Inspection on 06/09/07 for Manor Place Nursing Home

This inspection was carried out on 6th September 2007.

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

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

Other inspections for this house

Manor Place Nursing Home 31/03/08

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 Val Sevier Unannounced Inspection 6th September 2007 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Manor Place Nursing Home DS0000012150.V348909.R03.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.V348909.R03.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 Post 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.V348909.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th May 2006 Brief Description of the Service: Manor Place is a care home with nursing providing care and support for older persons. The house is a late 19th Century Victorian mansion, which until the 1980s was St Michaels Vicarage. About 15 years ago a 17-bedded extension was built and in February 2006 a further extension was completed to increase the number of beds available to 52. The home is divided into 3 wings, Victoria wing is in the older part of the home and has four shared rooms and 10 single rooms and accommodates 18 people. Nightingale wing has 17 bedrooms all with ensuite facilities. The new extension is Churchill wing and has 16 single rooms and one double room, which is occupied by a married couple. All rooms in Churchill wing offer en suite accommodation. The home also has a landscaped rear garden with raised borders and is easily accessible from all of the accommodation wings and there is seating for use by service users. The front of the property is tarmac and provides parking for 8 vehicles. Fees at the home range from £550 - £780 per week and service users are responsible for paying for their own toiletries, hairdressing, chiropody and items of a personal or luxury nature. Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These included: the Annual Quality Assessment and Audit document completed by the home (AQAA), an unannounced visit to the home, which was carried out on the 6th September 2007, during which the inspector was able to have discussions with staff and have interaction with the residents at the home. During the visit the inspector looked around the inside and outside of the home, which included a sample of bedrooms and bathrooms. Staff and care records were sampled and in addition to speaking with staff and residents, their day-to-day interaction was observed. The inspector was also able to speak with visitors on the day. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Commission for Social Care Inspection. What the service does well: What has improved since the last inspection? Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 6 An occupational therapist has been employed and she is currently assessing the homes equipment and ensuring that rooms and support are able to meet the needs of the people who live at the home. The home has bought new equipment and activities such as games and puzzles. A bathroom has been refurbished and redecorated and is now an accessible shower room. 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 Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 7 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.V348909.R03.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering using the service are given appropriate information about the service to enable them to make an informed choice. People that use the service can feel assured that their needs will be assessed and that the home has an understanding of their needs using the assessment process. EVIDENCE: The home has a statement of purpose and service users guide, which people who are interested in the service can use to make an informed decision. The service user guide also gives information on the care assessment that takes place before an individual comes to stay at the home it explains why it happens and what happens with that information. Over the past six months there have been concerns raised with the home regarding the acceptance of individuals with needs that the staff did not have the skills or ability to care for. This has been reviewed and staff spoken with Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 10 are very clear on the assessment process and needs that can be supported at Manor Place. On the day of the inspection arrangements were made to assess an individual at the local hospital. The assessment was to be carried out by a nurse so that needs could be assessed to ascertain the support required and the homes occupational therapist on order to ensure that there was appropriate equipment and that the rooms was adapted to meet any needs. The inspector sampled six care plans, two individuals had moved to the home in the last two months. The pre admission assessment looked at had information on the following: Name and preferred name Previous illness and current issues Personal care and well-being Diet, weight, dietary preference Sight hearing, communication Oral and foot care Mobility and dexterity Medication Mental state and cognition Social interests, religious and cultural needs Carer involvement Relatives who have commented, explained what had happened in the decisionmaking process regarding the home and how they had been involved. Residents who were able also commented that they had been to the home and had been asked if they would like to live there. The relatives commented that the admission process had worked, that they had been given adequate information to assist with the decision, making process. The relatives felt that on the whole most needs could be met at the home; in some cases the relatives appreciated being part of the process as they had cared for the individual and could continue to do so. Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were plans of care in place that ensured that people using the service received the basic help and support that they needed. The plans would however benefit from including needs other than those purely concerned with physical care and health and a consistency in information for staff to support needs. The people who use the service were seen to be protected by the home’s procedures and systems for administering medicines. People who use the service are not always respected and treated with dignity. EVIDENCE: The AQAA returned to us made reference to ‘well documented individualised case notes’, which are ‘focused and wholly formulated around the needs of the service user’. On discussion at the home with staff it would seem that these care plans have been put aside for another method of recording care plans and it was the latest one that the inspector saw being used at this visit. Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 12 The care plans sampled by the inspector were being used in conjunction with medication records and other health-monitoring tools that are used as part of the care planning for individuals with records of daily life written by the key worker. It was noted that not all identified needs or issues have care plans, for example not all those who had dementia had a care plan for staff to follow to meet needs associated with this illness such as communication, physical support, diversion, activities. There have been concerns raised by social services over the recording and information that staff have to enable them to support individual needs. This has led to social services working with the home looking at systems and records, as a result the home has changed its records and is currently moving all care plans to a new system. This new system has pre written pages which staff then complete for individuals, writing the needs and support to be given bys staff. The areas covered in the care plan included: Personal care Eating and drinking Physical well-being Mobility and dexterity Vision, hearing, teeth, feet and skin integrity History/risk of falls Psychological profile / emotional well being The inspector sampled six care plans and it was noted that the manner in which they are completed seems to depend on the ability of the individual staff member. Some were detailed and the inspector would have been able to use that document to support the individual concerned, others were not so detailed and were left to personal interpretation. Examples of detail were: “reluctant to accept support with personal care – takes a liking to some individuals, if there are difficulties use distraction such as humour and laughter”. “Likes to drink milk and juice”. In two care plans it was noted that a life history had been gained through speaking with the family, not all staff spoken with on the day were aware of this information or how they would use it to assist the individual they were caring for. There were notes regarding personal preferences of getting up and going to bed however, family spoken with on the day said that this was not always met, with their relative being in bed at 1.30pm and needing to receive care. There was difficulty in finding staff as they were ‘at lunch’. Family members also commented on the state of peoples clothing when they visited after meal times and how dishevelled and dirty their relatives appeared, when staff were asked to look at this the staff have allegedly said that there were not enough staff to do that. This was raised with the registered provider Dr Denning and is also looked at under staffing section of this report. Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 13 The care plans indicated that risks had been identified such as falls, choking, cross infection, skin integrity, sexual disinhibition entering other peoples rooms, eating and smearing faeces, however it was not always clear what action staff should take to assist with lowering these risks. The new occupational therapist employed at the home is currently undertaking assessments of the bathrooms and other communal areas and all individual rooms to ensure that there is adequate and appropriate equipment available to support needs and that rooms are safe for both the individual and the staff. It was seen in the care plans that physical health needs are also addressed with residents having access to opticians and dentists as needed. There were records of visits by the doctor, district nurse, speech therapists and social workers. Staff interaction across the three wings of the home seemed to vary, in two wings staff and resident interaction seemed good, and residents were able to comment on their thoughts about the staff, “They help me with everything, from taking my pills to taking me to the toilet”. “The people look after me very well”. “I have been here a while, staff are helpful they help me get washed and dressed”. On the third wing people are more dependent mentally and not able to give their views. One individual who was kicking the door to the wing was told by a member of staff to “sit down and go to sleep”. Another individual was seen kicking the door to the conservatory whilst trying to put a hoopla ring on their leg, the staff member that moved this person away did so gently but with no verbal interaction. The home had written policies and procedures concerned with the management and administration of medication. Medication was kept in a locked and secured cupboard and where required in a refrigerator. The home dispenses all medication from blister packs and the only staff in the home that dispensed and were responsible for the management and administration of medication on a day-to-day basis were the trained nurses. The inspector saw medication being correctly administered, staff followed the homes medication policy and procedure. The home uses a Medicine Administration Record Sheets (MARS) system, for recording the administration of medication. The records kept in conjunction with medication received and returned to the pharmacist were sampled and were found to be correct. Records of all staff trained to administer medication were found to be in order. Several staff were observed speaking and assisting the residents with dignity and respect, however this was not consistent with all staff across the whole Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 14 home. Affection was given appropriately to those residents who sought it this being observed with one resident in the garden who appeared upset. It had been seen on some care plans that the preferred choice of name had been recorded and some staff were heard to speak to residents by the name they wished. Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 15 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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have some access to activities and interests however the approach by staff in enabling this is not consistent especially for those with dementia and not supported currently by individual care plans. People who use the service are offered a choice in meals however there is a lack of consistency in how this is offered and presented to them. EVIDENCE: The manager came to the home on her day off to speak with the inspector about the areas where she has implemented change or plans to. It is planned that the new occupational therapist will introduce individual care plans for activities based on their interests and life histories, it is hoped that she will work with other staff members in putting the care plans into practice. There is activity equipment in the home and in two areas of the home individuals were seen interacting with staff playing draughts or discussing pictures. The care plans have a record and a key relating to different activities, on the care plans seen these were seen to have been completed daily since the care plans were introduced in August 2007. Activities have included cinema Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 16 (watching a film), singing, physiotherapy, hairdressing, television and reminiscence. There was no indication on the care plans seen that individuals were supported to maintain links with the community such as local parks, shops or churches, although there was evidence that family members visit. The inspector was able to spend time in the three main lounge areas and observe the interaction between staff and the residents. The interaction varied across the three wings of the home. In two areas residents seemed able to walk where they wished – if they were able; there was conversation between staff and residents and residents were able to express these wishes and needs. On the third wing where communication for residents was limited by their ability and their mental health there was less interaction between staff and residents. It was noted that the conservatory had two doors into the garden, which has been landscaped and is secure, however the two doors were closed and could not be opened easily by someone with impaired cognition. Family spoken with on the day said that the doors were never open. Whilst the inspector was in the lounge, two residents were seen to kick the conservatory doors and doors to the wing. There appeared to be no exploration of opening the doors and enabling individuals in that area to access the outside and stretch their legs in the open. It was noted that the other two wings had their doors open to the gardens enabling residents in those areas to use the gardens if they wished. Staff were seen using the garden the most to move from one side of the building to the other without having to walk through the home. There were date boards in all three wings encouraging awareness of the day such as the weather, however it was noted that in the wing where individuals all have a varying degree of mental awareness the date was wrong. Staff were observed to support individuals at lunchtime, and with drinks in the afternoon, again there was a variable level of support given with staff on two wings giving physical and verbal support, on the third wing there was support but little verbal interaction taking place. In one wing there were food and drink records being kept when the inspector looked at them they were not being kept daily although staff said that they were doing the records each day. When the inspector pointed out that there were records missing, staff said that sometimes they put information on the charts and sometimes on the care plans. The inspector spoke with the registered provider Dr Denning about record keeping being consistent as accurate information is important to help make decisions about care. The areas and manner in which meals are offered to individuals also varies across the home with some being enabled to have their meals in their room, whilst others have their meals in a dining area or the lounge with a small table. Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 17 One member of staff was seen supporting residents in the garden with afternoon tea and sandwiches, they were then observed carrying a piece of cake across the garden in their hands. The manager spoke with the inspector about the menus and choices offered to the residents at the home. The home also cooks meals for their sister home a short distance away, discussion between the two managers and the cook has noted that there is a lot of waste with the meals, indicating that the meals are not liked. The cook is working on new menus at the moment and the manager is looking at the supply of foods and the equipment in the kitchen for example fridges and a grill, enabling an improved method of ordering and different ways of cooking food. Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 18 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 & 18 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected through the open complaints process and the staff’s knowledge and understanding of Adult protection issues. However there seems to be some inconsistency amongst staff and how they respond to issues raised. EVIDENCE: The homes complaints procedure was seen to be available in the information given to people who use the service and their representatives and to be available on notice boards around the home. There have been two complaints and an allegation regarding care raised with the home and the commission since the last inspection in May 2006. The complaints and allegations have been addressed under Hampshire’s Safeguarding Adults policy and social services have been working with the home on issues such as records regarding finances and care plans. The registered provider Dr Denning has also reported to the commission and social service concerns she has had enabling an independent investigation into issues. Family and representatives have commented and their comments also vary from – knowing how to complain, have not needed to complain or that they have raised concerns with staff and that they do not feel heard. Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 19 Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 20 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 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive a different quality of environment depending on which area they live in. Need and illness lead to the decision about which area they live in, it is not necessarily a choice. EVIDENCE: The inspector looked around some of the home and was able to see communal areas such as the dining rooms, conservatory, kitchen, bedrooms and bathrooms. The AQAA had stated that the home is ‘accessible, safe and well maintained; meets service users individual and collective needs in a homely way’. ’Grounds are kept tidy, safe, attractive and accessible’. There are a variety of rooms available at the home, as the three wings have been built over a period of time. The original part of the home and the new wing were seen to be clean, brightly decorated and bedrooms were Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 21 personalised with individual’s belongings. The lounge in the new wing although bright and airy with access to the garden, had a lot of chairs in it, which could cause difficulties for people moving about, there were also several small tables in front of people restricting their movement. In the middle wing of the home it was noted that there was no access outside to the garden area, as there is in the other two wings. The bedrooms are decorated and personalised in some cases, there were also some rooms locked as one individual enters other people’s rooms and has been known to leave body fluids in them. The lounge leads through to the conservatory. The lounge had a strong malodour that was highlighted to the registered provider Dr Denning who went with the inspector to confirm it. The armchairs in this lounge were ‘plastic looking’ unlike the chairs and seating on the other two wings, and the majority were torn with the foam showing. There was hardboard on the wall where an investigation had taken place before the last inspection in May 2006 and the décor had not been replaced. A bathroom in the middle wing of the home has been refurbished and redecorated since the last inspection offering an accessible shower The home has a laundry and has dedicated laundry staff. The home only provides a laundry service for service users personal clothing and there is an industrial washing machine and tumble drier, all other laundry including sheets and towels are sent out and laundered away from the home. There is also a dedicated team of domestic staff; the manager has employed a new member of staff since starting at the home in August 2007. The home has introduced individualise laundry bags and new trolleys to help maintain a personalised laundry service. Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an inconsistency of care and support across the wings in the home, which may place some individuals who use the service at risk of not having their needs met. The recruitment policy of the home appears to protect the individuals that use the service EVIDENCE: The rota for the staffing at the home was seen, on the day of the visit there 45 people living at the home. On duty there were three nurses on in the morning two in the afternoon and one at night, plus eight care staff in the morning and seven in the afternoon and four at night. Kitchen, laundry and domestic staff support the nurses and care staff. The registered provider Dr Denning told the inspector that staffing had been lowered inline with the number of people living at the home. The inspector spoke with Dr Denning about this and how the number of staff relates to the needs and dependency of the people living at the home. In comments from relatives there were concerns about call bells not being answered, staffing and the number of falls of particular individuals, as well as positive comments about how helpful staff were. Relatives also commented on the lack of staff at weekends and particular times of day when staff are at lunch this was discussed with Dr Denning. Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 23 Recruitment and staff files of three staff were seen, it was noted that all checks had been applied for or received and that staff without a current CRB check had both references and a POVA first check, however there was no indication that new staff had started an induction programme at the home. Since the inspection Dr Denning has stated that new staff undertake an induction with the home. The manager stated that training had been reviewed with staff also being asked what they would like to do or feel they need to do in addition to looking at mandatory training. The competency of staff after training and the content of training given to staff are also being reviewed. The inspector was able to speak with several staff and they were aware in varying levels of the training that is planned in the next six months, areas such as: care planning, confidentiality, privacy and dignity, infection control, manual handling and equipment, activities, and pressure area care. It was noted that on the training programme some trainers are yet to be confirmed. Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. The new manager has a clear plan for the home, which needs to be implemented and sustained in order to be of benefit for the people who use the service. There is an inconsistency in the care, support and the environment experienced by people who live at the home placing some individuals at risk. The home is not well maintained in all areas but whilst health and safety is promoted, there is a lack records indicating that fire systems and equipment have been checked which may place residents at risk. EVIDENCE: Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 25 Since the last inspection in May 2006 there have been two changes in manager the current manager has been at the home since the start of August 2007. Previously she was the manager of a stroke unit in Winchester hospital and she has also managed an elderly care unit, she is a registered general nurse. The manager was on a day off on the day of the inspection but chose to come in for a few hours to speak with the inspector. Since coming to manage the home she has employed a domestic, to assist with the cleanliness and hygiene of the home, an occupational therapist three days a week and a occupational therapy assistant / carer. She hopes that this will then offer occupational therapy seven days a week. These two staff are looking at the individuals plans for activities and the manual handling equipment and support in all rooms. The manager has had one general staff meeting, a meeting with the domestic and laundry staff and a trained nurses meeting, the manager hopes to have these meetings monthly. She has looked at supervisions for staff and plans initially to do these herself. There is no consistency in the care and support offered at the home to the individuals that live in the three wings. Comments from staff, relatives and people who live at the home vary depending on which wing they work, live or visit. These comments were supported by the inconsistency in the care plans, staffing levels and environment. Comments from relatives included: “More activities are needed especially at weekends”. “Staff are friendly helpful and caring”. “Thank you for listening I am not sure that all staff do, or understand what I say”. “I think courses at meal times should be served separately”. “Glasses and walking frames need to be clearly marked”. “There do not seem to be staff around and when we look for them they are at lunch”. “I don’t think all the staff understand what my – is trying to say I know – has dementia, but still…” Comments from staff included: “There seems to be a ‘them and us’, among the overseas staff and the British staff”. “A relative told me they were glad they had spoken to me as I understood their concerns, they had spoken to some other staff (from overseas) and they did not feel that they were listened to”. “Staff from overseas regularly speak in groups in their own language, I don’t mind but they should not do it in front of the residents”. Since the last visit the management of personal monies at the home was bought to the attention of the commission and social services by the registered Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 26 provider Dr Denning, social services have worked with the home on the processes that had to be improved. It was noted that the home’s equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. passenger lift and hoists; fire safety equipment portable electrical equipment; hot water system; etc. There were contracts in place for the disposal of clinical and household waste. Records were kept of accidents. There was a fire risk assessment for the premises; tests of equipment and regular risk assessments of the premises and working practices were undertaken regularly however the last date of any test being carried out was the 25th and 27th July 2007. The registered provider stated that she was sure that they had been carried out since that date, but did not know why they had not been recorded. Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 27 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 2 8 1 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 2 X X 2 Manor Place Nursing Home DS0000012150.V348909.R03.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 Sch 3 (1)(b) Requirement 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. 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. Movement around the home must be risk assessed on an individual basis enabling individual choice and freedom. 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. All people who use the service must be offered a similar quality of environment and furnishings. The home must offer a pleasant and odour free environment to all people who use the service. DS0000012150.V348909.R03.S.doc Timescale for action 05/11/07 2 OP10 13 (6) 05/11/07 3 OP14 17 (2) 05/11/07 4 OP18 13 (6) 05/11/07 5 6 OP19 OP26 16 2 (c) 23 2 (c) 16 2(j) 05/11/07 05/11/07 Manor Place Nursing Home Version 5.2 Page 29 7 OP38 23 (4) A record of tests on fire equipment and systems must be in place to show that people who use the service are protected. 05/11/07 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.V348909.R03.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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.V348909.R03.S.doc Version 5.2 Page 31 - 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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