Inspection on 04/09/08 for Manor Park

This inspection was carried out on 4th September 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Park 31/07/07

Manor Park 27/04/06

Manor Park 19/10/05

Manor Park 26/04/05

Manor Park 25/11/04

Manor Park 16/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

CARE HOMES FOR OLDER PEOPLE Manor Park 55 Manor Park Lewisham London SE13 5RA Lead Inspector Wendy Owen Key Unannounced Inspection 13:30 4h September 2008 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 Park DS0000025632.V363843.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 Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor Park Address 55 Manor Park Lewisham London SE13 5RA 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 852 2407 0208 297 9963 M & A Care Limited Mrs Sheila Ruby R Naik Care Home 13 Category(ies) of Dementia (4), Mental disorder, excluding registration, with number learning disability or dementia (1), Old age, not of places falling within any other category (13), Physical disability (1) Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 13 persons of whom up to 13 may be elderly, up to 4 may have dementia, up to 3 may be elderly with a physical disability, up to 1 may have mental health problems and be over 55 years, up to 1 may have a physical disability and be over 55 years 31st July 2007 Date of last inspection Brief Description of the Service: Manor Park is a care home providing personal care and accommodation for thirteen people. It is owned by M&A Care Limited. The responsible person has two other partners in the company. The home is located near to public transport facilities at Hither Green and is less than ten minutes walk along a level road to a parade of shops. The home was opened in 1996 and consists of a large detached property set back from the road. There are three storeys and a basement used for staff facilities and some services for the home. There are nine single bedrooms and two sharing rooms. None of the rooms have en-suite facilities. There is a stair lift up one flight of stairs but there is another small flight of stairs to provide access to the first floor and another flight to the two rooms on the top floor. These rooms are no longer in use as it was recognised that they were difficult to access. There is an extensive garden to the rear of the building. The current range of fees for the home are £420-£460. This information was provided to CSCI in July 2008. Additional charges are made in respect to activities, hairdresser, transport if provided and other sundries such as toiletries and newspapers. Prospective service users and relatives are given information about the service on an initial visit to the home. It states in the service user guide that copies of CSCI inspection reports are available on request. At the time of the inspection the home was not fully occupied with eight residents living at the home. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 1 star. This means the people who use this service experience adequate outcomes. This was an unannounced inspection that took place over one and a half days. The registered manager was present when the inspection took place and was involved in the inspection process. The inspection included a tour of the home, discussions with staff and the manager. We also looked at the records in the home and sent out surveys to staff and people using the service. We received seven completed surveys from people using the service some who whom were assisted to complete the forms by relatives. We also received seven completed surveys from staff. We also considered the information supplied by the manager in the form of the Annual Quality Assurance Assessment (AQAA) and other information held by us about the service. We found that the manager and staff have worked well to meet a number of the requirements made at the last inspection and that they were open to continuing improving the service provided. What the service does well: The home provides a warm, comfortable and homely environment for people to live in. Staff generally have a good understanding of how to meet individuals’ needs, including healthcare. Staff encourage individuals to be independent and to take responsibility for their own personal hygiene. One resident wrote in a survey “I like life here” and a relative responded on a resident’s behalf “X seems to be happy with them” Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 6 Staff encourage people to maintain contact with relatives and friends and visitors are made to feel welcome ensuring good relationships withal involved in the individuals’ care. People living in the home are treated respectfully and their privacy is maintained with staff also respecting people’s rights to exercise choice and make decisions about their daily lives. The home provides varied and appetising meals to ensure people living there have nutritious meals to maintain their health and well-being. There are procedures in place to ensure complaints are responded to appropriately and, where required, improvements in the service are made. Adult protection procedures and practices ensure people living in the home are protected from harm. The home‘s recruitment practices are good ensuring residents are safeguarded from potential harm by staff caring for them. Many of the staff have achieved a relevant qualification to ensure that they work to a competent standard. The home is clean and hygienic and generally the home is managed well within the restrictions of the job role ensuring the health and safety of people living and working in the home. What has improved since the last inspection? At the last inspection improvements were made to ensure that all people have a falls risk assessment completed and reviewed regularly. This has now been complied with. The home has also improved in the provision of activities and stimulation to people living improving the person’s overall well-being. A number of improvements were required in the environment of the home to improve the standard of accommodation provided to residents. A number of these have been met at this inspection. The dining room has been redecorated with new curtains and table-wear, the kitchen has been refurbished and the hallway redecorated. Some new garden and lounge furniture have also been purchased along with the fitting of fire doors as required by the fire authorities. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 7 Work is underway to improve the external access, although there are still some health and safety concerns regarding the patio area and the uneven surface making it dangerous for people to walk on. There has been progress in staff training so that staff have improved their skills and practice in caring for people living in the home. What they could do better: There remains some requirements that remain unmet from the last inspection and include the need to ensure staff are trained in core areas to ensure people living there are cared for by staff who are safe and competent and secondly they were required to produce an annual development plan to improve the service in response to reviews undertaken. Failure to comply with the requirements has meant that the Commission is taking further enforcement action. The care plan must also be more made specific and include all areas of the person’s identified need in such detail that staff reading the information are able to provide care to meet those needs. Whilst medication practices generally ensure the safety of people in the home some improvements should made to further safeguard their health and wellbeing by minimising risks. The manager should also develop further risk assessments relating to the healthcare needs of individuals to ensure potential risks to their health are reduced. In order to determine the training needs of the staff team the manager should develop a training matrix and training plan so that people receive care and support from a safe and competent workforce. The environment is adequate with improvements made to provide a comfortable environment. However, further progress must be made to ensure all areas of the home are safe and comfortable for people to live in. Please contact the provider for advice of actions taken in response to this Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 8 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 Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 9 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 Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 5 & 6 (not applicable) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and relatives had access to the information they need to make an informed decision about the home. Residents’ needs had been fully assessed prior to them moving into the home so that staff have the information to ensure appropriate care and support is provided. EVIDENCE: A copy of the service user guide had been placed in each resident’s personal file, made available in each person’s room and in the entrance foyer of the home, making these documents accessible to both residents and relatives. The information is in written format and is completed in block text which makes is difficult to read. We continue to recommend that the information be provided Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 11 in larger print or other formats to enable people are able to understand them. For example providing the information in audio format. In the surveys completed by staff five of the seven told us they always received up to date information about people using the service. This enables them to provide care that meets the persons’ needs. The Annual Quality Assurance Assessment (AQAA) told us that prospective service users are able to visit the home prior to admission to see if it is suitable for them. One of the surveys received also told us that they had “visited twice” before their relative was admitted. The personal files of two newly admitted residents were viewed. The residents had transferred from a home that had recently closed. The files included a full review undertaken by Social Services as part of the closure. This gave the manager information they needed to make a decision on whether they were able to provide the appropriate care to them. The manager and another member of staff also undertake an assessment, using the home’s preassessment form. The assessment form is quite basic and allows only for minimal information to be obtained. This should be reviewed in the event of a privately resident where there is no other assessment information provided. We also saw the contracts relating to three people living in the home. This contained the terms and conditions between the individual and the home. Where the arrangements have been made by the local authority the home also obtains the placement agreement, although they had not received the agreements in respect of the recently admitted individuals. They must persevere and obtain these as they provide the individual with the information about their agreement. The terms and conditions viewed related to people who had their arrangements made by the authority. They detailed how much the fees are and what they included although it did not say who was responsible for payment of the fees ie the local authority. This should be made clear. Those we viewed had been signed by the relative or the person in receipt of care. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have most of the information to provide care that meets individual needs, although lack of information on healthcare needs places people at risk. Staff encourage individuals to be independent and to take responsibility for their own personal hygiene. Healthcare needs are met through robust medication practices and through access to appropriate healthcare professionals. People living in the home are treated with respect and dignity in all areas of their lives. EVIDENCE: Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 13 The personal files of two residents were inspected. The home uses the standex format for care plans and supporting risks assessments to provide staff with the information they need to care for those living in the home. Both residents had a long-term assessment of need and a care plan in place. Both documents addressed their health and personal care needs, although we noted that more detail was needed in respect of certain issues. For example one person is a diabetic controlled by diet and medication. The care plan stated this but there was limited information about the diet or meeting their healthcare needs. The care plan should detail the care staff role in ensuring their health, such as looking for signs and symptoms of poor health and what action to take ie calling DN for testing blood sugars etc. The care plan should also detail the importance of eye checks and footcare, including regular chiropody. Guidance should also be given on the individual’s diet to ensure their healthcare needs are met. We also noted that the staff had made contact with the continence advisor in respect of individuals although the care plans did not detail this particular aspect of their care. Although staff are able to think in a person centred way and are able to give a verbal updates on these issues. In other areas there was sufficient detail about individual preferences on personal care and daily routines, although once again these could be improved by ensuring where personal care is detailed, there is information on how a male resident ensures regular grooming such as shaving. Staff encourage individuals to be independent and to take responsibility for their own personal hygiene and the manager understands person centred planning and thinking but this theory is not always evident in practice. The need to ensure care plans are detailed minimises the risk of information being altered, missed or misinterpreted when provided by word of mouth. We also noted from discussions with staff and reading of information held that some residents may present with verbal aggression or suffer with mood swings. This information had not been recorded nor how staff are to act when this is presented. Care plans must include how staff to meet both physical and emotional needs. There were some details on social care needs and the home had completed life review forms with residents and relatives to gather more information about residents’ interests, hobbies and other information relating to this area. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 14 We would also recommend that the care plan detail how individuals’ monies are managed and responsibilities for this. This ensures individuals’ monies are protected and risk of financial abuse minimised. The care plans had been signed either by the resident themselves or a relative, on their behalf and shows some involvement in the delivery of care to meet someone’s needs. The last inspection required all residents to have a falls risk assessment completed and reviewed. We noted that this requirement had been met although these should be developed as soon as possible after admission. There was some evidence that individual risks had been addressed within residents’ care plans with the exception of the areas noted previously eg diabetes, aggression. We would also recommend that nutritional screening takes place on admission and risk of pressure sores be developed to ensure staff recognise where there are risks in these areas and prompt action taken. However, it is clear from observations, responses in surveys and discussions with staff that they provide a good quality of care in a relaxed and homely environment. Observations of interactions between care staff and residents were observed as warm and respectful and it was evident that residents felt relaxed and comfortable with care staff. Where residents were assisted with toileting it was observed that their privacy was always maintained. Furthermore, all residents were well dressed and groomed. The manager also told us in the survey completed that any health visits take place in people’s own room and that staff support each person to maintain their independence through prompting rather than doing for the person. When asked do you receive the care and support you need? Six of the seven said “always” whilst one said “usually”. All said that staff listen and act on what they say and six of the seven said staff are available when you need them There was also evidence within personal files that residents’ health care needs had been well met. A record of contact with a range of health professionals had been maintained although the manager is reminded of the importance of regular chiropody or footcare for those with diabetes. Six survey responses told us that they (service users) receive the medical attention they need. One did not respond. At the last inspection in July 2007 the medication procedures and practices were found to be satisfactory. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 15 The home has visits from the pharmacist responsible for provision of the prescribed medication with the last visit undertaken in June 2008. They were generally satisfied with systems and records in place with improvements needed in the records for “as required” and “as directed” medication administration. Since the last inspection the GP has also reviewed the medication of all the residents and in a few cases much of the medication had been stopped. As part of this inspection we viewed the procedures, the records relating to prescribed medication and the way in which medication was stored. We found the practices to be generally satisfactory. There were some areas requiring improvement such as ensuring all hand transcriptions have two staff signatures, that “PRN” medication has clear administration guidelines and that where medication is boxed the date of opening is recorded on the box. This enables sound auditing of the medication administered. We found two gaps on the eight records viewed. We were told that staff are provided with training by the operations manager. It does not appear to be accredited training and nor is there any competency assessment on completion to ensure staff are safe to undertaken this area of care. The last inspection also recommended the need to complete assessments on relating to residents ability to self medicate. There is no evidence that this has taken place. The manager audits medication and records the findings. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There have been improvements in the provision of activities and the way people are stimulated ensuring positive well-being. People were supported to maintain contact with family and friends to continue familiar relationships that are important to them. People receive a varied and appealing diet that is nutritious and healthy. EVIDENCE: At the last random inspection held in July 2007 we identified that improvements were needed in the range of activities provided and the opportunities for social interaction. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 17 There appears to have been a concerted effort to make improvements in this area with an increase in the number of trips outside the home enjoyed by residents and staff. The manager also acknowledges in the recent AQAA that this continues to be an area that could be improved upon. Staff told us about how residents benefit from these improvements including a weekly visit from a lady who provides opportunities for interaction, including quizzes, sing a longs and craft work. We observed her during the course of the afternoon encouraging interaction and laughter involving residents. One resident also told me about the “exercise class” that takes place. We also saw evidence of regular arranged entertainment and the home also continues with the mobile library making books accessible to residents that are of interest to them. The manager told us that they have set up a portfolio of activities and that this is an area that has improved greatly over the last twelve months. The survey responses confirmed that people generally benefit from a range of activities. The religious needs of individuals are met through regular visits by a local vicar and priest. This was confirmed by one resident spoken to and through reading of the daily records It was clear from individual files that staff encourage and support residents to maintain relationships with family and friends and that these visitors are welcomed by staff Relatives spoken to following the inspection stated they had always felt welcomed by the staff at the home and one relative commented that they are “always greeted with their name” There was evidence that the home is conducted so as to support residents’ capacity to exercise personal autonomy and choice, for example they are able to bring in personal possessions with them when they move into the home and there was evidence of this in inspecting individual residents’ rooms. Residents were also observed as being able to choose to become involved in activities or to spend time alone in their room as they wished. Following previous recommendation information regarding independent advocacy services had been obtained and had been included within the home’s complaint policy. There is a four -week rolling menu that offers a good variety of meals that are well balanced and nutritious. The cook asks the residents each day what they would like from the choices on offer. The survey responses confirmed that people generally enjoy the food provided with five saying they “always” like the food in the home whilst two said “usually”. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 18 One resident spoken to during the visit told us that they liked the food provided and that they had plenty. We were also told that apart from the main meals there are also light snacks and refreshments available. In the evening before people retire biscuits, sandwiches and hot drinks are available. We were told that the cook has recently consulted with people living there about what they would like to see on the menu and intends to make these changes. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a procedures in place that ensure peoples’ concerns are listened and responded to in order to improve the care for those living there. Measures had been taken by the home to ensure residents were protected from abuse. EVIDENCE: The home’s complaints policy is simply written and includes all the necessary information about the stages and timescales within which complaints will be dealt with. A copy of the procedure was seen on display in the entrance hall of the home and therefore could be viewed by visitors, staff and people using the service. This could be written in larger print for easier visibility or provided in other formats such as audio tape etc. A complaints log is used to record all formal and informal complaints but no complaints had been received by the home since the last inspection. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 20 It is clear from the surveys returned that people generally know who to speak to if they are not happy and are aware of the complaints procedure. “Staff are on hand and encourage relative to voice their views” wrote one relative. A comprehensive policy and procedure on adult protection is available for staff to provide guidance and information on how they can protect people living in the home. Since the last inspection a number of staff have received training from the operations manager, who is also a trainer, in the protection of people from abuse. However, new staff have not yet received training in this area although they are currently working their way through the Common Induction Standards booklet which may provide some guidance. One member of staff spoken to and the manager had a good knowledge of abuse and the types and forms of abuse. Both understood their roles in what to do in the event of a suspicion or allegation of abuse taking place. The care staff member also understood about “whistle-blowing” and how this impacts on staff. There had not been any adult protection investigations carried out in relation to the home since the last inspection. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a homely environment that is clean and generally comfortable. There has been progress in the redecoration of some areas of the home and ensuring access. However, there continues to be areas of the home requiring improvement to ensure individuals safety and comfort. EVIDENCE: The home provides a homely environment for residents but it was noted at the last inspection that communal areas of the home were in need of some redecoration. We noted at this inspection that there has been some work done in redecorating some of the areas, although to a basic standard. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 22 The work completed includes redecorating of the dining area along with new curtains and table-wear. The hallway has also been redecorated with the same colour throughout. New lounge furniture has been purchased and the kitchen has been refurbished. In addition, previous inspections have raised concerns about access issues outside and inside the home, resulting in the needs of residents not being able to be fully met as their mobility and health needs increase. During the inspection work had been completed on fitting a concrete ramp to the decking at the rear of the home making a walkway from the rear to the front of the house for people with mobility problems to access the home more safely. There are still safety issues with the patio area to the rear being uneven and therefore potentially dangerous to people with poor mobility. Inside the home there is a chair lift to the first floor, with five stairs to the second floor that is currently not in use due to access issues. The services of an Occupational Therapist may help the Provider in determining how the home can ensure the home is accessible for all people living there. At present the home does not have any residents that are wheelchair bound although it was reported that two of the residents do need wheelchairs to be able to go out and there are residents that can only mobilise with the use of a Zimmer frame living at the home. Communal space within the home is ample. There is a large lounge that is bright and spacious and a separate dining area. Furnishings are comfortable and domestic in character. The rear garden is large and generally well maintained and can be accessed via French doors from the dining room. There is an area with decking and also a sheltered area where residents can sit away from the sun. Some new garden furniture has been purchased although some of the old furniture remains The home has a sufficient number of toilets and washing facilities for residents with the ground floor bathroom, shower room, wc being the most used. This has recently been painted. A bath hoist has been purchased for the for the ground floor bathroom. The bath in this bathroom was quite dirty and appears not be used, although the manager stated the hoist had been replaced to ensure it could be used. However, we noted that there was no water supply to this bath. We were also informed that a new bathroom suite had been delivered and was ready to be fitted to this bathroom to enable it to be used. However, without water supply the new furniture is of no use. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 23 This bathroom also contained a shower that was in use and since the last inspection a fit for purpose shower chair has been purchased, replacing the plastic garden chair that was being used and was potentially unsafe for use. Residents’ bedrooms were generally of a good size, comfortable and suitably personalised. Since the last inspection new wardrobe and drawers have been purchased to replace the dated and old furniture. We noted that the new furniture did not have lockable space for people. This needs to be addressed particularly if a resident wishes to keep their medication. The home was clean and hygienic on the day the inspection was held and free from any offensive odours. All of the surveys returned sated that the home is fresh and clean. We had a brief tour of the newly refurbished kitchen which we found to be clean. The Environmental Health report on the visit in October 2007 showed the kitchen to have a three star rating of good. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of staff with the skills and competency to care for people living in the home. Recruitment practices are robust to protect people from the employment of unscrupulous staff. The lack of training for new staff in core areas means that there are risks to people’s safety and well-being. EVIDENCE: We viewed the home’s rota was checked and reflected the staff on duty on the days of the inspection. There are always two care staff that work during the day and early evening with one care worker sleeping in and one who does a waking night. The manager is an integral part of the staff care team working shifts as well as managing the home. This means shoe has a good knowledge of what is happening in the home and about individuals care needs although this also Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 25 limits the time spent on undertaking management tasks that impact on the smooth running of the home. The chef and a domestic provide further support to ensure people have the care and support they need. We received seven completed surveys from staff and there were mixed responses about whether there were enough to meet the individual needs of the people who use the service. Five said “always”, two said “sometimes” and one said “usually”. When asked if they felt they (staff) had the right support, experience and knowledge to meet the different needs of people-four said “always”; two said “usually” whilst one said “sometimes.” One staff member staff felt that they provide “a good level of care. Staff try and make a homey atmosphere and makes visitors welcome to the home.” Another said they provide “a home from home.” We would agree with those statements. At present of the eleven carers presently employed to work in the home, five have completed a National Vocational Qualification (NVQ) Level 2 and some continuing on to NVQ Level 3. Since the last inspection the home has recruited three care staff. The recruitment records of these three staff were checked and were all found to include the necessary documents and information required by Regulation, including two references, proof of identity and Criminal Records Bureau (CRB) check. Staff surveys told us that they had checks undertaken before they started work in the home. We also looked at the staff training matrix which had been developed since the last inspection, viewed training records and talked to staff about the training they had received. All of the seven surveys told us that they received induction training and that it was generally done very well, enabling them to do their job. All staff said they received on going training on how to meet the needs of people living there. The Provider is responsible for making decisions and arrangements for the training of staff with much of it provided by the Operations Manager. The manager recognises the importance of training, and tries to delivers a programme that meets any statutory requirements and the NMS. It was noted at the last inspection that some mandatory training needed to be updated, specifically in relation to manual handling. This had been provided in October 2007. However, the home has recruited new staff since then and they have not received this basic training or fire training and there is no evidence that they came to the home with recent training already in place. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 26 In trying to determine the training provided this was found to be quite difficult as the training matrix was not up to date and therefore we had to look at individual files, the training file and the matrix. We also noted that a number of staff have received first aid training, although for many this has expired over the last few months. The manager told us that training was due to be provided in October 2008. The manager is aware that there are some gaps in the training programme and tries to resolve this with the Provider. We were informed, and saw from records that the operations manager provides most of the training. The Provider is reminded that for training such as moving and handling and for first aid the trainer must be competent and accredited. We would also expect that medication training is provided by an accredited trainer. Furthermore, it was identified that the cook who works at the weekend still had not completed a food hygiene course or infection control. This is a repeated requirement made at the last inspection. There was evidence that the new care staff were in the process of completing the induction work booklet that is used by the home and meets with Skills for Care specifications. However, when we viewed the file of the two staff most recently employed we found that there was no evidence of one of them receiving moving and handling training and in the second file viewed there was a copy of a certificate from the previous employer dated 2006. Once again this requirement is repeated requirement from the last inspection. The lack of training in these areas places vulnerable people at risk to their health, safety and well-being. There is evidence of some staff receiving heath and safety training, provided once again by the operations manager. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements for the home means that, whilst the home is generally well run and the health and safety of people living there is promoted and protected the capacity to improve is restricted. The quality of care is monitored through various systems, although to continually improve the service the views of others must be sought and action taken. Peoples’ finances are effectively safeguarded. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 28 EVIDENCE: Whilst the registered manager has relevant experience to be able to run the home effectively she does not yet have the qualification required by the Commission. At the last inspection she told us that she was is in the process of completing the Registered Manager’s Award (RMA). However, this has not been followed through although she is currently undertaking a foundation degree in care management. This may not provide her with the desired qualification so we advise that she check that this would give her the qualification required by the Commission to manage a care home. She is open and transparent and shows a willingness and desire to improve the quality of care for the people living there and to improve her skills and practice to benefit others. This is as stated later restricted by the current system in place for managing the home. All sections of the AQAA were completed and the information gives a reasonable picture of the current situation within the service. The evidence to support the comments made is satisfactory, although there are areas where more supporting evidence would have been useful to illustrate what the service has done in the last year, or how it is planning to improve. There are systems in place to ensure procedures are being implemented and to monitor the quality of care provided. Care planning, finances, health and safety and medication audits are taking place regularly, although the time between each audit is very much dependent on the manager’s time balancing being part of the care team and managing the home. It is clear that this division often means either management tasks are not completed or the manager spends her free time trying to complete these tasks. This may restrict the capacity to continually improve the care and provide a good or even excellent service. The Provider that they review the structure to provide more management time in the home. We are also concerned about arrangements for the training of staff and lack of core training provided. The lack of training means that people are placed at risk through poor or unsafe practices. The lack of a computer with internet access also restricts the manager’s ability to keep up to date with practice and to deal with information and communication efficiently and effectively to move the service to a higher level. She does not benefit from this very useful resource at the moment and means she has to look to the Provider to provide this support and look at other ways of keeping up to date. The Provider’s last survey completed in consultation with people using the service was undertaken in December 2007. The home has not drawn up a Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 29 development plan reflecting the aims and outcomes for residents based on their views detailed in the surveys. Without such information how can the service be improved or change to meet peoples’ needs. This is once again a repeated requirement and may lead to enforcement action. At the last inspection there was no evidence of monthly provider visits to the home or the required reports on the visits. At this inspection we saw evidence of the reports from two visits completed on two different forms. The information provided on these reports would benefit from more detail on the findings and where there are areas to be addressed the action to be taken and how these are then monitored for compliance at the next inspection. Previous reports also stated that resident’s meetings had not been held. The manager has tried to address and evidence of two meetings in June and August support this. However, we recommend that the meeting minutes detail any action to be taken and by whom to ensure residents’ issues are addressed and resolved. Good practice would also dictate that the residents are advised of the outcome at the next meeting. This would ensure they feel they have been listened to and improvements made. There is evidence of regular staff supervision taking place with the manager supervising all staff. There is also evidence that appraisals have also taken place, as required at the last inspection. We had discussions with the manager about the difference between supervision and appraisals and she felt she would benefit from further training in this area to ensure the process is what is required. Staff surveys showed also us that the manager regularly meets with staff team and that she is very supportive. She is “…very supportive. We discuss all the time about what to do for the welfare of service users. ….She always asks for feedback from us……..” Another staff member said “ The manager is very supportive. I feel I can approach at any time and she is willing t listen and advise.” The home manages the personal allowance for all residents living at the home and there are robust procedures in place to ensure these are effectively managed. Each resident has a book in which all transactions are recorded and receipts are also kept. Fortnightly audits of residents’ finances are carried out. A part of the identified needs of individuals the manager must also ensure that the care plan details the individuals’ needs in the management of individuals’ personal monies. For example where the Provider is appointee or the relative is Power of Attorney, how are the monies managed. There was evidence that the health, safety and welfare of residents had generally been promoted and protected. We viewed the records of the monthly health and safety checks and sampled maintenance records. There were up to Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 30 date maintenance certificates in place for gas, portable electrical appliances, hoist and fire alarms and equipment. A copy of the fire risk assessment could not be located at the last inspection and was viewed on this occasion. Fire alarm call points had been tested weekly and regular fire drills had been carried out. We made some suggestions to improve the recording of the drills and the staff involved. The records also still do not detail how long it took to complete. We have made comments under the staffing outcome group regarding core training for staff, including the gaps in training for new staff. Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 31 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 3 3 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 2 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 x 3 3 x 2 Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 32 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 OP7 Regulation 15 Requirement Staff must have written information about individuals’ identified health, social and personal care needs to ensure they receive the care and support needed. Where medication is prescribed, “as required” there must be full details of administration for staff to follow and the care plan must detail the person’s needs in this area. There must be a water supply in the ground floor bathroom to enable people to have access to the bath. The canopy at the front of the house must be replaced to provide a comfortable environment for people living there. All staff including the ancillary staff must complete training in mandatory topics and this is updated as required. (Previous timescale not met) An annual development plan must be drawn up for the home that is based on a systematic DS0000025632.V363843.R01.S.doc Timescale for action 01/11/08 2 OP9 12 01/11/08 3 OP25 23 01/11/08 4 OP19 23 01/01/09 5 OP30 18(1)(c) (i) 01/12/08 6 OP33 24 01/01/09 Manor Park Version 5.2 Page 33 cycle of planning -action-review, reflecting aims and outcomes for service users. (Previous timescale not met). 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 2 3 4 Refer to Standard OP2 OP3 OP8 OP9 Good Practice Recommendations Contracts should be amended to make clear who is responsible for payment of the fees. The assessment format should be improved upon to ensure full information can be obtained about the prospective person wishing to use the service. Risk assessment should be developed in relation to risks of pressure sores and nutrition. Staff should record on medication boxes when the date the medication is commenced. All medication that is hand transcribed should have two staff signatures to confirm the accuracy of the transcription. Individual assessments with new service users should be carried out on whether they can take responsibility for taking their own medication and this is recorded. The complaints policy should be produced in other formats that are suitable for residents, relatives and any other visitors. Minutes of residents meetings should include the action to be taken and by whom in response to issues raised. We strongly recommend that the home is provided with a computer and internet access. Medication training should be provided by an accredited trainer with an assessment of competency completed on all staff. 5 6 8 9 11 OP9 OP16 OP14 OP37 OP9 Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Manor Park DS0000025632.V363843.R01.S.doc Version 5.2 Page 35 - 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. 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