Inspection on 01/03/07 for Manor Rest Home

This inspection was carried out on 1st March 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 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 Rest Home 04/12/08

Manor Rest Home 13/02/08

Manor Rest Home 19/06/06

Manor Rest Home 26/01/06

Manor Rest Home 25/07/05

Manor Rest Home 11/03/05

Manor Rest Home 07/12/04

Manor Rest Home 30/03/04

Manor Rest Home 30/10/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Manor Rest Home 35 Manor Road Westcliff On Sea Essex SS0 7SR Lead Inspector Mrs Bernadette Little Unannounced Inspection 1st March 2007 09:00 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 Rest Home DS0000015461.V332254.R02.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 Rest Home DS0000015461.V332254.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor Rest Home Address 35 Manor Road Westcliff On Sea Essex SS0 7SR 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) 01702 343590 01702 343590 manorresthome@btinternet.com www.mrh.org.uk Mrs Rebecca Mary Hart Mrs Rebecca Mary Hart Care Home 19 Category(ies) of Dementia - over 65 years of age (1), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (19) Manor Rest Home DS0000015461.V332254.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home provides accommodation and personal care for up to 19 Older People over the age of 65 years. The home provides accommodation and personal care for one service user with dementia over the age of 65 years whose identity is known to the Commission for Social Care Inspection. The home provides accommodation and personal care for one service user with a mental disorder over the age of 65 years whose identity is known to the Commission for Social Care Inspection. 19th June 2006 Date of last inspection Brief Description of the Service: Manor Rest Home was formerly two large semi-detached houses, which have been made into one property and is situated in a residential area of Westcliffon-Sea. It is a short distance from bus routes, main line railway station and the seafront. The home has its own minibus. The home provides personal care and accommodation for 19 older people in 7 single and 6 double rooms. Some rooms have en-suite facilities. The home is privately owned. There are two separate lounges, and a dining room/ conservatory. There is a garden to the rear of the property with seating for residents and a parking area at the front. The registered manager advised that the weekly fee ranges from £338 to £400. Additional charges/costs incurred by residents were advised by the registered manager as being hairdressing at £7.50 to £25, chiropody at £12.50 magazines, newspapers and toiletries at cost, an escort at £6.50 per hour plus taxi costs, £1.50 per week to pay for the blister packing of medication from the pharmacist and trips on the minibus being charged at between £5 and £40, depending on the trip. Manor Rest Home DS0000015461.V332254.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was undertaken by two inspectors, Bernadette Little and Vicky Dutton who together spent a total of sixteen hours at the home. The registered provider/manager was on duty at the time of the site visit. Staff also assisted with various aspects of the site visit. Three care staff were spoken with. Seven residents and a GP were spoken with. A tour of the premises was undertaken and records, policies and procedures were sampled. Care files for three residents were case tracked in detail and sampled for a fourth resident in specific areas. There were eighteen people resident at the home at the time of this site visit and some residents at Manor Rest Home have varying degrees of confusion. Information on the views possible to obtain as well as observations made during the inspection are also reflected throughout the report. Completed comment cards were received from eight relatives/residents following the site visit. All confirmed they were satisfied with the overall care provided at Manor Rest Home. What the service does well: What has improved since the last inspection? The radiators in residents’ bedrooms have been made safe, as have the opening upstairs windows. There has been more training in basic areas for all staff such as manual handling training, basic training in the management of substances hazardous to health (COSHH) and very recent fire training. Manor Rest Home DS0000015461.V332254.R02.S.doc Version 5.2 Page 6 Recent staff recruitment shows all references and checks were done at the right time. The induction training given to the new staff covered the right subjects and was well recorded. The home looks after money for fewer residents and the systems for managing this were clear. The manager has arranged to attend Registered Manager’s Award training this year and introduced supervision for staff. 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 Rest Home DS0000015461.V332254.R02.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 Rest Home DS0000015461.V332254.R02.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): 1, 3, 4, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Users of the service felt they had been given enough information about the home. Clearer assessments of residents needs and further training for staff with support better care outcomes for residents. EVIDENCE: The surveys received from the relatives/residents advised that they felt they had received enough information about the home before they moved in. The current service user guide states a weekly fee of £410. This is different from the information provided by the registered manager at the time of the site visit. The service user guide does not provide all the information about fees that is now required following the change to the Regulation in September 2006. It does not mention the availability/inclusion of the most recent inspection report, or include residents views about the home. Manor Rest Home DS0000015461.V332254.R02.S.doc Version 5.2 Page 9 Each of the three care files tracked contained pre-admission information from social services, including for the emergency admission. Each of the files also contained an assessment, identified as a pre-admission assessment, but while they were signed, they were not dated. One was well completed, while the other two contained adequate, but brief information. The home’s assessments identified the reason for admission, which is a positive development since the last inspection. There was no evidence on the files that the home had written to the prospective residents prior to admission as required by regulation to confirm that, based on their pre-admission assessment, the home could meet the resident’s needs. The home was advised of the need to do this in the report of the other key inspection of this home undertaken this year. Manor Rest Home had previous agreement to care for one named resident who had dementia. The home had admitted residents with a diagnosis of dementia prior to the last inspection and had been informed that they must ensure that their own assessment is thorough enough to identify the residents main care needs, and must provide written confirmation to the resident prior to admission, that based on the assessments, the home can meet their needs.” It was identified from the assessments viewed on this occasion that the home had admitted further residents with a diagnosis of dementia/Alzheimers. Detailed information and advice was given to the registered manager/owner on ensuring that the home can meet residents’ needs and the options available to them. The last inspection report identified that several staff, including the registered manager, have not had basic training in some areas, such as fire and moving and handling. Improvement on this is noted in this report. The homes’ Service User Guide states that staff undertake regular and varied courses. However most staff had not had training on specialist areas or on conditions associated with older people such as sensory impairments, falls management, continence care, medication, nutrition, dementia/Alzheimers and the management of behaviour that challenges. This could clearly have an effect on the homes ability to meet the needs of residents with these conditions. Manor Rest Home does not offer intermediate care. Manor Rest Home DS0000015461.V332254.R02.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, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Users of the service able to participate felt that they were provided with appropriate care, but this was not always evidenced for all residents through good care planning and review, safe management of risks, and support for staff through training. EVIDENCE: All of the surveys received from residents/relatives said that residents always received the care and support needed, including medical support. Care plans were in place on each of the three files case tracked. One was not dated as written until two months after the resident was admitted. No photographs were available of the residents. A long-term care plan document gave an overview of the resident’s overall needs, but not instructions for staff on how to carry this out on an individual and daily basis. Manor Rest Home DS0000015461.V332254.R02.S.doc Version 5.2 Page 11 Some short-term care plan issues were identified on each file, which is positive. However, they varied in content and so did not include all aspects of the resident’s assessed needs, or tell staff how to meet them in the best way for each person. This included needs such as dementia, disorientation, behaviour that challenges, hearing loss, oral care, frail skin, identified interests and religious needs, continence support, or nutritional issues/preference/ allergy. Where, for example, continence issues were identified in a care plan, they did not identify which particular type/size of aid was to be used for that person, and what ‘toilet regularly on our toileting programme’ meant in practice. One resident’s assessment identified that they were admitted for respite and rehabilitation to enable the resident to go home. This was not reflected in the care planning available. Care plans were not routinely signed and dated. Keyworkers provided a monthly overview of the resident. The registered manager was advised that this should reflect that it represents and includes a review of the care plan and any changes required to it etc. A tick box format is used to record several aspects of care and daily recordings/observations of the residents are only written spasmodically. The tick box chart for one resident recorded that they had one hair wash and one bath during the month of February. The daily records for one resident indicated that they had had a headache on three occasions in a 14 day period, and the last entry one week before this site visit said the resident had been confused that morning. Height and weights were recorded and included in the moving and handling document. Risk assessments relating to nutrition and falls, even where these were indicated, were not available to support health and wellbeing. The manager was advised that the available risk assessment form was often being used for recording incidents rather than actually assessing risks. The risk management strategies for a resident diagnosed with dementia simply referred to ensuring the door was kept secure. Accident forms were generally satisfactorily completed, however the section on action to be taken was left blank. An additional care plan was sampled as numerous falls for one resident were identified that led to a mattress being placed on the floor next to the resident. No risk assessment was in place to show how this action was arrived at as being the best/safest care for that resident and no care plan was available relating to it. On one file, visits by the GP were well recorded, on another file there was no follow-up to an entry that advised that a urine sample had been taken to the surgery. A care plan was available on each file relating to medication, which is positive practice. None of the current service users administer their own medication. Manor Rest Home DS0000015461.V332254.R02.S.doc Version 5.2 Page 12 A photocopy of the sample signatures/initials and the names of fourteen staff that administer medication was kindly provided. This included the husband of the registered manager who does not provide care tasks at the home, and who, along with the registered manager and seven other care staff were not recorded as having received any training in medication. The last inspection report identified that the home’s policy and procedure on medications requires annual updates for staff in medication training, but this had not occurred. The manager advised that she had tried to arrange training with one large local company, but this had not been successful and she had not gone elsewhere. Case tracking of the residents’ medication administration records (MAR) showed no omissions, which is positive. A letter was available from the GP to confirm that the homely remedies provided were suitable for his patients. Photographs were not available of residents on the MARs, to support staff to ensure the medication is administered to the correct resident, especially as these were also not available on the care plan. Protocols were again not available in relation to ‘as required’ (PRN) medications on all files sampled, and the need for and benefits of this were again explained. Medication care plans were adequate but could be more specific. Handwritten entries/changes to the MARs were not double signed, as is good practice. The deputy manager agreed that the start date would be recorded on the box or bottle of medication in future as it is opened, to support a safe audit trail. Risk assessment for medication and the home’s policy and procedures will be considered at future inspections. It was observed that residents were treated respectfully throughout the day by the staff, who took time to interact with them in a pleasant manner. Staff were also seen to provide a good level of monitoring and supervision of residents throughout the day. The telephone available to residents is sited in the main hallway and does not afford privacy. The availability of incontinence pads on the open display in bedrooms, the poor maintenance and decoration of some residents’ bedrooms and other areas, the very poor condition of, for example, the commode chairs to be used by residents, the poor cleanliness of residents’ bedrooms and bathrooms, the dirty hair brushes, the broken headboards, stained pillows and carpets, the lack of locks on bedroom doors and lack of some form of protective covering on the windows of residents’ bedrooms where the resident may not be fully aware that they were overlooked, did not support a positive approach to respecting the choice for privacy and dignity of the people living at Manor Rest Home. Manor Rest Home DS0000015461.V332254.R02.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, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunities for meaningful activities were shown to be available for some residents, but could be developed for others. Relatives and friends are encouraged to have regular contact with the home. Residents were satisfied with the meals provided. EVIDENCE: The home employs an activity co-ordinator for two hours each week. The activities person was on site and involved several residents in a table game. A volunteer also comes in once a week to do manicures etc. Residents preferences were recorded to some degree in the long-term care plan, however for example, the activities care plan for one resident did not reflect their previously identified interests and needs, for example reading and large print books. For another resident where their assessment identified they were practising their religion, there was no evidence that this was being supported or that their previous interests had been taken into account and provided for, although staff advised that the vicar does visit. The home uses a tick box recording system for many aspects of the care provided, including activities. This identified residents’ daily activity as being in Manor Rest Home DS0000015461.V332254.R02.S.doc Version 5.2 Page 14 a particular place, e. g ‘the red lounge’ or the green lounge’, but not actually what they might have being doing, or whether they were involved in any meaningful activity or interaction. Of the eight surveys returned, four stated that they were always activities arranged by the home that the resident could participate in, one said that the person chooses not to take part in the activities available, one said there were usually activities available and one said that there were never activities available that the person was able to take part in. Visitors were seen to be made welcome during the day and offered drinks. The service user guide identifies that visitors are welcome between the hours of 8am and 8pm, with arrangements available for other times. The manager advised that they had had information on advocacy available for residents, and plan to obtain more leaflets as these had all gone. The home does not provide a planned menu to inform residents of the options and choices. The home-made shepherds pie to be eaten on the day of the inspection had spoilt and so fish and chips was bought in for residents, which those spoken with said they enjoyed. A group of residents spoken with the later in the lounge also said that they were happy with the food served at the home. Seven of the eight surveys returned stated that the residents always liked the meals served and one commented “ the food is excellent”. The nutritional record showed that there were a lot of processed foods for teatime meals such as chicken dippers, beefburgers, pasties, sausages, hash browns or chicken kievs and there was no indication of whether are any fresh vegetables were offered. The nutritional record was inadequate as it did not identify breakfast or supper meals or what individual residents had eaten. Manor Rest Home DS0000015461.V332254.R02.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, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents felt listened to and able to raise any concerns. Staff training and knowledge generally safeguarded residents but could be developed to protect both residents and staff. EVIDENCE: The registered manager said that no complaints had been received by the home since the last inspection. The Commission for Social Care Inspection has not received any complaints about Manor Rest Home since the last inspection. Information on the complaints procedure was displayed in the home. It included the advice provided at the last inspection on updating the complaints procedure to identify that the Commission for Social Care Inspection does not investigate complaints on behalf of individuals, but would record them as information and pass them to the home to deal with under the complaints procedure. Advice was provided on informing residents that they can complain directly to their funding authority and this is recommended to be included. All eight surveys returned by residents/relatives confirmed that they would know how to make a complaint. The GP spoken with stated that they had no concerns regarding this home. The registered manager advised that all but three staff have undertaken training on protecting vulnerable adults (POVA). The registered manager had acted appropriately on being informed of a past POVA issue at the home. This Manor Rest Home DS0000015461.V332254.R02.S.doc Version 5.2 Page 16 had identified a support need for staff in relation to whistleblowing. The registered manager advised on this occasion that whistleblowing had been discussed with staff, and was again advised to evidence this, for example in the minutes of the team meeting signed by staff. One file sampled contained a copy of the whistleblowing policy signed by the staff member. Two staff were spoken with regarding protection of vulnerable adults and whistleblowing. One advised that they had not yet done training on abuse, although the training matrix indicated that both had attended this training in the past year. Both staff advised that they would report any concerns to the manager but did not show awareness that they could also go directly to social services or the commission, if this was more appropriate. The homes policy and procedure did inform staff that they can contact social services or the commission directly to report any concerns. There was no evidence in the training matrix provided that staff had attended training in management of behaviour that challenges, although this may have been covered to some degree in the up-to-date two day dementia awareness course undertaken by two staff. This is an area the home needs to develop as they have some residents with dementia and were considering registering for this category of care. Manor Rest Home DS0000015461.V332254.R02.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, 21, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some areas of the premises were pleasant and homely while other areas did not provide residents with a safe, clean, pleasant and well maintained living environment. EVIDENCE: As previously, the communal lounge and dining areas were all pleasantly furnished and decorated. The home had a garden and patio area, although accessibility to residents was limited due to furniture blocking the fire door/ access from the conservatory, and the number of broken fence panels on the conservatory waiting to be removed. All eight surveys received stated that the home is always fresh and clean. Following an immediate requirement notice issued at the last inspection, several radiators have been covered to make them safe and to protect Manor Rest Home DS0000015461.V332254.R02.S.doc Version 5.2 Page 18 residents. A radiator in one bathroom was advised as having been turned off completely which made it safe. No other heating was available in this room and a safe alternative needs to be reconsidered. Other radiators had had a shelf fitted. The proprietor advised that this was adequate following risk assessment and is aware of the potential risks to residents. The opening upstairs windows had also been made safe. The administrator confirmed that the downstairs bath was now in working order, and it was seen to be clean. The suitability of the bathing facilities for all residents will be considered at future inspections. Some new bedrooms curtains had been fitted and a few bedrooms were nicely personalised. Many areas of the home were poorly maintained, for example torn wallpaper in a resident’s bedroom. Furnishings in many areas were also in poor condition, for example very rusted commode chairs, a headboard falling off a bed, cupboard drawer fronts missing or broken and vanity units damaged. Several areas were in need of thorough cleaning, for example toilet areas, scaled taps, bedside cabinets, mould growing in an undersink vanity unit, or a stained bed, pillow or carpets in different areas. There were some overlooked windows near to sinks where residents would wash, which, while having heavy curtains, did not offer residents any other form of privacy. Bedrooms doors did not have locks. Hairbrushes in several rooms were very dirty. Many bedrooms had plastic bags accessible and in some rooms there were latex gloves, both of which could present a hazard to confused people. In residents’ toilets, toilet roll holders and soap containers were empty, but there were large heavy toilet rolls placed on the back of the toilet, and not easily reached by a frailer older person. One double downstairs room contained a hoist. There was an electrical wire training across the floor presenting a hazard. This residents’ bedroom also contained the sink used by the hairdresser for all residents. The laundry room was well equipped. A bin by the fire door presented a hazard. A wedge was being used to hold open a resident’s bedroom door. The above issues were fed back in detail to the registered manager/proprietor. Advice was also provided on the provider’s plans for improvement to the premises. Manor Rest Home DS0000015461.V332254.R02.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, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents wellbeing would be better supported by ensuring adequate staffing levels were always available and that staff had additional training. Recent recruitment and induction practices protected residents. EVIDENCE: Residents spoken with had positive comments about staff. Most surveys said that staff were available when needed. Staffing rosters for a four-week period were inspected. The registered manager was advised that the use of correction fluid on the rota is not good practice. She advised that staff do not sign in and out and the rota is retained as the record of hours worked. The sleeping in staff member was not always identified on the rota, although ensuring that there was an identified member of staff on duty sleeping in at night, and identified on the rota was raised as a concern at the last inspection, and included in the Immediate Requirement notices issued. The registered manager’s husband undertakes management (clarified by the manager as not care) tasks at the home, and while named on the rota, his hours were not recorded. The rosters showed three recent occasions in one week where minimum care staffing levels had not been met on the late shift. The registered manager advised that two staff had started NVQ training sometime back but did not finish it. The Service User Guide states that the deputy manager and one carer have achieved NVQ Level 2 and three staff Manor Rest Home DS0000015461.V332254.R02.S.doc Version 5.2 Page 20 were close to completion. The registered manager advised that one staff is expected to commence this training very shortly. The training matrix at the last inspection also indicates that two staff had additionally undertaken NVQ level 3. The registered manager advised that she had recruited four staff since the last key inspection and retained one. She is now recruiting and awaiting clearance of two staff, one of whom is recruited from abroad. The file for the newly recruited member of staff was inspected. This contained all appropriate records and checks obtained in a timely manner, with the exception that there was no photograph of the staff member or no photographic identification. It was identified that an agency member of staff was planned to be on duty on the afternoon of the site visit. A record from the agency was available confirming the person’s criminal record bureau disclosure number. There was no information on persons training or confirmation that the agency had taken up references and checks and were satisfied that these were suitable. The induction record for newly appointed permanent member of staff identified training in fire, accidents, personal care, missing resident and care of the dying resident. Certificates were seen in relation to food hygiene awareness, moving and handling, fire evacuation procedures, adult abuse and raising concerns and whistleblowing, understanding dementia and effective communication. In addition the registered manager advised that the staff member had undertaken a two-day dementia training course this week. The staff training matrix provided indicated that staff had had more basic training opportunities in the past year, for example all care staff had attended manual handling training, basic training in the management of substances hazardous to health (COSHH) and very recent fire training, which is positive. This indicated that few staff have had recent/training on health and safety and infection control. There was limited evidence that staff had had training on conditions associated with older people for example sensory impairment, falls prevention, nutritional needs, continence management, prevention of pressure sores, Parkinson’s disease or diabetes, although the manager stated that they had no current service uses with the latter three conditions. Other comments relating to training have been noted in this report for example in relation to medication and management of behaviour that challenges. Manor Rest Home DS0000015461.V332254.R02.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, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While further developments are needed, the improvements planned/introduced by the management team since the last inspection show more effective management and benefit both residents and staff. EVIDENCE: The registered manager advised that she has obtained a place and will be starting NVQ 4, Registered Managers Award training, this month. The registered managers training file shows training on adult abuse February 2007, fire evacuation procedures January 2007, in-house training on COSHH (Control of Substances Hazardous to Health), laundry procedures February 2005, staff supervision May 2004, dementia care March 2002, and dementia awareness November 1998. Manor Rest Home DS0000015461.V332254.R02.S.doc Version 5.2 Page 22 The registered manager advised that she had sent questionnaires to all relatives, GPs, district nurses, community psychiatric nurses, the chiropodist and funding authorities in August/September last year. The outcomes of this were provided. It was recommended that these could be provided in a more resident focused format, and residents’ meetings be introduced to give residents opportunity to express their views. A development plan for the home was not available. The home looked after money for only two residents and a separate record was maintained for each. Receipts are available for outgoings and it was recommended that the residents sign to record receipt of money when this is paid to them directly. For other residents, the home pay for the service and invoice relatives directly. Information on the introduction of formal supervision was displayed for staff. The supervision system will be fully inspected at a future inspection when the home will have had time to show it being fully implemented. The displayed fire plan did not show the conservatory extension and fire exit. The fire door from the conservatory was blocked with furniture and the patio area outside blocked with old fence panels etc. A record of fire drills was provided containing two entries in July 2006 and January 2007. No times were recorded and it was clear that not all staff were recently/regularly involved in fire drill training. A fire risk assessment was available dated 2007. The administrator advised that checks of the water system were undertaken monthly but no records were available to evidence this. No risk assessments were available relating to safe working practices. Data sheets were available giving information about hazardous substances used in the home. Current safety inspection certificates were available in relation to gas, electrical fixed wiring and the hoist. Manor Rest Home DS0000015461.V332254.R02.S.doc Version 5.2 Page 23 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 X 2 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Manor Rest Home DS0000015461.V332254.R02.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 Requirement The Service User Guide must include all information regarding fees as required by the amendment to Regulation 5 (September 2006) Timescale for action 01/06/07 2. OP3 14(1) The registered person must write 01/03/07 to each prospective resident stating that, based on its assessment of their needs, the home can meet those needs. The home must be better able to evidence it’s ability to meet the needs of residents in staff training on the conditions associated with older people and the home’s specific client group. Each resident must have a written care plan that includes detailed information for staff to follow to meet and manage all aspects of the residents needs, in terms of their welfare. (Previous timescales of 15/09/05 15/03/06, 01/10/06 not met.) Care plans must be reviewed regularly. DS0000015461.V332254.R02.S.doc 3. OP4 18 01/06/07 4. OP7 15(1) 01/03/07 Manor Rest Home Version 5.2 Page 25 5. OP8 13(4) Risk assessments must be in place for residents to meet their identified needs. Residents must be protected by having written protocols or guidance in place for medicines prescribed on a “when required” basis. Residents must be supported to make choices and their right to privacy and dignity must be respected, as identified in the body of this report. Residents must be consulted about their social interests and arrangements made to support them to participate in social and community activities and other appropriate leisure pursuits as indicated by their condition, or in their individual assessment/care plan. Residents must be provided with a choice/varied diet. A record must be kept of the food served to residents in adequate detail to show whether the diet, including any special diets, are satisfactory. The policies and procedures in place must protect residents from abuse. (Previous timescale of 01/03/06 and 18/06/06 not met. This includes a review of staff competence and awareness of the whistle blowing procedure and staff training in the management of behaviour that challenges. 01/03/07 6. OP9 12(1) 13(2) 01/03/07 7. OP10 OP14 12(2) 12(4)a 01/03/07 8. OP12 16(2)n & m 01/03/07 9. OP15 16 (2)(j) Sch4 (13) 01/03/07 10. OP18 13 (6) 01/03/07 Manor Rest Home DS0000015461.V332254.R02.S.doc Version 5.2 Page 26 11. OP19 16(b &c) 23(2) All areas of the residents home must be maintained to a reasonable standard of decoration and maintained to a standard that protects residents. Previous timescale of 01/10/06 not met. This now also includes the specific of ensuring that residents are offered a home that is furnished and furbished to a reasonable standard. This includes adequate safe heating in the bathroom. 01/06/07 12. OP21 23(2)j Residents must be provided with appropriate bathing facilities to meet their needs and preferences. This was not inspected on this site visit and will be carried to a future inspection. Residents must be provided with a home that is kept clean. There must be enough staff on duty at all times and available to meet the needs of the residents. (The inspection reports of 7/12/04, 11/03/05 and 25/07/05 26/01/06 and 19/06/06 identified this issue as a requirement, and the previous timescales set have not always been met). The rota of staff on duty must show all staff working at the care home and the hours they work. 01/03/07 13. 14. OP26 OP27 23(2)d 18(1)a Sch4 (7) 01/03/07 01/03/07 15 OP29 19, Sch 2 Residents must be protected in staff recruitments procedures/ records kept. Confirmation of suitable checks, identification DS0000015461.V332254.R02.S.doc 01/03/07 Manor Rest Home Version 5.2 Page 27 and references must be obtained and available for each agency staff member before they start working at the home. Previous timescale of 19/06/06 not met. A photograph must be available of all staff. 16. OP30 18(1) & 13(5) Residents must be cared for by a suitably trained staff group. All staff must be provided with appropriate training for the work they are to perform, for example training in medication and other basic mandatory training plus resident specific training. Previous timescales from 15/09/05 to date identified this issue as a requirement, and have not been met). 17. OP33 24 As part of the homes’ quality monitoring practices, the inclusion of residents in the system for reviewing and improving the quality of care provided at the home must be developed. Previous timescales 01/12/06 Residents and staff must be safeguarded *by all staff being involved in regular fire drills and practices. (Previous timescale of 19/06/06) *Fire exits must be kept clear. *Fire doors must not be wedged open. . Residents must be safeguarded and records must show that *water temperatures are checked regularly and *assessments are done on safe DS0000015461.V332254.R02.S.doc 01/06/07 01/06/07 18. OP38 23(4) 01/03/07 19. OP38 23 13(4) 01/03/07 Manor Rest Home Version 5.2 Page 28 working practices * hazardous items must be not be placed where they could cause potential risks to residents. This includes the electrical flex, and the disposable gloves and plastic bags in bedrooms. 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. Refer to Standard OP9 OP9 Good Practice Recommendations Care notes should be written regularly to inform of the residents progress and support good monitoring. The registered person should consider the provision of a photograph of residents is held with the medication records to enable correct identification. The registered person should consider that hand-written changes or additions to instructions for prescribed medicines are signed and dated by two person making the entry. A planned menu should be available and should be readily known and available to residents. The complaints procedure should include information on contacting the funding authority. 50 of care staff should achieve NVQ level 2 The registered manager should achieve NVQ Level 4 training, Registered Manager’s Award. The risk assessment relating to the water system should include more detail and clear instructions on actions to be DS0000015461.V332254.R02.S.doc Version 5.2 Page 29 3. OP9 4. 5. 6. 7. 8. OP15 OP16 OP28 OP31 OP38 Manor Rest Home taken. This refers to complying with the homes own policy and procedure in relation to the testing of cold water temperatures. It also refers to ensuring that all outlets are recorded as run regularly. Manor Rest Home DS0000015461.V332254.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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. 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