Inspection on 19/06/06 for Manor Rest Home

This inspection was carried out on 19th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 01/03/07

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 19th June 2006 9:50 19/06/06 09:50 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.V293497.R01.S.doc Version 5.1 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.V293497.R01.S.doc Version 5.1 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 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.V293497.R01.S.doc Version 5.1 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 dementia over the age of 65 years whose identity is known to the 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 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. 26 January 2006 3. 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 pre inspection questionnaire did not provide information on the home’s fees. The administrator advised that the weekly fee ranges from £320 to £390. Additional charges/costs incurred by residents were identified in the preinspection questionnaire. This included hairdressing at £7.50 to £25, chiropody at £10, magazines, newspapers and toiletries at cost, taxis and an escort at cost and trips on the minibus being charged at between £5 and £40, depending on the trip. Other charges that were being made to residents were identified during this site visit are noted in the report. Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was undertaken as part of the key inspection of Manor Rest Home. Eight hours were spent at the home as the site visit. The registered provider/manager or deputy manager were not on duty at that time. The husband of the registered provider/manager attended and assisted for the majority of the site visit. He undertakes a lot of the administrator of work at the home, and simply for clarity, is therefore referred to in this report as the administrator. Staff also assisted with various aspects of the site visit. Three care staff were spoken with. Nine residents 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 third resident in specific areas. A pre-inspection questionnaire was received from the registered provider prior to the site visit and information from that document was also used to inform this report. Discussion of the inspection findings took place with the administrator throughout the inspection and guidance and advice was given. Three Immediate Requirement forms were issued to the home in response to areas of immediate concern identified at the site visit. These related to the safety of the premises, the safety of staffing levels/deployment and to the management of residents’ monies. No completed questionnaires/comment cards were received from residents, prior to the site visit. 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 fifteen relatives, before and following the site visit. All confirmed they were satisfied with the overall care provided at Manor Rest Home. Comments were also received from four care managers/social work teams, all of whom had satisfactory/complimentary comments regarding the home, particularly in relation to a resident with mental health needs and another who had dementia. What the service does well: All the comments made about staff, whether by relatives or residents, were complimentary and said that the staff were nice. Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 Page 6 All those who commented, including the residents, relatives and social workers said they were satisfied with the overall care provided. Comments included “is an outstanding care home... I cannot praise Rebecca, David and the staff enough, the care given a Manor Rest Home is excellent. The staff are all extremely friendly and also able to help in any way. Some parts of the home provide residents with a nice comfortable place to live. One relative commented that the home is very clean. What has improved since the last inspection? 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. Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 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.V293497.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6 The judgement in this outcome group is adequate. This judgement has been made using available evidence including a visit to this service. Information about the home is available to those considering coming to live there. Assessment needs to be clearer in identifying the prospective persons needs so that the home can be sure they can meet them. EVIDENCE: The administrator confirmed that the changes identified in the last inspection as needing to be in the statement of purpose had not been included. Resident files sampled contained a statement of terms and conditions/ contract that were signed by a next of kin and also in one case by the resident, which is positive. The file for a recently admitted resident indicated that a pre-admission assessment had been undertaken by the home. There was a lack of clarity on the actual reason for admission, for example in identifying the resident’s main Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 Page 9 area of need. A copy of the pre-admission assessment from the local authority (COM 5) was not available. The home is registered to admit one resident who has dementia on admission. The administrator was unclear which resident this actually was. The notes for a resident recently admitted from another care home indicated that the person had chronic dementia. The notes from the recent initial placement review at Manor Rest Home states the nursing needs assessment states that (the resident) has dementia but no other document states this”. The review did identify however that the resident has chronic confusion. It appeared that the registered provider/manager had admitted residents outside the conditions of their registration. Their own assessments were not always thorough enough to identify the residents main care needs, and they had not provided written confirmation to the resident prior to admission, that based on the assessments, the home can meet their needs. The section on training identified in this report under the section on Staffing, shows that several staff, including the registered manager, have not had basic mandatory training in some areas. Additionally several staff had not had training on specialist areas for example on conditions associated with older people. This could clearly have an effect on the homes ability to meet residents’ needs. The administrator confirmed that the home’s policy is to invite prospective residents to visit the home prior to admission and stay for lunch if they wish. He confirmed that a recently admitted resident and a member of their family visited prior to admission. Manor Rest Home does not offer intermediate care. Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8. 9. 10 The judgement in this outcome group is adequate. This judgement has been made using available evidence including a visit to this service. Care records varied in the information provided to ensure consistency of care for residents. Some aspects of the homes approach to the management of medication need to be improved to ensure residents are safeguarded. Residents’ dignity and privacy was respected. EVIDENCE: A care plan was in place on each resident file sampled. The home use a Standex system, this includes using tick boxes to record that certain actions/care have occurred. The system uses an initial long-term care plan on admission, which is to be followed up by short-term care plans. The care plans sampled varied in the quality and quantity of relevant detail recorded. The care plan for a very highly dependent resident included pressure area care, and fluid intake and turning charts were maintained, which is good practice. The care plan identified a change where the resident now refused a soft diet, and had been provided with build-up drinks. A risk assessment was in place relating to the use of bed rails, a Kings Fund bed had been provided and there was peninsular bed access. The risk assessment was dated January Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 Page 11 2005. There was no evidence of updating to ensure the residents safety, especially in light of likely weight loss. A member of staff was able to advise that the home had arranged for all medications to be dispersible or in liquid form for the resident. This was not identified/recorded in the plan of care. A long-term care plan identified that a resident can become quite intolerant of other residents at times. There was no instruction for staff on how to manage this within a care plan, long or short term. The care plan did not identify how often, or when best to, offer a bath to the resident where an issue with personal hygiene was identified. Moving and handling assessment identified the need for one carer, but did not identify what assistance this was and whether any equipment was required. A falls risk assessments was in place on one file sampled. Risks in relation to absconding or wandering had been identified and recorded. A file sampled did not include a care plan in relation to routine health care screening, for example foot, dental or optical care. It was confirmed however that the chiropodist does visit six weekly. This needs to be more clearly identified as a care need and recorded as a care action for each resident. There was a clear care plan in relation to a residents diabetes. Medical records demonstrated regular monitoring in relation to diabetes and cholesterol, flu jabs as well as appointments with the optician and chiropodist. Files indicated that residents were weighed monthly and this was recorded in their moving and handling assessment. As noted, some care actions are not detailed but are recorded in a tick box system. Allowing for this, some care notes did not contain adequate detail. For example where a residents records recently report confused and banging doors, wanted to hit me, in and out of bed, that was no record of how staff managed this behaviour. Key workers review each file monthly, which is positive. It would be more effective if issues identified by key workers, for example a note of increased tremors/shakes affecting a residents ability to eat in a comfortable manner, was identified as a care management issue in the care plan with instructions on how best to assist the resident. Care plans generally had been reviewed regularly. It was disappointing to note that where a resident had previously signed their care plan, there was no evidence of this following a recent review. Photographs were available on some files and others identified that the resident had refused to be photographed. One file did not have a photograph and there was no evidence that the resident’s view had been sought on this matter. Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 Page 12 The medication administration recording (MAR) sheets did not evidence any omissions, which is positive. Photographs were not available on the MAR sheets and it is recommended that this be considered as a safeguard. A current signatory list was available. A copy of the Royal Pharmaceutical Society Guidelines on Medication in Care Homes was available. MARs and actual medications sampled tallied. No protocols were available for as required medications. Where a resident was self-administering medication, which could be seen as a positive approach, there was no risk assessment to ensure the safety of that resident and others in the home. A senior staff member was unaware of the homes policy and procedure on medications. This was found to be available but did not refer clearly to protocols for ‘as required’ medications or reference to risk assessment for selfmedication. The policy and procedure does state that staff administering medication will have annual updates. The pre-inspection questionnaire identifies the staff responsible for administering medication. This was compared to the staff training matrix, which identified that four of the responsible staff have never had training on medication, and that for some staff, their most recent training was five years ago. A limited number of homely remedies were available and when administered were recorded on the back of the MAR. A general agreement was available from the GP surgery to confirm that the homely remedies identified were acceptable for use with residents at Manor Rest Home. This is good practice. Staff were seen to knock at doors, to wait to be invited in and also to use residents’ names when speaking to them. Residents spoken with confirmed that staff did treat them with respect. Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The judgement in this outcome group is adequate. This judgement has been made using available evidence including a visit to this service. The range of activities provided needs to show more clearly that they meet with individual residents needs. Visitors felt welcome. Residents exercise choice in some areas. Residents are provided with a nutritional diet. EVIDENCE: An activities coordinator provides two hours input each week and a beauty therapist also provides two hours input each week. Care staff were seen to undertake activities with residents, for example there was a game of bingo. Where assessment identified, for example, that a resident loved walking, this was not included in a care plan related to their social/leisure needs and preferences. The residents file identified it was not safe for them to go out alone and that they were to go out on assisted walks only. There was no evidence in the care notes to show that the resident was taken out regularly for walks by staff. The tick box record for social activities however recorded that wandering was a regular activity for this resident. Some residents were able to operate some choices. One resident spoken with said they keep occupied and watch sport on television. Another resident said that they watch films on television. Residents who were able chose where in Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 Page 14 the home they spend their time. One resident goes out regularly to a planned group resource group. All fifteen of the relatives who replied via a comment card confirmed that the staff and owners make them welcome in the home at any time and that they can visit their friend/relative in private. On the day of the site visit lunch was sausage and mash with an alternative of burger. Condiments were seen on some tables and tablecloths and flowers were also seen. A diabetic resident was offered fruit or yoghurt as an alternative to the pudding. No planned menus were available. The weather had been extremely hot recently and there was no evidence that, for example, salads had been offered. Residents are asked each afternoon which of the next days choices e.g. sausage or burger they would like for their meal. There are also asked for their choice for the tea that afternoon and the record of food served show that residents do have variety at this time. Breakfasts were not recorded and it was recommended that the home considered providing an occasional cooked item as a choice at this time. The record of main meals was discussed with the administrator as being repetitive, for example pork chops on Tuesday followed by pork casserole on Wednesday. Washing-up was being undertaken by care staff while residents were eating lunch. When collecting plates however it was noted that staff did offer some assistance to residents and some spoke to residents more than others. All the residents spoken with said that the food was satisfactory. Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 The judgement in this outcome group is adequate. This judgement has been made using available evidence including a visit to this service. Relatives/visitors were aware of the homes complaints procedure. Arrangements for the protection of residents were not satisfactory in some aspects, placing them at possible risk of harm or abuse. EVIDENCE: The administrator advised 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. The complaints procedure was not displayed in the home. The administrator advised that it is included with the service user guide. Advice was provided 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 on the complaints procedure. Of the fifteen comment cards received from relatives/visitors, all said they had never had to make a complaint to the home and only one stated they were unaware of the homes complaints procedure. Residents spoken with said they would be able to tell staff if they were unhappy with something. Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 Page 16 The administrator advised that cards for postal voting were taken round to residents when they arrived. No residents have chosen to/being able to use these recently, but have done in the past. The last inspection report identified that the arrangements for the protection of residents at the home were not satisfactory and that staff had not been provided with appropriate support and training, for example in protecting vulnerable adults or in the management of behaviour that challenges. It is noted positively that nine of the care staff have attended training on adult abuse in 2006. One senior carer is the only staff member recorded as having attended training on the management of aggression, although not within the past year. This needs to be reconsidered in line with the recordings identified in the care notes sampled. Since the last inspection, one incident regarding this home was reported to social services under the protection of vulnerable adult (POVA) protocol. Social services advised that no action was to be taken and the Commission did not log it as a POVA incident. It is however considered in this report under the section on Staffing. Since the last inspection one other incident was reported under POVA, which alleged an assault on a resident. The registered person is still awaiting a response from social services as to the outcome of the investigation, but took appropriate disciplinary action regarding the member of staff. The registered person identified a concern that during the investigation, staff had been aware of other relevant incidents/poor practice but had not reported it. It was of concern at this inspection that, although the administrator stated that they had had some conversations with staff, there had been no formal/evidenced action by the registered person to address this with staff and to ensure appropriate knowledge, skills and care practices. Advice was provided that the registered person discuss the matter with all staff formally, for example at a staff meeting, which could be minuted, and ensure staff are offered formal supervision sessions where such issues could have been picked up and addressed. There was concern identified with the administrator about his use of some aspects of residents money, with no receipts or proper explanations about certain withdrawals. Additionally, there were hidden charges to residents that were inappropriate, for example the cost of packing their medication. An immediate requirement form was issued. This concern is also considered under National Minimum Standard 35 in the Management and Administration section of this report. Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 25, 26 The judgement in this outcome group is poor. This judgement has been made using available evidence including a visit to this service. Some aspects of the premises presented residents with a pleasant and well maintained environment. Other areas of the premises were not as well maintained and safety issues identified did not best protect residents. EVIDENCE: The communal lounge and dining areas were pleasantly furnished and decorated. Residents had access to a garden area and a lovely large patio with plenty of tables and chairs. The administrator advised that two bedrooms had been re-carpeted and redecorated recently. Other areas of the premises were noted to be in need of decorating and carpets in several areas were stained. The Medi-bath continues to leak and this has been raised at two previous inspections as unacceptable. There was a clear area of mould growing on the shelf by the pipe/bath. The call bell in this bathroom was not working. Wash hand basin taps in other areas were deeply scaled looked unsightly and were in need of a thorough cleaning. Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 Page 18 Bedrooms varied in the quality of their decor and furniture. In some rooms residents had no access to a lamp, or switch to turn on the main light, when in bed, to help them to see when they got out of bed in the dark. In one room the main light was not working and there was no lamp. The vanity unit in one room was in very poor condition. Hairdressing is undertaken by using a specific sink that is sited in one of the downstairs double bedrooms used by residents. This does not respect the privacy and dignity of residents and is not considered good practice. The temperature of the hot water was sampled in areas throughout the home and found to be satisfactory. The restrictors were missing from some opening upstairs bedroom windows. The administrator advised that they had been in place previously but must have been removed up to a year ago by the decorators and not replaced. This placed residents at potential risk. An Immediate Requirements form was issued to the home requiring them to make this safe immediately. Radiators throughout the home were found to be too hot to the touch. When drawn to his attention, the administrator advised that somebody must have turned up the thermostat. While risk assessments were in place relating to the radiators, they were inadequate in scope and there was clearly a risk to residents. An Immediate Requirements form was issued to the home requiring them to provide a specific plan/timescale to the Commission within seven days as to how they would make the radiators safe. The last inspection report identified that the homes laundry requires work to be carried out to the walls, flooring and hand washing facilities. The preinspection questionnaire did not identify that any work has been undertaken to the laundry. Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The judgement in this outcome group is poor. This judgement has been made using available evidence including a visit to this service. The management of staffing levels/deployment were not considered adequate to best protect residents. The management of recruitment and training did not safeguard residents. All residents and visitors who expressed a view were complimentary about the individual staff at Manor Rest Home. EVIDENCE: Manor Rest Home maintained a staffing level of three staff, including a senior, for most of the day. This however was reduced to two staff for an hour during the afternoon. It is considered unacceptable to have two staff caring for 19 residents and their presenting needs. The home should maintain the minimum staffing level all day and could use this time effectively, perhaps to provide one-to-one activities or to take residents out. The senior carer undertakes the cooking. This is not considered appropriate deployment of staff and the senior carer should be on duty on the floor, monitoring and managing the residents care. As noted earlier the home reported an incident under Regulation 37 as required earlier this year. This identified that the on-call system in the home was not safe or effective. The system is that the deputy manager, who lives upstairs, undertakes all the sleeping night duties seven days a week. This was not identified on the rota. The system had been shown as ineffective and unsafe when put to the test. Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 Page 20 The administrator advised that, since the incident, they have been trying to recruit somebody from the local hospital to undertake night duties in the home, but have been unsuccessful and therefore have not taken any other action. At the time of this site visit, the deputy manager was away on holiday and she was paying another member of staff to sleep in the home. The administrator was advised that the registered person is responsible for ensuring the employment of staff at the home. An Immediate Requirement form was issued to the home requiring that they put in place appropriate night staffing levels, that a clear protocol for sleeping in duties was to be sent to the CSCI within three days, and a record of the night staff to be clearly recorded on the roster. The roster also needs to identify the full name of all persons working in the home and which member of staff is undertaking cooking duties each day. The administrator advised that the deputy manager has completed NVQ 2, as had three other staff. An additional two staff have completed the course but unfortunately the college has lost their work. The training matrix also indicates that two staff had additionally undertaken NVQ level 3. The staff recruitment file was sampled for one more recently employed member of staff. While no formal application form was on file, the interview details confirm a history for the past 10 years. A declaration of offences and of mental and physical health was on file as was evidence of identity, which is positive. A current photograph was not on file but one was available on an ID badge from a previous employer. One reference was dated as received on the day employment started and the other as received a week later. A Povafirst check is recorded as having been received 10 days after the person started working at the home and there was still no CRB check evidenced. The administrator stated that this was in his briefcase at home. There was no job description or contract of employment on file. The induction format contained very limited entries although the person had been in post for at least two months. The home advised that their deputy manager is a trained moving and handling instructor. It is again noted with concern at this inspection that the majority of staff, including the registered manager, do not have up-to-date moving and handling training and some staff are recorded as not having had the training at all. The training matrix shows that several staff had attended training in Adult Abuse and Safer Food Better Business in the past year. One staff has attended Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 Page 21 Training on falls prevention, two in vital signs and two in moving and handling. The training matrix shows that nine staff have not had fire training and of the five that have, these date back as far as 1995. The administrator advised that the manager is to undertake fire training in September and then will have a hand in the induction of new staff. One care assistant out of the entire staff team is recorded as having attended infection control training. The issue of medication training has already been raised. Three staff have current first aid certificates. The administrator advised that training is planned for four staff in protection of vulnerable adults, three staff in prevention of falls, two staff in dementia care, to one vital signs and one on continence management. Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 The judgement in this outcome group is poor. This judgement has been made using available evidence including a visit to this service. The management team have not evidenced the understanding of, and skills for, managing the home effectively to safeguard residents and to meet national minimum standards and regulation. EVIDENCE: The registered manager/provider was not on duty at the time of this inspection and so was unable to provide input to this report. The registered manager/provider qualified as a nurse some 15 years ago and has no formal management qualification. Advice was provided at the last inspection for her to consider completing at least the management section of the Registered Managers Award. The training matrix indicates that the registered manager/provider has attended very limited updated training and apart from one course attended in 2006, no dates are given for any other of her training. Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 Page 23 The administrator advised that the home did do questionnaire exercises in the past but have not done so in the last year. Residents meetings are not held. There was no evidence of any effective quality assurance system in the home. As noted earlier, the homes practice did not comply with National Minimum Standard 35. An Immediate Requirement form was issued to the home, as proper records were not kept about the use of residents money, some receipts were absent, residents money was pooled together, and also pooled with the homes own petty cash money, which made auditing extremely difficult. The home did not have a written record of their charges to residents, including any additional amounts payable for any additional services not covered by the charges and the amounts paid by/or on behalf of each service user. The administrator advised that the home do not provide formal supervision for any staff. This has been raised previously and it was advised at the last inspection that the manager had undertaken training in this subject over a year ago, but had not implemented a supervision system. Records of weekly checks of the fire alarm were available. Fire drills need to better evidence that all staff have been included and record the time of the event. Evidence was available of satisfactory inspection in relation to the emergency lighting, fire alarm and call bell system, as well as the gas and electrical fixed wiring. Records of cold water temperatures or checks of all outlets were not available. The safety inspection certificate in relation to the hoist had expired. Data sheets and risk assessments were not available in relation to COSHH items. Risk assessments were available in relation to safe working practices. Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 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 2 3 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 4 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 1 1 3 1 X X 2 1 2 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 1 1 X 2 Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 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 OP1 Regulation 4 Requirement The Statement of Purpose must include information on the homes aims, objectives and philosophy of care and identify more clearly the physical environment standards met, or not met, by the home in relation to standard 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10. A summary of these should appear in the Service User Guide. The registered person must ensure that evidence of an appropriate and detailed assessment is available in relation to each resident and the actions required in the Regulation have been complied with. 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 DS0000015461.V293497.R01.S.doc Timescale for action 01/11/06 2. OP3 14(1) 01/10/06 3. OP4 18 01/11/06 4. OP7 15(1) 01/10/06 Manor Rest Home Version 5.1 Page 26 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 and 15/03/06 not met). 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 health. (Previous timescales of 15/09/05 and 15/03/06 not met). The registered person must ensure that risk assessments are reviewed regularly for residents to ensure they continue to meet their identified needs. The registered person must make arrangements for the safe recording and keeping of medications in the care home. (The inspection reports of 7/12/04, 11/03/05, 25/07/05 and 26/01/06 identified different aspects of medication management as a requirement, and the previous timescales set have not been met in all areas). The issues noted at this site visit include appropriate risk assessments for self-medication, the availability of protocols in relation to as required medications, and updating of the homes policy and procedure in relation to medication. 8. OP9 13(2) & 18(1)c (i) The registered person must ensure that staff employed at the care home are provided with training appropriate to the work they are to perform. This refers DS0000015461.V293497.R01.S.doc 5. OP8 15(1) 01/10/06 6. OP8 13(4) 01/10/06 7. OP9 13(2) 01/10/06 01/11/06 Manor Rest Home Version 5.1 Page 27 to medication training. (Previous timescale of 15/09/05 and 01/03/06 not met). The person registered must 01/11/06 consult service users about their social interests and make arrangements to support them to participate in social and community activities and other appropriate leisure pursuits as identified in their Individual assessment and care plan. The person registered must provide residents with a varied diet. The registered person must ensure that there are policies and procedures in place to protect residents from abuse. (Previous timescale of 01/03/06 not met. This includes a review of staff competence and awareness of the whistle blowing procedure, staff training in the management of behaviour that challenges and the appropriate use of residents’ money. 12. OP19 23(2)b & d The registered person must ensure that all areas of the home is maintained to a reasonable standard of decoration and that the home is maintained to as a standard that protects residents. The person registered must ensure that there are appropriate facilities for residents to bath/wash and they that are kept in good working order and are clean and well maintained. DS0000015461.V293497.R01.S.doc 9. OP12 16(2)n & m 10. OP15 16 (2)(j) 01/10/06 11. OP18 13 (6) 19/06/06 01/10/06 13. OP21 23(2)c & j 01/10/06 Manor Rest Home Version 5.1 Page 28 14. OP24 23(2)p The person registered must ensure that lighting is provided in all parts of the home that is suitable for the residents needs. This includes in residents’ bedrooms. The person registered must ensure that all parts of the premises used by residents are safe and any hazard/ unnecessary risks are identified are removed as far as possible. This refers to the surface temperatures of the radiators anti opening upstairs windows. The registered person must ensure that the laundry area is refurbished to prevent the spread of infection and toxic conditions. This is outstanding from the last inspection, timescale of 01/04/06 not met. The registered person must ensure that staff numbers and deployment meet the needs of the residents. (The inspection reports of 7/12/04, 11/03/05 and 25/07/05 and 26/01/06 identified this issue as a requirement, and the previous timescales set have not been met). 01/10/06 15. OP25 13(4) 23(p) 19/06/06 16. OP26 13 (3) 01/11/06 17 . OP27 18(1)a 19/06/06 18. OP29 19, Sch 2 The registered person must ensure that the details of all persons working at the home include all the elements required by regulation. This includes evidence of a Criminal Record Bureau check. (The inspection reports of 19/06/06 Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 Page 29 7/12/04, 11/03/05 and 25/07/05 and 26/01/06 identified this issue as a requirement, and the previous timescales set have not been met). 19. OP29 19 The person registered must evidence a robust recruitment procedure and that all references and checks are in place prior to the person taking up employment. The registered person must ensure that all staff are provided with appropriate training for the work they are to perform, for example training in moving and handling and other basic mandatory training plus resident specific training. (The inspection reports of 7/12/04, 11/03/05, 25/07/05 and 26/01/06 identified this issue as a requirement, and these previous timescales have not been met). 21. OP31 9 (1) & (2) The registered manager must demonstrate that they have the skills and training to manage the home effectively. The person registered must establish and maintain a system for reviewing and improving the quality of care provided at the home, and will include as part of this consultation with residents and relatives. The person registered must maintain appropriate records of all monies received and spent on the half of residents and the purpose for which the money or valuables were used. DS0000015461.V293497.R01.S.doc 19/06/06 20. OP30 18(1) & 13(5) 19/06/06 19/06/06 22. OP33 24 01/12/06 23. OP35 17(2) Sch 4 (9) 19/06/06 Manor Rest Home Version 5.1 Page 30 24. OP36 18(2) The person registered must ensure that staff are provided with appropriate supervision. The inspection reports of 30/03/04, 7/12/04, 11/03/05, 25/07/05 and 26/01/06 identified this issue as a requirement, and these previous timescales have not been met. 19/06/06 25. OP37 17(2) & Schedule 4 The staff roster must include the 19/06/06 name of all persons working at the care home and a record of this must identify their position and the hours actually worked by them. Previous timescale of 15/09/05 and 01/02/06 not met. A record must be kept in the care home, of the care home’s charges to residents, including any extra amounts payable for services not covered by those charges, and the amounts paid for by, or in respect of, each resident. (Previous timescale of 15/09/05 and 01/02/06 not met). A copy of this must be sent to the Commission in response to this report. The person registered must ensure that all staff are involved in regular fire drills and practices. The person registered must ensure that all equipment to be used at the care home must be maintained in good working order. This relates to the hoist certificate, a copy of which must be sent to the Commission in DS0000015461.V293497.R01.S.doc 26. OP37 17(2) & Schedule 4 19/06/06 27. OP38 23(4) 19/06/06 28. OP38 23(2)(c) 01/10/06 Manor Rest Home Version 5.1 Page 31 response to this report. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP15 OP16 OP28 OP31 OP38 OP38 Good Practice Recommendations A planned menu should be available and should be readily known and available to residents. The complaints procedure should be displayed in the home. 50 of care staff should achieve NVQ level 2 The registered manager should achieve NVQ Level 4 training, Registered Manager’s Award. Data sheets and risk assessments should be available in relation to COSHH items. 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 cold water temperatures. It also refers to ensuring that all outlets are recorded as run regularly. Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Manor Rest Home DS0000015461.V293497.R01.S.doc Version 5.1 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!