Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 04/12/08 for Manor Rest Home

Also see our care home review for Manor Rest Home for more information

This inspection was carried out on 4th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Manor Rest Home provides people with a friendly, family run service in a homely environment. There is a warm and welcoming atmosphere where people can feel relaxed and at home. People can come and go as they wish and welcome their visitors at any time. One person said, "There is always a calm and relaxed atmosphere in the home." There is a low staff turnover at the home. This helps to provide people with consistent care from staff who have a good knowledge of what their individual needs are. People said that the home provide very good care and made comments such as, "The care given is of a high quality," "I can`t think of anything they don`t do well, [relative] is forever saying how well they are looked after," and "I feel lucky to live here, it is a very good home." Management and staff work well with relatives and professionals involved with people`s care. In general people are cared for by well trained and skilled staff who work very well together as a team.

What has improved since the last inspection?

Management and staff at the home have worked hard to meet the requirements made at the previous inspection. Care planning has improved, and is moving towards providing a more comprehensive and person centred approach. Staff training at the home has been ongoing. Many staff have completed a good course in dementia care which they found stimulating and educational. Staff spoken with felt that it had enhanced their skills. Management have also done well in enabling staff to undertake National Vocational Qualifications to enhance their knowledge and skills. A high percentage of staff now have this qualification. The way in which the home recruits staff has improved, so that people are better protected by safe procedures. The management of health and safety at the home has improved with water checks and room audits being undertaken. Areas of the home have been redecorated, and further works are planned to provide a continually improving environment for people to live in. Staff have continued to develop activities to provide stimulation and occupation for people. People living at the home now have more opportunity to express their views through residents meetings.

What the care home could do better:

Although outcomes for people living at the home and their families are good, documentation sometimes needs to be improved to show that people are being cared for in a way that is safe, and meets their needs. Care planning has improved, but further work is needed to ensure that all people`s needs are clearly identified and staff clear about what care is needed, and how people like things done. Although the management of health and safety at the home has improved, further attention to detail is needed to ensure that the home is run in as risk free way as possible. As the home is registered to provide care for people who have dementia, risks around the building need to be clearly identified and as far as possible eliminated. Staff training has been ongoing over the last year and staff have undertaken a number of useful courses. However training in core areas such as moving and handling and food hygiene have not always been kept up to date so that people are cared for by staff whose practice is demonstrably current.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Manor Rest Home 35 Manor Road Westcliff On Sea Essex SS0 7SR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vicky Dutton     Date: 0 4 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Manor Rest Home 35 Manor Road Westcliff On Sea Essex SS0 7SR 01702343590 F/P01702343590 manorresthome@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Rebecca Mary Hart Type of registration: Number of places registered: Mrs Rebecca Mary Hart care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 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. The home provides accommodation and personal care for up to 19 Older People over the age of 65 years. Date of last inspection Brief description of the care home Manor Rest Home is privately owned. It was formerly two large semi-detached houses, which have been made into one property. The home is situated in a residential area of Westcliff-on-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 Care Homes for Older People Page 4 of 32 Over 65 12 1 19 0 0 0 Brief description of the care home personal care and accommodation for 19 older people. Within this number twelve people may have have care needs associated with dementia. Bedrooms are located on both the ground and first floor in seven single and six shared rooms. A stair lift is available to support access. Some rooms have en-suite facilities. There are two separate lounges, and a dining room/ conservatory. There is a pleasant 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 £345.00 to £435.00 Additional charges/costs incurred by residents were for personal items such as hairdressing, chiropody, magazines, newspapers, toiletries, alcohol and cigarettes, escort and taxi costs, and trips on the minibus. The Home has a Statement of Purpose and Service Users Guide available. The home has a website available on www.mrh.org.uk Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key site visit. The previous inspection of the home took place on 13th February 2008. At this visit we (CSCI) considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. The level of compliance with requirements made at the previous inspection was assessed. The site visit took place over a period of seven and a half hours. A partial tour of the premises was undertaken, care records, staff records, medication records and other documentation was sampled and assessed for their suitability, comprehensiveness and compliance with regulations. Time was spent talking with people who live in the home, Care Homes for Older People Page 6 of 32 and talking with staff and management. The homes Annual Quality Assurance Assessment (AQAA) was completed and sent into us (CSCI) at the time when we asked for it. The AQAA told us how management at the home feel they are performing against the National Minimum Standards, and how they can evidence this. The AQAA gives the opportunity for management to reflect on what they do well and what still needs to be improved. Before the site visit a selection of survey forms with addressed return envelopes were sent to the home for distribution to residents, relatives, staff and involved professionals. Six resident, six relatives, three staff and two professionals surveys were returned to us. The views expressed on surveys and at the site visit have been reflected in this report. We were assisted at the site visit by the manager, administrator, and other members of the staff team. Feedback on findings was provided to the manager throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the manager, staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 32 Although outcomes for people living at the home and their families are good, documentation sometimes needs to be improved to show that people are being cared for in a way that is safe, and meets their needs. Care planning has improved, but further work is needed to ensure that all peoples needs are clearly identified and staff clear about what care is needed, and how people like things done. Although the management of health and safety at the home has improved, further attention to detail is needed to ensure that the home is run in as risk free way as possible. As the home is registered to provide care for people who have dementia, risks around the building need to be clearly identified and as far as possible eliminated. Staff training has been ongoing over the last year and staff have undertaken a number of useful courses. However training in core areas such as moving and handling and food hygiene have not always been kept up to date so that people are cared for by staff whose practice is demonstrably current. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into Manor Rest Home can be assured that their needs will be assessed to ensure that the home can care for them properly. Evidence: We saw that the home had an up to date Statement of Purpose and Service Users Guide in place. The Service Users Guide had been reviewed in August and contained good information for people including up to date details of fees charged. Six people living at the home returned surveys to us. All said that they has received sufficient information about the home and had received a contract. People said, I visited the home and spent the day there including lunch, I received a contract and the staff discussed my needs, and, I was given the statement of purpose, service users guide, contract and a recommendation from a social worker. The previous inspection confirmed good practice in the assessment of needs Care Homes for Older People Page 11 of 32 Evidence: undertaken before prospective residents move into the home. We looked at the file of the person who had most recently moved into Manor Rest Home. A good preadmission assessment had been carried out to identify the persons individual needs. There was also information available from the Health Authority. It was seen that the manager had confirmed the assessment in writing to the person confirming that their needs could be accommodated by staff. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although not always based on robust care planning, people receive good care and support from staff that have a good awareness of their needs. Evidence: At the site visit and on surveys people were positive about the care and support they received at Manor Rest Home. On surveys received all six people ticked that they always received the care and support they needed. One person said The staff are aware of all my needs. Relatives also felt that care was good and made comments such as, Everyone seems to be given the individual care they need, and, They do everything that we wanted for our peace of minds and the comfort and well being of our [relative]. To see how well peoples care is planned for and arranged so that staff are aware of their needs, and meet them in an individual way, we looked at three care files in detail. From the previous inspection we saw that work had been undertaken to try and make peoples care plans more detailed and person centred. The care planning system in use at the home is a modular one, (Standex,) whereby different elements can be added to suit the homes/peoples needs. Since the previous inspection Care Homes for Older People Page 13 of 32 Evidence: different elements have been added such as falls assessments, personal life histories and multi-disciplinary records. This has provided a more comprehensive approach to identifying and recording peoples needs. Overall care files contained the information needed to enable staff to offer appropriate and individual care. However much of the information was contained on the Long Term Needs assessment section. This information, particularly in relation to social needs and choices, had not then been translated into care plans. Care plans in place tended to concentrate on peoples physical and behavioural care needs such as personal care, mental health, diet, mobility and personal safety. For one person with a range of different needs there was only a mental health care plan in place. Some people had signed their care files, and the manager explained that they did try to get people or their families involved, and discuss plans with them. We also saw that care plans are kept under review and updated as necessary. A key worker system is operated and each key worker writes up a summary of the persons needs and any changes each month. Observations and discussions during the day showed that staff had a good awareness of peoples individual needs and preferences and probably met them in practice. For example one member of staff was offering people drinks. When they came to a person who had dementia they told them the options available, but also explained to them what they usually had and enjoyed. The home has a strong and stable staff team that supports this process. Staff spoken with said that communication is good and keeps them aware of changes in peoples needs. At the site visit a handover was observed to take place between shifts. A member of staff said, We are always given a verbal handover when we come on shift. All relevant information is in care files. Satisfactory daily care records were maintained, with appropriate individual risk assessments in place so that people are cared for as safely as possible. On surveys people felt that they received the medical support that they needed. Relatives felt that they were kept well informed and made comments such as, Very good at keeping us informed about any health problems at any time, and We are always told of everything and when we visit they answer all questions we ask of them. Care records showed that people can access a good range of heath care professionals to support their needs. This included optical, dental, and chiropody services. Records showed that management is proactive in seeking appropriate support as peoples needs change such as from district nursing, mental health and falls prevention teams. Involved professionals were impressed with the home and said, There is always a calm and relaxed atmosphere in the home. Carers will quickly flag up any concerns regarding the mental health of their residents and unlike many of the other homes I visit they are prepared to work alongside the community mental health team and implement strategies which can often avoid an admission to hospital, and, The care given is of a high quality. Carers have a good knowledge and understanding of mental health needs. Peoples nutritional needs, and their risk of developing Care Homes for Older People Page 14 of 32 Evidence: pressure sores is not routinely assessed. We did however see that if cause for concern is identified appropriate actions such as pressure relieving mattresses and close monitoring of peoples nutritional intake is undertaken. Medication at the home is generally well managed so that people are assisted safely with this aspect of their care. Staff involved in administering medication have received a good level of training through a pharmacist and a distance learning package. The manager and staff said that staffs practice and competence is monitored, but that this is not recorded. The manager was reminded that when handwritten entries occur on medication administration record (MAR) sheets these should be signed by two members of staff to confirm that details recorded are correct. Where medication is prescribed to be taken on an as and when basis, (PRN) a protocol to be in place to ensure that it is used in a consistent way. The manager undertook to address this. During the day staff were observed to treat people with kindness and respect. Shared rooms had either mobile or fixed screens to protect peoples privacy. A care plan viewed referred to protecting the persons dignity by ensuring that the screen was used when carrying out personal care. Involved professionnals said that staff were, Very considerate of each individual, and, This is a home that shows great respect to each individual. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to lead a lifestyle that meets their needs and preferences. Evidence: As mentioned in the previous section, care plans are not robust in assessing and identifying peoples social or activity needs and aspirations, or how these should be met on an individual basis. This could be particularly important for people who have dementia and may be unable to express their preferences. Some records did show a recognition of peoples occupational needs, such as one person being encouraged to help fold the laundry. In general though people seem happy with the level of activity provided. On surveys out of six people five said that there were always activities provided that they could join in with, and one said that there usually were. One person said, We have quite a few activities. The minutes of a recent residents meeting showed that people are consulted about activities and said, Generally everyone is happy with the activities, although some more trips out would be nice. [Resident] thought that a dance or some keep fit would be nice. Individual rooms and communal areas showed evidence of peoples art work. There is a basic weekly timetable of activities is in place that is adapted as going along to suit peoples needs and preferences. There were plenty of games and materials available to encourage Care Homes for Older People Page 16 of 32 Evidence: activity. The AQAA said that more equipment such as floor scrabble had been purchased since the previous inspection. Relatives felt that people were occupied. They said, This is why the house has a good feel when you enter. Each person doing their own thing, and, People live the life they choose. This is very important to the individual and is nice to see. Records are kept of activities undertaken. Management provide additional hours (some volunteer hours) for activity both during the week and at weekends. During the site visit people were enjoying the hairdressers visit. Many were enjoying having and reading newspapers and doing things such as word searches and playing dominoes. During the afternoon people who wished enjoyed having a manicure from a regular volunteer visiting the home. Individual wishes such as remaining in their bedrooms or going out were respected by staff. At the recent residents meeting one person had said that they were happy with everything at the home and, liked the freedom to be able to come and go whenever they wished. Peoples preferences of daily routine were recorded in care records. No church groups or ministers currently visit the home but the manager said that people are asked about their religious preferences and these would be met on an individual basis as required. For example one person regularly attends a local church. Visitors are always made welcome in the home and staff and management communicate well with peoples families. People said, My [relative] is very well looked after and has made her life very comfortable for the years they have left. The staff are very friendly at all times making visitors feel very welcome. Any queries are always answered in full, and, All staff have time to welcome visitors and pass the time of day and make residents feel comfortable in a homely environment. There is good information available to people in the entrance area of the home about advocacy services and other agencies who may provide independent support and advice. Everyone said that they enjoy the food provided. Some comments made were: I enjoy all the meals I receive, all homemade, The staff help me with the food. Meals are always on time and always nice portions with a good variety, and, I have limited likes, but the home does cater for me. Mealtimes were observed to be leisurely and social occasions. The home does not not have a structured menu plan in place, but meals are planned on a day to day basis in line with peoples known preferences. The main meal of the day is served at lunchtime with people asked to select their preference from two options the day before. The manager plans to put up a menu board so that people will know/remember what meals are to be served and the options available. From nutrition records viewed we saw that a good range of nutritious food is offered to people. As seem from meetings minutes people are able to comment on the food, and make suggestions. Care Homes for Older People Page 17 of 32 Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected through a clear complaints procedure and practice, and staff awareness of safeguarding. Evidence: No complaints had been received by the home or through us (CSCI) since the previous inspection. The complaints procedure on display for people was an old version, but we saw that an updated version was available. On surveys everyone said that they knew how to make a complaint. Staff said that they knew what to do if someone raised a concern with them. The AQAA completed by the administrator said, We have never, in 24 years, had a serious substantiated complaint. When a problem does arise we act swiftly and appropriately. The complaints policy is displayed on the notice board by the front door. We saw that appropriate policies and procedures were in place to make sure that people are safeguarded from abuse. The latest local guidelines and forms were available so that any concerns would be reported using the right processes, and to the right people to avoid delay. Staff records showed that staff had undertaken training in safeguarding. Some training had involved staffs knowledge being tested and evaluated through the use of questionnaires. Staff spoken with had a good understanding of abuse, and understood about whistleblowing. Some people living at Manor Rest Home can be challanging in their behaviours. Care Homes for Older People Page 19 of 32 Evidence: Although no spesific training has been undertaken, most staff have undertaken a good level of dementia training. The manager and staff spoken with thought that this equipped them well in understanding and managing peoples behaviour. There was also information available to staff about managing challanging behaviours. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a homely and clean place to live. Evidence: Manor Rest Home provides people with a choice of communal areas as it has two lounges, and a dining room/conservatory area. One person appreciated this and said, I like it here because they do not play loud music, they have a quiet lounge where I can sit. Communal areas were homely for people. There is a pleasant garden which people can enjoy. This includes a patio area with seating available. This area has been fitted with a special surface to make it safer for people should they have a fall. A patio heater means that this area can be used in all weathers. People spoken with were happy with the overall accommodation provided. A partial tour of the premises showed that the general level of decor and maintenance is satisfactory. The AQAA recognised that A few areas are still in need of redecoration. The administrator showed that redecoration and renewal is ongoing. A renewal and maintenance audit of the home had just been undertaken with a sheet for each room identifying issues that need addressing. For example new vanity unit needed as soon as possible. The premises seemed generally clean, although there were one or two isolated areas of odour. On surveys five people said that the home was always fresh and clean and one that it usually was. People said that the home was, Cleaned on a regular basis, Care Homes for Older People Page 21 of 32 Evidence: and that, They have a very good cleaner. The laundry area is suitable to meet the needs of the home. The administrator recognised that the laundry floor would benefit from repainting to maintain a readily cleanable and hygienic surface. Since the previous inspection staff have completed or are completing a distance learning package in infection control, the home have completed a Health Protection Agency infection control audit, and policies and procedures are now in place. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be cared for by skilled staff who are available in sufficient numbers to meet their needs. Evidence: We received very positive feedback about the homes staff. On surveys people said that staff were always available, and listened to what they said. At the site visit we saw that staff and residents had a good rapport based on affection and respect. When a call bell was pressed staff responded very quickly. People said, When I am stressed the staff try to find out the reason behind it to ease the situation, There is always plenty of staff available, The staff are always willing to help with any problem or just have a friendly chat, and, They are all very good and listen to what you say. Relatives commented on the Good continuity of staff. One person said When I visit the attention of the staff is very good and attentive. Involved professionals said, A very caring home, very organised staff, a nice feeling in the house. Very good staff who always support each individual. Although some agency staff are used to cover shifts, this is not frequent. Staffing at the home is generally very stable with many staff having worked there for a number of years. This provides good continuity for people. Staff were positive about their role and felt that there was very good teamwork at the home. One member of staff said that they never looked to see who they were working with as, All staff get on with each other and work well as a team. Care Homes for Older People Page 23 of 32 Evidence: Another said that the home, Maintains a small friendly happy atmosphere where we have enough experienced staff who have worked at Manor for many years. Rotas viewed showed that a basic level of three staff, with one of these being in charge, were available during the day, and one awake and one sleeping in person on duty at night. The manager is supernumerary on some days. Each day an additional member of staff is available between 10.00 and 14.00 to encourage the provision of activity. The administrator is always supernumerary and carries out much of the administration and other tasks within the home. A cleaner is employed each morning Monday to Friday. We saw that peoples dependency levels are assessed and that current staffing arrangements seemed adequate to meet peoples needs. Management have done well in ensuring that staff access National Vocational Qualification (NVQ) training. This will enhance staffs skills in working with people. Out of 18 senior/care staff 12 have an NVQ in care at level two or above. To see how well people are protected by the homes recruitment procedures we looked at the files of the two most recently recruited staff. Generally it was possible to see that management had carried out appropriate checks to verify peoples identity and background. POVA Ist checks had been carried out through an umbrella organisation and no documentation was available, but the date the home had been advised of satisfactory check had been recorded. Criminal Records Bureau (CRB) checks had been undertaken and references sought. One member of staff had not completed a proper application form, but relevant forms and details of employment history had been taken when they attended the home for interview. For one person although two references were in place one could only confirm details of employment dates and not any qualitative details. Neither applicant had provided evidence of previous qualifications. The manager said that this had been asked for. It was positive to see that when agency staff are used confirmation of their checks and training are sought from the supplying agency and recorded. On surveys staff felt that their induction training had been good. Both newer staff files viewed had a copy of the homes induction programme in place, but although both staff had worked there of a number of months these had not been properly completed. For one newer member of staff the training matrix had been ticked that they had undertaken a common induction standards package, but there was no evidence of this. Management have continued to provide staff with a good level of training opportunities. Many staff have just completed a detailed course in dementia care. A training programme showed training courses coming up including Parkinsons Awareness, Care of The Dying, Pressure Care and Continence Care. These will enhance staff skills in caring for people. Staff felt that training opportunities offered were good. Some comments were: I have completed dementia course asset level 2 this year. I Care Homes for Older People Page 24 of 32 Evidence: am now doing handling of medicines asset level 2, I will complete this in November 08. We are also doing a selection of small courses that CSCI would like all staff to do. I have achieved a number of certificates relevant to my job throughout the years I have been a carer, There is always up and coming training. I have recently taken Asset 2 in dementia care qualification, attended a protection of vulnerable adults course and care of diabetes. The proprietor is always looking to update staffs training, and Manor rest home is currently undergoing an extensive training programme covering many subjects. I have recently completed NVQ level 3 in Social Care and am just starting level 2 in dementia care. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is generally well managed and where they can express their views. However people cannot always be sure that their welfare is fully protected by the homes health and safety procedures Evidence: The manager and administrator have owned and run Manor Rest Home for many years. Both are experienced and qualified. The Manager has a nursing qualification, but has not yet attained the recommended additional qualifications for registered managers. The administrator has the Registered Managers Award, and other qualifications. The management team is also enhanced by the deputy manager who has recently achieved NVQ at level four. Since the previous inspection management have worked to meet the requirements made then. All have been addressed either fully or mostly. Staff were positive about the management team and said that the manager was very approachable and supportive. Although formal staff meetings are not held staff spoken with felt that daily hand overs also provided opportunity for Care Homes for Older People Page 26 of 32 Evidence: general discussion. They also felt that they could talk privately with the manager at any time. Periodic residents meetings have been introduced this year to provide opportunities for people to express their views on the service. The minutes for the last one held in August were viewed. This showed that peoples views are listened to. For example one person had said that food should be served on warm plates, and this now happens. Management feel that because the home has a very open culture and there is good communication between everyone in the home, that people feel able to express their views at any time. It was also felt that peoples views are frequently being sought in one to one situations to make sure that they are happy with everything. The AQAA said that what the home could do better was to Introduce regular resident surveys. It was seen that a quality assurance exercise using surveys to relatives and health professionals had been undertaken with positive results. The administrator said that this exercise would be due to be repeated again in the new year. The AQAA was briefly but fully completed and gave us good information about the home. The AQAA recognised areas of improvement and also identified where further improvements are needed. The home only holds monies for one person. When we looked at this we found that the monies held were more than those accounted for, as records had not been updated to include the most recent in payment. The administrator undertook to rectify this. Staff felt that communication in the home was very good, and that they could approach management at any time. The manager works alongside staff to guide practice and pick up any issues. However from records viewed formal staff supervision, although happening is irregular. For example one person has had three supervision meetings in the last eighteen months, only one of these this year. It is important for staff to have regular opportunities in a one to one situation to discuss practice, identify training needs and so on. Since the previous inspection management have worked to improve aspects of health and safety in the home through developing safe working practices, better monitoring and risk assessment and improvements to fire procedures. Some issues still remain however. As the home is now registered to provide dementia care potential risks need to be carefully monitored. A risk assessment and procedure is in place relating to legionella. Water temperatures are now regularly tested. However we noticed that the temperature of the water in one sink was quite hot. Records of testing showed that temperatures in hand basins are sometimes very hot as they are not thermostatically controlled. The administrator was advised that this situation should be risk assessed on a room by room basis according to the needs of occupants to ensure that they are Care Homes for Older People Page 27 of 32 Evidence: safe. We also noticed that there are still some uncovered radiators that were very hot. Management felt that the risk from these was low, but this needs to be established through a proper assessment process. The most recent visit from the fire service found everything to be satisfactory. We saw that records now show what staff have attended fire drills, and that regular checks are carried out for all fire equipment. A recent environmental health officer visit advised improvements to physical aspects of the kitchen, but found procedures to be satisfactory. The AQAA which said under plans for improvement over the next twelve months, Staff training in all core areas. A training matrix showed that training and updates are needed to ensure that staff practice is safe and up to date in a number of core areas such as moving and handling, food hygiene, first aid and health and safety. We saw that training sessions are planned in health and safety. The administrator said that moving and handling training is about to be updated for all staff by the deputy manager who is a trainer in this area. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must continue to be developed into a robust system that identifies all of peoples assessed personal, health and social care needs. So that peoples needs are fully recognised and met by staff in a consistent and person centred way. 01/02/2009 2 38 12 All risks identified in the 01/01/2009 home including water and radiator temperatures must be fully identified and assessed for the level of risk they may present. People, particularly those who may have dementia and be unable to recognise hazards must be cared for safely. 3 38 18 Staff must be trained and 01/03/2009 kept up to date in core areas such as moving and handling, food hygiene and health and safety. Care Homes for Older People Page 30 of 32 So that staff have the correct skill and are up to date in their practise in caring for people safely. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 12 So that people have the right opportunities for occupation and social activity their individual needs should be assessed and appropriate actions identified in care plans. Records relating to the management of peoples monies should be properly maintained and kept up to date. Staff supervision should take place six times a year and provide opportunities to discuss all aspects of practise and career development. 2 3 35 36 Care Homes for Older People Page 31 of 32 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - 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!