Inspection on 07/10/08 for Manor Mews

This inspection was carried out on 7th October 2008.

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

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

Other inspections for this house

Manor Mews 01/11/06

Manor Mews 16/01/06

Manor Mews 22/08/05

Manor Mews 24/01/05

Manor Mews 02/07/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Manor Mews Manor Mews Cowick Lane Exeter Devon EX2 9JG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Teresa Anderson     Date: 0 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Manor Mews Cowick Lane Manor Mews Exeter Devon EX2 9JG 01392438048 Telephone number: Fax number: Email address: Provider web address: sally.cross@talktalk.net Name of registered provider(s): Name of registered manager (if applicable) Mrs Sally Ann Cross Type of registration: Number of places registered: Mrs Sally Ann Cross care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: On the termination of the placement of either of the named service users, the registered person will notify the Commission in writing and the particulars and conditions of this registration will revert to those held earlier The maximum number of persons accommodated at the home, including the named service users, will remain at 10 To permit two named persons outside the categories of registration being over the age of 65 to remain in the home Date of last inspection Brief description of the care home Manor Mews provides accommodation and care for up to ten adults who have a learning disability. The majority of people who live at the home have lived here for over 10 years. The home is situated close to the town centre. Bus stops are close by giving easy access to the city and surrounding areas. The owner lives on site and provides transport for outings and when needed. The home is a detached Georgian Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 10 Brief description of the care home style property that stands in large well maintained gardens. The building is decorated in a homely manner with contemporary furniture and fittings. Information about this home, including reports, is available direct from the home. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place as part of the normal programme of inspection. It started at 12.00pm and finished at 4.30pm. We last inspected this service in November 2006. During the inspection we (the commission) spoke with or observed all of the 10 people whose home this is. The majority of these people have some degree of communication disability so it was not always possible to get their views on this service. We looked closely at (case tracked) the care and accommodation offered to 3 people living here, including people with communication difficulties. We did this as a way of helping us to understand the experiences of the people who live here. We spent time Care Homes for Adults (18-65 years) Page 6 of 28 observing the care and interactions between staff and people. We spoke with the owner/manager and with 2 of the care staff. Records in relation to care planning, residents monies, staff training, staff recruitment and safety were inspected. Before the site visit surveys were sent to all the people who live here and all were returned. We also sent surveys to some staff and these were returned; and to some health and social care professionals who have contact with the home and none were returned. Feedback contained within these surveys is included in the report. In addition to the above the owner provided us with comprehensive information in the Annual Quality Assurance Assessment that we asked her to send us. Information about fees related to this service are available direct from the service. What the care home does well: What has improved since the last inspection? What they could do better: During this inspection we found that the home has a homely medicines policy. This means that people can have over the counter medicines for those aches and pains that do not need the attention of a doctor. However, whilst the medicines on this list have been approved by the Primary Care Trust, they have not been approved by each Care Homes for Adults (18-65 years) Page 8 of 28 persons GP as they should be. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who come to live here can be assured that the staff will have a good understanding of them and what their needs and desires are. Evidence: The people who live at Manor Mews have lived here for a long time. The most recent admission was nearly 6 years ago. In surveys all the people living here say that they had wanted to move into this home and that they had enough information about the home before moving in. It is anticipated that the current group of people living at the home will not change. However, staff describe how they would help people to get to know the home and the other people living here, in order to help them make a decision about where to live. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here have a plan of care that ensures staff understand each individuals needs and how these should be met. People are helped to make decisions about their lives and how they live them and this includes managing and taking risks. Evidence: Each person living at the home has a plan of care. This gives details of their physical, emotional and social needs and describes how each person likes to have these needs met. Each plan is goal orientated and records show that these goals are reviewed regularly. Staff demonstrate a good understanding of the people who live here. They were overheard offering choices about food, what to wear and helping one person to come to a decision about what to do next. Records show that people are involved in making decisions about their lives. One Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: person we spoke with told us the effect this had had on their life. For example they look after their own monies, have a job and go out and come back when they like (within reason). Another person we spoke with also enjoys going out when they like. As this person gets older and their memory deteriorates, staff talked of the balance they have to reach between trying to ensure this person is safe whilst allowing them to take risks which enhance their quality of life. Records show that frequent risk assessments are undertaken and this person told us that they do not feel that their freedom to go out is restricted. Some people need help with managing their monies. There is a system in place for recording this. As one of the people we casetracked manages their own monies, we looked at the other two accounts. We found these to be in order. All monies are kept securely, recorded and receipts are kept. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here experience a lifestyle that enhances their quality of life. The rights of people who have disabilities are protected and promoted by the staff and the ethos of the home. People benefit from a diet that is varied, nutritious and which is enjoyed. Evidence: We spoke with two people about how they spend their days. One person told us they come and go as they please, that they have a job and that they enjoy the clubs they belong to. Another told us that they enjoy gardening and meeting with people and that they do this. This person showed us a selection of the many photograph albums they have recording their activities. We observed the third person we case tracked as they could not talk with us. This Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: person has limited mobility. They enjoy watching DVDs and listening to music. This person has headphones which means that they can enjoy their DVDs and music without disturbing anyone else. Records demonstrate that activities include pottery, craft (such as making necklaces), going into Exeter, going out for trips and to local places of interest. We observed people enjoying a selection of in house activities throughout the day. One person told us of the holiday they are going on and another showed us how they are helped to enjoy their interest in animals and wildlife. This person keeps gerbils and has a bird. In addition the home employs a drama therapist to come to the home once a week to work with the people who live here. Some people are involved in a home working programme for which they are paid. The amount of work they do is not pre-determined but is decided by each person on a session by session basis. The home has its own transport and this is used to support people to visit their families when needed as well as for outings. During a tour of the home we saw that all bedrooms have locks although people choose not use keys. People say they enjoy the food. Those who could talked about the types of things they like and what they eat. Some people would prefer a much less healthy diet and staff do a good job ensuring there is a balance between choice and nutrition. Staff make recordings regarding nutritional needs and intake. In surveys one person said they would like to be more involved in cooking. This person has very limited abilities. However, this person had been part of the baking session which had taken place on the morning of this inspection. We talked to some people about the routines in the home. They say there tend to be set times for meals, but that if someone is out their meal is kept for them. They say they go to bed when they like and get up when they like (within reason) and that mostly we do what we like. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live here are helped to stay healthy through proactive management. Personal support is offered to people in a way that offers choice and promotes independence. Medicines are well managed, however the policy relating to homely remedies requires changes to ensure these are used safely. Evidence: The people who live here have lived here a long time. As they grow older some people are requiring more support to meet their personal and healthcare needs, whilst others require less support and are more independent. At the moment observation, records and discussion with some people show that the home is managing all these needs well. For example one person shows signs of memory problems. Staff have taken this person to see their GP who has in turn referred them to a specialist. This person is now taking medication to help with this, and records show staff are monitoring its effectiveness. Another person is being cared for in bed as they are recovering from an acute episode Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: of illness. Both the GP and district nurse have been involved in their care. This person is cared for in a specialist bed and on a specialist mattress purchased by the home. They have equipment which helps them to move around the bed and a hoist to help staff to move this person in and out of bed. Although this person does not like the hoist, we observed staff very skillfully negotiated its use with this person to ensure that they are moved safely. Another person is very physically able and has some mental health needs. Staff demonstrate that they manage these needs sensitively and records show appropriate actions are taken when needed. Records also show that people living here see healthcare professionals regularly. These include dentist, GP, optician and chiropodist, and in this way are helped to remain healthy. We looked at how medicines are managed in the home. We found that staff show a good understanding of them and that medicines are kept safely and securely. All records are up to date and accurate. The home uses a monitored dosage system and staff receive training in how to manage this. We noticed that those medicines that are approved to be used as homely medicines((such as paracetamol) have not been approved by each persons GP. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here are protected from harm and can be sure any grievances will be listened to. Evidence: In surveys all respondents say that staff always listen to them, that they know who to speak with if they are not happy and that staff treat them well. Some say they would speak with their key worker and named this person. Neither the home nor the commission have received any complaints about this home. Staff are trained in safeguarding adults. They watch a video produced by the Department of Health and many have attended training sessions organised by the local authority. They demonstrate a good understanding of issues related to abusive practice and know who to tell, both inside and outside the home, if this happened. Observation of interactions between staff and residents show mutually respectful and relaxed relationships. One person living here said its instant dismissal if staff hit someone. When asked if Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: this had ever happened, this person said no. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live here enjoy an attractive, clean and homely environment. People are provided with specialist equipment if needed. Evidence: The home is well decorated and maintained. It is clean throughout and people, in comment cards, say it is always clean and fresh. Staff showed us how clinical waste is dealt with and this is appropriate. People living here do not do their own personal washing. This is cared for by staff in a dedicated laundry. One bathroom has been converted into a wet room to ensure that the needs of all the people living here, including those with mobility problems, are met. In addition the home has other equipment such as hospital beds, specialist mattresses, a hoist and a bed riser to support those people who are less mobile. Although the lounge has steps to it and cannot therefore be accessed by those who use wheelchairs, the owner reports that she would put a ramp over the steps if this were needed. One person who uses a wheelchair told us they like to sit in the Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: lounge/diner or their bedroom. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living here benefit from an experienced and well trained workforce who are recruited using robust methods which helps to keep people safe. Evidence: During this inspection the owner/manager was on duty with 2 members of staff. The duty rota shows that this is the usual staffing level. At night there is a waking member of staff on duty and the owner/manager acts as the sleeping member of staff. In surveys staff say they know who to contact in an emergency and what to do if a peoples needs change. Staff also say they receive clear instructions about what they are expected to do and about each residents needs. People who could tell us say they like the staff and that they help us. We looked at three staff files and found that staff working at this home are employed after appropriate police and other checks are undertaken. These include taking two written references, obtaining proof of identity and having a well completed application form where any gaps in employment are identified and reasons recorded. Induction records show that this initial training is based on the Learning Disability Award Framework (LDAF) as is good practice. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Other training is undertaken to help staff develop the skills needed to meet the needs of the people who live here. This has included Epilepsy training and training in the Mental Capacity Act. 2 of the 8 staff have attained a National Vocational Qualification (NVQ) in care at Level 2 or above, and 2 other members of staff are studying to gain this qualification. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is well managed, is safe and is run in their best interests. Evidence: The owner of this home is also the Registered Manager who manages the home on a day-to-day basis. She is qualified in care and management to National Vocational Qualification (NVQ) Level 4 and holds the Registered Managers Award. Staff say they find her approachable and helpful and that the home has a nice atmosphere. She keeps up to date with best practice through additional training and reading. In addition, and in order to ensure her practice is monitored and improved, she has monthly coaching/supervision sessions from a person qualified to do this. The AQAA, providing information about this home, was sent to us when we asked for it and was comprehensively completed giving us a lot of information about the home before we visited. In the AQAA the owner reports that appropriate maintenance checks and contracts are Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: in place for systems such as heating and electrics. Appropriate fire checks take place and staff demonstrate a good understanding of this. They also demonstrate a good understanding of the residents’ lack of understanding around fire drills and they know what to do to compensate for this. Risk assessments of radiators have resulted in all radiators being covered and thermostatic valves being fitted to the hot water bath tap to prevent scalding. Window restrictors are in place where needed. Staff receive appropriate training in manual handling, fire safety, first aid, food hygiene and infection control. The manager carries out annual quality assurance checks asking for feedback from people living here, from relatives and from health and social care professionals. This has not resulted in any changes to the way the home is managed. The manager has acted on all the recommendations from the last inspection. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 20 32 Any homely remedies used for people should be approved by each persons General Practitioner. Work should continue towards ensuring that 50 of the care staff are qualified to NVQ Level 2 or above. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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