Inspection on 31/03/08 for Manor Place Nursing Home

This inspection was carried out on 31st March 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 Place Nursing Home 06/09/07

Manor Place Nursing Home 16/05/06

Manor Place Nursing Home 17/11/05

Manor Place Nursing Home 27/06/05

Manor Place Nursing Home 13/12/04

Manor Place Nursing Home 13/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Manor Place Nursing Home 116 Church Lane East Aldershot Hampshire GU11 3HN Lead Inspector Peter J McNeillie Unannounced Inspection 31st March 2008 09:45 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 Place Nursing Home DS0000012150.V359587.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 Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor Place Nursing Home Address 116 Church Lane East Aldershot Hampshire GU11 3HN 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) 01252 319738 01252 327899 Dr Zyrieda Denning Vacant Care Home 52 Category(ies) of Dementia (52), Old age, not falling within any registration, with number other category (52) of places Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th September 2007 Brief Description of the Service: Manor Place is a care home with registered to provide accommodation, nursing care and support for up to fifty two older persons some of whom may have dementia The home is located in a 19th Century Victorian mansion on to which a 17bedded extension was built and later in February 2006 a further extension was completed to increase the number of beds available to 52. The home, which is sited close to Aldershot town centre, shops and other local amenities, is divided into three wings. Victoria wing is in the older part of the home and has four shared rooms and ten single rooms and accommodates eighteen people. Nightingale wing has seventeen single bedrooms all with en suite facilities. The latest extension is Churchill wing and has sixteen single rooms and one double room all of which offer en suite accommodation. The home also has a secure landscaped rear garden, which is easily accessible from all of the accommodation wings. Parking is available in the front of the property with spaces for 8 vehicles. At the time of this visit charges in the home were £560 to £800 per week. Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This report was written after taking into consideration a number of sources of information and evidence including a site visit to the premises, the managers pre registration report, previous reports, sampling residents and those relating to staff training records. We talked with residents, staff and management and received a response by the manager to a pre inspection Annual Quality Assurance Assessment. (AQAA). The results of a pre inspection CSCI in house satisfaction questionnaires completed by residents and resident’s representatives were also viewed. During this inspection which took place on 31/03/08 between the hours of 9.45 am and 3.45 pm the inspectors Peter McNeillie and Sandra Holland were assisted by The Manager, the home’s Mental Health Manager and the Responsible Individual. This was the first inspection for the year 2007/08 during which of the key standards for older persons and any previous requirements were inspected. As a result of this visit we found all previous requirements had been complied with and are commented on in the main body of this report. The results and findings contained in this report will determine the frequency and type of future inspections. What the service does well: What has improved since the last inspection? In addition to compliance with previous requirements, which related to care plans, the dignity of residents, risk assessments, complaints, the environment and the testing of fire equipment, a number of other significant improvements have been made. These include the appointment of more qualified staff, activities organisers, a new management team and the development of an improvement/action plan. Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 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 Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. 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 system of assessing and identifying residents needs which ensures residents safety and that their assessed needs can be met. Intermediate care is not provided so this standard does not apply. EVIDENCE: The home had written policies and procedures regarding the admission of new residents to the home, which stressed the importance of accurately accessing the help and support required by potential residents before they moved into the home. A sample of four residents records and pre admission assessments of need and risk chosen at random were viewed. Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 9 All of the records viewed confirmed that potential residents are only admitted following a full assessment by the manager or another member of the homes management team of their care/nursing needs and risks, which are present. Whilst talking to residents we established they or their representatives had been involved in the initial assessment process, and the records viewed confirmed this. As part of the admission process management also liaise with external health and care professionals regarding any care needs, risks, equipment and aids, that need to be taken into consideration when developing a plan of care. Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,and 10. 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 well-developed system of planning and reviewing care, which reflects residents, wishes, and aspirations and ensures resident’s needs are met. A risk management policy involves residents and resident’s representatives or relatives in decisions that affect them. All previous requirements have been complied with. EVIDENCE: Following the last inspection two requirements were made that: 1)” The care plans must have identified needs both physical and mental health, and they must have detail on how the individual is to be supported by staff”, and 2) “People who use the service must be treated with dignity and respect. Staff must be able to demonstrate their understanding of this and how they enable individuals to express themselves”. Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 11 In response to these requirements the home sent us a detailed improvement plan advising how they intended to comply with these requirements. On checking progress we found when viewing a sample of four residents care plans that: All of the detailed care plans which were reviewed at least monthly were based on pre admission assessments to identify what help and support individuals needed and any attendant risks. (The previous section, Choice of Home, standards 1-6 of this report refers) Some residents verbally confirmed they were consulted about and participated in the production of the plan, others could not remember and in some instances were probably not able to participate due to their dementia. Records seen confirmed this. All of the residents spoken with confirmed they were very satisfied with the care and support they received. They advised us they were contented, liked the staff and management and were treated with respect. They felt wanted and would recommend the home to anyone”. Residents responses to our questions about how they were cared for and liked living in the home were all very positive and included comments such as “ Hotel service”” I am more than happy”,” Well satisfied and content”,” Care is very good” “The staff are lovely and very kind”.” You wont find anything wrong here”, ”The best”. Resident also confirmed that staff always knock on their bedroom door and wait before entering, a practice we observed during this visit. In the light of the above information we consider both previous requirements have been complied with. Residents spoken with also confirmed they were able to see the doctor of their choice or any other health and social care professional when they needed to. The records viewed indicated that apart from doctors, district nurses, physiotherapists, occupational therapists, other specialists had been consulted when required. Records were kept of appointments with GPs, dentist, optician, chiropodist and any other external health and social care professional and included details of any advice and treatment given. To ensure equality and diversity are promoted within the service the home informed us in their AQAA that: “race, gender identity disability sexual orientation age, religion, and belief are incorporated into what they do”. Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 12 This statement translates itself into action in a number of ways such as; ensuring all residents have choice in all aspects of thir daily lives, the availability of clergy compatible to their particular faith, individual activities plans, plans to produce an environment for persons with dementia and providing menus in different formats to ensure all residents can read them etc. Medication records confirmed that all prescribed drugs and medicines, which are securely stored, are dispensed by a pharmacist into a blister pack system. These are administered in accordance with a medication policy and procedure by qualified nurses who confirmed they were aware of and had read the procedure. The record of drugs and medicines administered to residents and unwanted drugs disposed of were complete and accurate. A procedure was in place to enable residents who wish to assume responsibility for their own medication. At the time of the inspection no resident was managing his or her own medication in accordance with a risk assessment. Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The social activities family contacts and the provision of varied and nutritious meals were well managed and reflected residents interests and choices. EVIDENCE: Since the last inspection two former carers have been re deployed as activities organisers and are responsible for developing, organising and carrying out a publicised programme of events and entertainments. In discussion, the homes management agreed with us that the current programme of activities is very limited and does not take into account the wide needs of residents especially those with dementia. Some work and research with outside bodies such as the Alzheimer’s Society is currently taking place to improve the activities available. As part of the improvements taking place, individually tailored activity programmes are also being developed during the initial assessment and care Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 14 planning process, taking account the residents wishes, preferences, abilities and special needs. Residents confirmed how important the activities were and how much they enjoyed them. All confirmed that participation was up to the individual; no one was forced to join in. The home has regular visits from local Church of England and Roman Catholic clergy who conduct services and communion in the home. The needs of members from any other faiths would be if required catered for but at the time of this visit no members from other faiths were residing in the home. Following the last inspection a requirement was made that:” Movement around the home must be risk assessed on an individual basis enabling individual choice and freedom”. Residents confirmed they were fully consulted and were able to exercise choice in all aspects of their lives for example; when to get up and go to bed, mealtimes and where meals are taken, visiting times, the right to receive and converse with visitors and to make and receive telephone calls in private. These comments in tandem with risk assessments referred to earlier in this report confirmed the previous requirement had been complied with The quality, quantity, presentation and choice of food served came in for particular praise from the residents. The management and the cook advised us the menus had recently been reviewed and revised but as a daily menu was not displayed, none of the residents or care staff knew what was going to be served until the meal was put onto plates. Alternatives to the main menu were available, as were meals in a different format such as puréed for those residents that required it. We highlighted that some residents may not fully understand menus produced in a written format and that alternatives to a written menu is of importance for persons in particular those with dementia who may find the addition of pictures would be beneficial to their understanding and assist in them making meaningful choices. A verbal undertaking was given by the manager in future to display and produce menus in a format that all residents are able to understand. Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure was satisfactory with evidence that residents feel their views will be acted upon in compliance with a previous requirement. The home has clear policies and procedures in place which ensures residents are protected from abuse. EVIDENCE: The home has an Adult Protection policy and procedure that operates in tandem with the policy and procedure produced by Hampshire County Council. The Hampshire procedure is based on National Guidelines and the document No Secrets that is designed to safeguard residents from abuse. Records viewed and staff spoken with confirmed they had received training in recognising various types of abuse. All were able to demonstrate they knew the procedure to follow should they witness or suspect the abuse of any resident. Following the last inspection a requirement was made that:” Staff must also be able to demonstrate how they listen to and respond to, concerns raised by relatives or representatives and by people who use the service”. Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 16 In response to this requirement, in their improvement plan the home informed us more regular residents meetings had been scheduled, supported with individual one to one meetings with a member of the management team. Minutes of all meetings are kept, typed and a personal copy given to each resident. The homes complaints procedure, which included information on how to contact The Commission for Social Care Inspection (CSCI), was seen, as was a record of complaints. The procedure, which was included in the service users guide, was also displayed within the home. No complaints had been received by CSCI since the last inspection. Residents spoken with said they felt comfortable in raising any concerns they had with the homes management or any member of staff and were confident any matters raised would be dealt with fairly and promptly. Staff also confirmed they felt confident in raising any matter or complaint with the homes management on behalf of a resident and that they were aware of the complaints procedure and where a copy was kept should they need to refer to it. In view of the residents comments and the actions taken by the home we are satisfied this requirement has been complied with. Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A safe, well maintained, clean and suitably furnished home is provided for residents which meets their needs in compliance with a previous requirement. EVIDENCE: Following the previous visit a requirement was made that: ”The home must offer a pleasant and odour free environment to all people who use the service”. As part of their improvement plan the home informed us they would be carrying out an assessment of all furniture and undertake a redecoration programme that took into consideration the needs of residents in particular ensuring an appropriate environment for those residents with dementia. We found furniture was comfortable, homely and met residents needs. Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 18 All areas of the home that were seen were clean and free from unpleasant odours and obvious hazards in public areas. The implementation of infection control measures was evident as soon as we entered the home. Residents spoken with confirmed the home is always clean and smells fresh. In view of our findings and residents comments we are satisfied the previous requirement has been complied with. Professional assessments are carried out to ensure that any equipment and personal aids required by residents was available. This had been carried out sometimes as part of the pre admission assessment. Aids currently in use within the home include hoists, special beds, special baths, walk in shower, bedsides, grab rails, ramps, lifts and handrails. During our visit a resident invited us into their room where we observed secondary heating in the form of an electric heater had been fixed to the wall. On testing the outer case of the heater was very hot and was likely to burn the resident if they touched it. A trailing electrical flex also presented a possible hazard. The manager informed us he would deal with this matter and a similar one in an adjacent bedroom urgently. We have since been informed both heaters have been taken out of use and no others are present in the home. In general the decoration within the home is good and in some places excellent. In the older part of the building it was noted there are many areas that have been damaged and scraped by the passage of wheelchairs and looked unsightly. To overcome this we have been informed that since the inspection that an in house check has been undertaken and repairs organised. We have also been informed that in the future all areas will be inspected on a regular basis and any damage repaired at least every six weeks and earlier if the damage warrants it. Investigations are also being made to provide suitable protection for walls in the more vulnerable areas. Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is good. Resident’s needs are met by sufficient numbers of well trained and supported staff who are recruited and selected using a procedure designed to protect all residents. EVIDENCE: The planned daily staffing levels for the home each day is: 8am –4pm: Three qualified nurses and nine carers. 2pm –10 pm two qualified nurses and eight carers. A manager, five cleaners, a chef and kitchen assistant, one laundry assistant and an activities coordinator support care staff. At the time of our visit the number of care and nursing staff met residents needs, a view supported by residents who informed us there were always enough staff on duty and they rarely had to wait for attention It was clear through observation that staff had developed a good relationship between themselves and residents. Since the last inspection more qualified nurses and managers have been employed easing any staff shortage problems and releasing some to staff to concentrate on other areas such as activities. This has been referred to earlier in this report. We viewed three staff recruitment and training files. Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 20 Not all of the files seen included information that staff were employed in accordance with a robust recruitment, equal opportunities and selection procedure designed to protect residents. This should include the completion of an application form, the signing of a rehabilitation of offender’s declaration, an interview, and satisfactory Criminal Record Bureau (CRB) disclosure, Protection of Vulnerable Adults (POVA) and reference checks. On viewing the records, information such as a full employment history and satisfactory Criminal Record Bureau (CRB) checks was found to be missing in a file and there was no records to support any queries had been followed up. Following their appointment, on commencement of employment all new staff who are given a copy of the General Social Work Councils code of practice and an in house staff handbook are subject to an in house induction and compulsory training programme that include first aid, handling medication, moving and handling, POVA infection control and dementia. Whilst we were satisfied that pre employment checks are undertake and new staff are involve in an induction programme, records were fragmented. In some files information was missing, available else wear or not filed. The manager gave a verbal undertaking that a review of the files would be undertaken as a matter of urgency to ensure all of the information as detailed in Schedule 2 of the Care Home Regulations was readily available. As part of a review of all training, and in particular, induction training, we were informed, it has been decided in future all induction training will be based on a “Skills for Care” model. All staff are expected to undertake a National Vocational Qualification (N V Q) course. Currently 69 of staff has been trained to at least NVQ level two of these three (10.3 ) have obtained NVQ level three. Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home ensures the health, safety and welfare of residents and staff are promoted and the home is run in the best interests of the residents, whose views about living in the home are formally sought. EVIDENCE: Following our last visit we reported “There has not been clear consistent leadership in the service for about six months that has had a detrimental effect on those living and working there”. Since the above was written there have been major changes within the home. Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 22 As part of their improvement strategy a qualified and very experienced Manager has been recently appointed and is in the process of applying for registration by The Commission having taken up his post on 04.02.08. Prior to the above appointment a further senior qualified manager was appointed in October 2007 and it is planned will assume the role of the Responsible Individual for the home in the very near future. CSCI had been informed of this change just prior to this visit. The influence of both of the above appointments has been significant in bringing about and planning further change within the home. The home now has a clearly defined management structure which has produced a very comprehensive improvement/action plan (parts of which have already been implemented) which sets out aims and objectives to take the home forward and improve the standard of the existing service. Staff spoken with all confirmed they were aware of their responsibilities and the limits of their authority. They described the management team as approachable and accessible and willing to listen to any ideas they may have for the improvement of the service. All felt the home had improved since the new management changes had been implemented As part of the homes quality monitoring system, residents, resident’s relatives and visiting health and social professionals are invited to participate in satisfaction surveys. The views expressed in the surveys are seen as key in highlighting areas that may require improvement or attention and the future development of this service. We checked records and monies held on behalf of residents for safekeeping. All receipts for monies spent were available and the cash balances accurately matched with the records. Following the last inspection a requirement was made that:” A record of tests on fire equipment and systems must be in place to show that people who use the service are protected.” We found a health and safety policy was in place to ensure the day-to-day safety of staff and residents. Procedures included health and safety checks including fire safety equipment, the regular servicing of equipment, staff training in the techniques of moving and handling, infection control, control of substances hazardous to health (C.O.S.H.H.) first aid, health and safety, reporting accidents and procedures to follow in the event of fire (including evacuation). Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 23 As part of the health and safety arrangements and to protect residents, all of the hot water supplies to baths were fitted with thermostatic controls are set at 43 degrees centigrade and all radiators and hot pipes covered. Based on the evidence seen we are satisfied the previous requirement has been complied with Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP32 Regulation 19(1) Schedule 2 Requirement All staff recruitment records must be complete and include all of the information as specified in schedule 2 of the Care Home regulations Timescale for action 18/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Manor Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Place Nursing Home DS0000012150.V359587.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!