Inspection on 13/02/08 for Manor Rest Home

This inspection was carried out on 13th February 2008.

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

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 01/03/07

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 13th February 2008 10:00 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.V359837.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 Rest Home DS0000015461.V359837.R01.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 F/P 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 (12), 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.V359837.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 a mental disorder over the age of 65 years whose identity is known to the Commission for Social Care Inspection. 1st March 2007 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 for resident use. 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 £344 to £435. Additional charges/costs incurred by residents were for personal items such as hairdressing, chiropody, magazines, newspapers, toiletries, alcohol and cigarettes, escort and taxi costs, the blister packing of medication from the pharmacist and trips on the minibus. Manor Rest Home DS0000015461.V359837.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 1 star. This means the people who use this service experience adequate quality outcomes. This was a routine unannounced key inspection and the site visit took place over an eight hour period. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a tour of the premises was undertaken. Residents and staff were spoken with and the comments of those able to participate are reflected throughout the report. Prior to the key inspection, the registered provider/manager had submitted an Annual Quality Assurance Assessment, detailing what they do well, what could be done better and what needs improving. Surveys were sent to the home for distribution to interested people, including relatives and staff. Seven surveys were received from residents, six from relatives and three from staff members and the information they contained is also reflected within the report. The inspector was assisted at the site visit by the manager and other members of the staff team. Feedback on findings provided throughout the inspection process. The opportunity for discussion or clarification was given. The inspector would like to thank the manager, staff team, residents and relatives for their help throughout the inspection process. What the service does well: Manor Rest Home provided a family run service in a friendly and homely environment that made residents feel at home. There was a stable staff team that offered residents familiar faces and continuity of care. People living at the home had good opportunity to participate in a range of interesting activities and outings that enriched their everyday lives. Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 6 Residents and relatives expressed their satisfaction with several aspects of the service including the care, food, activities and staff. Comments from residents and relatives included such as “the food is great”, “there is a great atmosphere here” and “the staff are always friendly and have time for a chat. I think we were very lucky to find such a good home.” What has improved since the last inspection? What they could do better: The management team need to make sure they have all the information required to ensure that they are employing people in a way that safeguards residents. They need also need to continue to arrange more training and include all staff to develop staff skills to ensure best practice for residents. Care plans need to develop to include all aspects of the residents needs, written in a person centred way, with clear instructions for staff to follow so that best possible care outcomes are achieved in a consistent way. Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 7 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.V359837.R01.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 Rest Home DS0000015461.V359837.R01.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, 5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can expect to be given information about the home on which to base a decision to live there and to have their care needs assessed by the management team to ensure that the proposed placement is suitable. EVIDENCE: The manager had a statement of purpose and service user guide available and it was noted positively that the service user guide had been amended as required following the last inspection. The documents were written in a large print to help make them easier to read and had relevant information about the home and the services provided. The contact details for the Commission will need to be updated following an address change. The seven resident surveys and six relative/advocate surveys received confirmed that people felt they had been given enough information about the home to help them make decisions. Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 10 The Annual Quality Assurance Assessment (AQAA) advised that an assessment would be carried out before people are admitted to the home and the statement of purpose confirms that this was to be undertaken by the manager or deputy manager. A review of two recent admissions documentation confirmed that the people had had a detailed assessment prior to admission so that the manager could be sure that the staff team at Manor Rest Home could meet the person’s individual needs. The manager had also written to people to confirm this, a positive development from the last inspection. Residents spoken with confirmed the information in the AQAA that they or their representative were invited to visit the home prior to admission so they could see what it was like and if it suited them. The assessment documents reviewed both recorded visits by the prospective residents and their relatives. Intermediate care is not offered at Manor Rest Home. Manor Rest Home DS0000015461.V359837.R01.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s health and care needs are identified and planned for, however shortfalls were identified which could affect residents wellbeing. Residents can be sure that their medication will be managed safely, and that staff will treat them respectfully. EVIDENCE: Residents spoken were satisfied with the level of care received at Manor Rest Home. All responses on surveys received confirmed that people always received the care and support they needed, including medical support, and one described it as “excellent”. Residents spoken with were also satisfied with comments such as “you couldn’t find better care than here” or “it’s brilliant here, I am very settled”, and confirmed that staff respect their privacy and dignity at all times. This was observed in the way that staff spoke to residents. Relatives’ surveys also contained positive responses regarding the staff team’s ability to meet the needs of their relative/ friend and had comments such as “she is well looked after” and “caters well for all my relatives needs”. Two care Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 12 plans were viewed in depth and another for specific issues. Care plans were available for all residents and contained relevant information in some areas to help the staff team to support people in the way they needed and preferred. Life histories were noted and provided good information that could be better developed into person centred care plans. Residents signed their care plans, showing their involvement, which is also good practice. A tick box format was used to record several aspects of daily care provided, however they continued to show gaps of ten to twelve days between baths. The manager said this was just because staff had not ticked the boxes to keep the records accurate and up to date. The long term care plan format continues to give an overview of the person’s overall needs with information such as “carer to assist with general bath”. This did not offer sufficient detail for staff to follow consistently, for example, as to when this was to occur, and was not written from a person centred approach, for example, what skills the person retained and how these could be supported to maintain their independence and dignity. Short term care plans were also limited in information in some cases, for example where a resident had a pressure sore the care plan did not specify how often the person was to be turned or what pressure relieving equipment was to be used, to support healing. The manager advised that the pressure sore had developed in the home, during a period where the resident had been unwell. A preventative tissue viability risk assessment tool was not in place. It was noted positively that turning and fluid intake charts were in place, however the latter were not always completed by staff so giving the impression that the person had not been offered or had any fluids for long periods. No care plan was in place relating to some other needs such as continence management, oral and foot care or medication. Risk assessments were in place, such as for moving and handling and falls, which is good practice to safeguard residents and those supporting them, and reviews were noted as resident need changed. Specific information was not included for example where a hoist is used to identify which sling is to be used for each person. Residents’ weight were monitored and recorded. Healthcare records show access to local services, which was confirmed by residents spoken with and confirmed in surveys received. Evidence of district nurse intervention for the person with the pressure sore was noted in records, as were interventions for other residents including GP and chiropodist. Medication was examined and improved management was noted. No omissions were seen on the Medication Administration Recording (MAR) sheets. They again did not contain a photograph of the resident to support identity. Staff confirmed the AQAA that medication training had been provided. Handwritten entries to the MAR were now double signed. There was no care plan for a resident who had been prescribed antibiotics to support care during their illness. Staff said that a medication policy specific to the home was not Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 13 available. This is recommended so that staff have clear information on what is expected of them. A copy of the Royal Pharmaceutical Guidelines were available and a current medications directory as guidance for staff. Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. People living Manor Rest Home had opportunities to participate in activities that are appropriate to their needs, support to maintain relationships and had a varied diet that they enjoyed. EVIDENCE: The manager and team at Manor Rest Home had improved the opportunities for residents to participate in a range of interesting and appropriate social and leisure pursuits. The additional staff hours provided had supported this. The manager provided a minibus to take residents on outings and the charges for these trips were then invoiced to the resident/relative. An activity co-ordinator was employed for two hours weekly, a volunteer came in to do manicures and hand massage and the hairdresser visited weekly. All but one of the resident surveys received stated that there were always activities available to them that they could take part in. One person commented “all activities are eagerly awaited and enjoyed”. Residents spoken with were positive about these, advising that they enjoyed the hoopla, painting and games, that “there was lots to do and join in with” or “plenty to do, if you Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 15 want”. An information area in the main entrance hall now displayed residents’ paintings along with information, for example on the mobile library visits The statement of purpose stated that all efforts would be made to assist any resident who wished to attend a religious service. The manager advised that none of the residents are currently practicing their religion and the vicar no longer comes into the home. The minutes of the recent residents’ meeting showed that resident views and suggestions on activities had been invited and received. Staff maintained a record of activities that residents participated in. This will help monitor their suitability. Visiting at the home was open as advised in the statement of purpose. Residents spoken with said their visitors were always made welcome, offered a drink and had a good rapport with staff and management at the home. Evidence was seen of staff supporting residents to maintain relationships outside the home, for example in making telephone calls. Information on advocacy services was readily available. Residents spoken with confirmed they could make choices in their day to day life at Manor Rest Home, for example whether to join in activities, or to spend time in their own room, with food or the time they go to bed etc. A nutrition record that includes all meals, snacks and drinks was available and supported staff to clearly monitor resident consumption to ensure good nutrition and fluid intake was maintained. This showed that there was a choice of main meal most days and a roast dinner on Sundays. It also demonstrated that residents specific needs and preferences were accommodated, such as having a sherry, or a liquidised diet or dietary supplements. No planned written menu was available so that residents could know, or remember, at any time what meals were to be served and the choices available. The administrator stated that residents are informed the day previously and asked for their choice at that time. On the day of the site visit residents had a choice of burger or chicken kiev for their main meal. All residents spoken with were satisfied with the meals served at Manor Rest Home. The seven resident surveys received showed that all residents were always happy with the food served and comments included “the food is lovely and there is plenty of it” and “I look forward to the meals and I have not been disappointed yet”. Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 16 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. People who use the service have access to an effective and understandable complaints procedure that ensures that they are listened to and they can expect that the procedures followed by staff would help to safeguard them. EVIDENCE: A complaints procedure was clearly displayed in the home so that residents and visitors would know how to raise any issues. It should be updated to reflect the Commission’s new contact details and it is recommended that it advise people that they may approach the local/funding authority if they wish to raise any concerns and offer contact details. Information was available in the statement of purpose on this aspect and on the complaints process. The manager stated that they not received any complaints since the last inspection. The Commission had not received any complaints about Manor Rest Home. All surveys from residents and relatives/advocate confirmed that they would know how to make a complaint. Residents spoken with confirmed this and that they would comfortable to raise any issues with the staff and management team, with the expectation that they would be listened to and acted upon. A whistleblowing policy was available and information on this was also seen in the statement of purpose, which reassured people that complaints are viewed Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 17 positively as a means of ensuring standards are maintained. Staff spoken with had an understanding of protecting vulnerable people and a clear understanding of whistleblowing. The AQAA stated that one area where the service has improved was in the provision of abuse training for staff. This would help staff identify types of abuse and the most effective way to report it to safeguard residents. The training matrix provided at the site visit showed that thirteen of the eighteen care staff have attended this training during 2006/07 and this basic training needs to be provided for all staff, and is noted as part of Standard 30 of this report. . Standard 29 of this report also identified staff recruitment as an area where practice did not best safeguard residents. The manager advised in the AQAA of plans to provide continued training in areas such as challenging behaviour. This would help staff support residents positively, particularly as the home is registered to provide care to people with dementia. The manager advised during the site visit that this forms part of the current Aset Level 2 training on dementia care that six staff were in the process of completing and evidence was seen in the course file. Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although some aspects of the home environment are recognised as satisfactory, others areas were highlighted that do not provide all residents with a pleasant and well maintained environment. EVIDENCE: Manor Rest Home offered residents a choice of sitting areas with two separate lounges and the dining room/conservatory. These rooms were pleasantly decorated and furnished providing a pleasant environment for residents. The pleasant level of décor and furnishing carried onto many, but not all of the bedrooms. The AQAA shows the manager’s awareness that further work is required. One bedroom carpet was particularly stained and some furniture had broken drawer fronts etc, which does not show appropriate respect for the people living in these rooms. The manager confirmed that some new furniture Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 19 had been ordered and that this carpet was to be changed in the near future as finances allowed. Residents spoken with said they were satisfied with their bedrooms, one person said they had been able to bring their own bed, another said their room was “lovely” and another was happy that they had their own television in their room. Shared rooms had curtain or screen dividers to support privacy and dignity. Net curtains had been fitted to all bedroom windows including on an overlooked window since the last inspection, to protect the resident’s dignity while washing. The manager has advised that residents no longer use the hairdressing sink that was sited in a resident bedroom and did not promote privacy and dignity but now utilise a bathroom and the far end of the conservatory. The resident telephone is sited in the main hallway, limiting privacy. The administrator stated in the AQAA that recent improvements to the home were the fitting of covers to radiators in resident bedrooms and confirmed in discussion that the risk assessment of the other radiators ensured resident safety. The upstairs bathroom had been refitted and redecorated and had a new chair hoist, so providing more choice of bathing facilities for people living at the home. One resident said they liked having a bath as they sit can down into it. New commodes were available, providing better and more respectful facilities for residents. Hairbrushes, combs etc. in residents’ bedrooms were notably cleaner than at the last inspection, which respects resident dignity. There was an accessible patio with furniture that provided an alternative place to sit in nice weather. This had recently been fitted with a special surface to make it safer for residents should they have a fall. A commercial style patio heater with canopy had been obtained so that people could use the patio in all weathers, accommodating the needs of people who wished to smoke. The premises were notably cleaner on this occasion. The laundry was well equipped. Residents spoken with said their clothes were well looked after and they were satisfied with the laundry services at Manor Rest Home. The AQAA identifies that none of the staff had attended training on infection control and the manager had no policy on or action plan for infection control management, to support resident wellbeing. The administrator advised that this was now being worked through and the manager advised that this is training that will be considered for staff once they had completed the training they were currently undertaking. This will be considered at future inspections. The majority of resident surveys received said that the home is always fresh and clean and one said it usually is. Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to be cared for by a stable and reasonably informed staff group that offers them consistency of care. Recruitment procedures do not fully safeguard residents. EVIDENCE: Residents spoke positively about their relationships with, and the care provided to them by, staff at Manor Rest Home. Comments from residents spoken with included “staff are so kind and helpful” staff are “lovely”, “wonderful” and “they have a sense of humour”. The rosters sampled showed staffing levels of one senior and two care staff were maintained as a minimum during the day, an additional staff member was available most days between 10am and 2pm, and one awake and one sleep in member of staff were available to residents at night. A housekeeping staff member was available for some hours each day. This is an increased staffing level since the last inspection and is noted positively in line with the home’s increased registration to care for people who live with dementia. Surveys from residents showed they felt that staff always listened and acted on what they said and were always available when they needed them. The training matrix identified that fifteen care staff were employed, in addition to the manager and administrator. The administrator had achieved National Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 21 Vocational Qualification (NVQ) Level 4 and the deputy manager had almost completed this course. Of the care staff, one had achieved NVQ Level 3 and six staff were undergoing NVQ Level 2 training. The team have not yet achieved the recommended target of 50 of care staff trained to NVQ 2 or above. Staff spoken with advised that they will be commencing NVQ training in the near future once they have completed their current training course on dementia. The staff files of two of the more recently recruited members of staff were viewed. These showed some areas where practices that protect residents had not been maintained. Prospective staff did not complete a written application but their details were recorded on an interview checklist, and so a full employment history was not available as required. A photograph or other evidence of identity was not available as required in one case, an issue also noted at the last inspection. Other required references and checks, including povafirst/ criminal record bureau checks were in place, as was a declaration of physical and mental fitness for the job, which is positive. The manager advised that they staff team is now stable and no agency staff had been used for some time. The AQAA stated that most of the staff had worked at the home for many years. This provides continuity for residents and opportunity to build relationships with familiar people. Documentation sampled showed that the home had systems in place to ensure that staff received an induction into the home, both an in-house induction and an induction to common induction standards, depending on experience. This ensures that residents receive care from staff that had received initial training to assist them to know the home and the care residents require. The AQAA stated that staff may benefit from additional training outside the core areas. Since the previous inspection training at the home had improved and a training matrix has been produced that shows training provided and needed in a clear and easy to read way. This showed the additional training provided but also identified that some staff need to be provided with basic training/updates such as moving and handling, first aid and protection of vulnerable people as well as in areas such as continence management, infection control, preventative pressure area care or falls prevention. The AQAA advised that advanced medication training had been provided for staff that administer medication. Staff spoken with confirmed this and the ongoing training on dementia care that was being undertaken by seven staff, including the manager. Staff surveys confirmed that staff felt they were given adequate and relevant training to meet the individual needs of the residents. The manager advised that the deputy was booked to update their training as a moving and handling instructor in the near future and staff will then be given this training or updates. Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 22 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, 37 and 39 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Manor Rest Home benefited from an increasingly effective management team who generally worked in the best interests of the people who lived there, but did not best promote and protect their health and safety in some aspects including safe staff recruitment procedures. EVIDENCE: At this inspection it was positive to note that progress has been made by the management team at the home to address several of the previous identified shortfalls and requirements. However, some aspects were disappointing such as ensuring that all staff had basic training in moving and handling, protecting vulnerable people and fire drill practices and evidence of robust staff recruitment procedures to safeguard residents. Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 23 The manager at Manor Rest Home is supported by her husband the administrator, and a deputy manager in the day to day running of the home. The manager was undertaking an ongoing dementia care training course and had also attended an advanced medication course since the last inspection. The administrator had achieved Registered Manager Award NVQ Level 4, training for managers on protecting vulnerable people, and the training matrix stated that he is a qualified trainer in health and safety, fire, safer food handling and the Mental Capacity Act. The AQAA stated that the management team recognised that they needed to develop their quality assurance systems and planned to introduce resident meetings and surveys. This would allow residents to have a clear and regular opportunity to express their views about the home and have a say in the way the home is run. Minutes were available to show that a recent resident meeting had occurred. An analysis was available of surveys that had been sent to relatives, outside agencies and professionals that showed satisfaction with value for money, cleanliness of the home and the overall standard of care provided. A survey had also been prepared that was to be distributed to residents. An audit of the premises had been undertaken and an action plan was being worked through to improve the premises for the residents. The manager holds monies on behalf of residents and records are maintained in the home. Inspection of a random sample of individual resident’s monies showed that they were in order with receipts available and the resident’s signatures was now available where they withdrew cash. Records were sampled and outcomes noted during this inspection report show an improvement to the recording systems as well as to the content in most instances. Accident records were maintained and completed appropriately. A photograph was not available of all residents to support identification. The manager advised that in one case the person refused to have their photograph taken and in the other the manager had forgotten to take it. Aspects of health and safety were reviewed. Current inspection certificates were available relating to the fire alarm, emergency lighting and nurse call system. Tests of water temperatures were recorded quarterly and the manager is recommended to ensure that this meets required responsibilities in relation to prevention of legionella as well as protecting resident safety. Fire drills were recorded regularly but again did not show that all staff had had fire drill practice/ training. The administrator stated that risk assessments for safe working practices were not available. Records showed weekly testing of the emergency lighting and fire alarm, which is good practice and safeguards those who live and work at Manor Rest Home. Manor Rest Home DS0000015461.V359837.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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 X 3 X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 2 2 Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement So that residents are cared for safely and in a way that meets all of their care needs, care plans must identify all their individual assessed needs. Care documentation must provide staff with sufficient information to enable them to offer residents proper and consistent care and assistance. This includes areas identified in the report such as preventative pressure care, continence management, medication or oral care. Previous timescales from 15/09/05 not fully met. 2. OP19 16(b &c)23(2) All areas of the residents home must be maintained to a reasonable standard of decoration and furnishing including carpets. Previous timescale of 01/06/07 not met. 3. OP29 19, Sch 2 So that residents are safeguarded, there must be evidence of robust and safe DS0000015461.V359837.R01.S.doc Timescale for action 01/04/08 01/04/08 13/02/08 Manor Rest Home Version 5.2 Page 26 recruitment procedures and all the required records and documents must be available at all times for inspection, including photographs and evidence of identity. Previous timescales of 19/06/06 and 01/03/07 not met. 4. OP30 18(1) & 13(5) So that residents are cared for by a suitably trained staff group, all staff must be provided with appropriate training for the work they are to perform, to enable them to meet resident’s care needs. This includes the training needs identified in the report. Previous timescales from 15/09/05 to date identified this issue as a requirement, and have not been met. 5. OP37 17(1)a Sch3(2) To support accurate identification 01/04/08 to safeguard residents the manager must ensure that a photograph is available of each resident. Residents and staff must be safeguarded by all staff being involved in regular fire drills and practices. Previous timescales from 19/06/06 not met. 6 OP38 23 13(4) Residents and staff must be safeguarded and records must show that water temperatures are checked regularly and assessments are done on safe working practices Previous timescales from 01/03/07 not met. 01/04/08 13/02/08 01/04/08 5. OP38 23(4) Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 27 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. Refer to Standard OP7 Good Practice Recommendations Care notes should be written regularly to inform of the residents progress and support good monitoring. Outstanding from the last inspection report. 2. OP9 A photograph of residents should be held with the medication records to enable correct identification. Outstanding from the last inspection report. 3. OP9 The manager should provide staff with a clear policy and procedure on management of medication so that staff know what level of practice is expected of them to ensure resident wellbeing. A planned menu should be available and should be readily known and available to residents. Outstanding from the last inspection report. 5. OP16 The complaints procedure should include information on contacting the funding authority. Outstanding from the last inspection report 6. OP26 The manager should provide staff with a clear policy and procedure on management of infection so that staff know what level of practice is expected of them to ensure their own and residents’ health is promoted and protected. 50 of care staff should achieve NVQ level 2 Outstanding from the last inspection report 5. OP31 The registered manager should achieve NVQ Level 4 training, Registered Manager’s Award. 4. OP15 4. OP28 Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 28 Outstanding from the last inspection report 6. OP38 The risk assessment relating to the water system should include more detail and clear instructions on actions to be taken. This refers to complying with the homes own policy and procedure in relation to the testing of water temperatures. It also refers to ensuring that all outlets are recorded as run regularly. Outstanding from the last inspection report Manor Rest Home DS0000015461.V359837.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Regional Contact Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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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