in the care home as a matter if urgency. Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 25 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 2 2 1 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 1 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 1 3 2 1 3 Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 26 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 OP1 Regulation 5.1 Requirement The registered person must ensure that the Services Users’ Guide to provide accurate up-todate information, to be in a format suitable for the residents and to include all the information listed in standard 1 of the NMS and regulation 5 to the Care Homes Regulations 2001. (Timescale 30/11/05 not met) The registered person must ensure that all service users have a signed contract in place. The registered person must ensure that service user needs are appropreatly assessed prior to admission. The registered person must ensure that following assessment the care home is suitable for the purpose of meeting service users needs in respect of health and welfare. The registered person must ensure that service users care plans accurately indicate all of the assessed needs and how those needs are to be met. Timescale for action 31/08/06 2. 3. OP2 OP3 5 14.1(a) 31/08/06 31/07/06 4. OP4 14.1(d) 31/07/06 5. OP7 15.1 31/08/06 Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 27 6. OP7 15.2 7. OP7 13.4(c ) 8. OP8 13.1 9. OP9 13.2 10. OP9 13.2 11. OP10 12.4(a) 12 OP12 15.2 13. OP18 13.6 The registered person must ensure that the care plans are evaluated and reviewed and updated accurately at least monthly or as service users needs change. The registered person must ensure that risk assessments must be implemented for service users presenting challenging behaviour and indicate preventative measures/strategies for staff. (Timescale 15/11/05 not met) The registered person must ensure that any advice from health professional regarding service user care is accurately recorded on the individual care plans. (Timescale of 15/11/05 not met) The registered person must ensure that all medication is accurately administered and recorded in the care home. (Timescale of 31/10/05 not met) The registered person must ensure that all prescribed medications are available at all times. The registered person must ensure that any aspect of personal care is performed privately to ensure service users dignity. (17/10/05 not met) The registered person must ensure that any limitations or choices made by the service user in respect of their daily living is clearly recorded on their individual service user plan. The registered person must ensure that the adult protection policy and procedure is in line with government guidance on management of allegations of abuse and is available in the home. (Previous timescale of DS0000058844.V292239.R01.S.doc 31/08/06 31/08/06 31/07/06 31/07/06 31/07/06 31/07/06 31/08/06 31/08/06 Manor II Version 5.1 Page 28 14. OP18 18.1(c )(i) 15. OP27 18.1(a) 16. OP27 18.1(a) 17. OP30 18.1(c)(ii) 18. OP30 18.1(c) 19. OP33 24.1 20. OP34 25.1 21. OP36 18.2 22. OP37 37 31/08/05 not met) The registered person must ensure that all staff that are in the care home are fully aware of Adult Protection procedures issues are referred to the host authority and the Commission for Social Care Inspection without delay. The registered person must ensure that at all times staff are present in such numbers that are appropriate for the health and welfare of the service users. The registered person must ensure that all staff are competent to meet the assessed needs of service users. (Timescale of 15/11/05 not met) The registered person must ensure that staff a minimum of three days paid training in line with the National Minimum Standards. The registered person must ensure that all staff undertake induction training in line with the National Minimum Standards The registered person must establish and maintain a system for improving the quality of care provided in the care home. The registered person must ensure that there is a system in place for the accessing of funds, for the day-to-day running of the home. The registered manager must ensure that all staff in the home are appropriately supervisied at least six times a year. The registered person must ensure that the Commission for Social Care Inspection inform of all incidents under regulation 37 of the Care Homes Regulations 2001. DS0000058844.V292239.R01.S.doc 31/07/06 31/07/06 31/07/06 31/08/06 31/08/06 31/08/06 31/08/06 31/08/06 31/07/06 Manor II Version 5.1 Page 29 23. OP37 17 The registered person must ensure that records are maintained accurately and up to date. 31/07/06 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 OP2 Good Practice Recommendations It is recommended that service users and their families be provided with a blank contract prior to service users admission to allow time to read and fully comprehend the document prior to signing. It is recommended that staff further develop activity programmes to provide more choice for service users. It is recommended that the registered person develop the community links in line with service users wishes. 2 3 OP12 OP13 Manor II DS0000058844.V292239.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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