CARE HOMES FOR OLDER PEOPLE
Manor Rest Home The Bullingham Lane Lower Bullingham Hereford Herefordshire HR2 6EP Lead Inspector
Denise Reynolds Unannounced Inspection 13th October 2005 4:40 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 The DS0000024736.V260393.R01.S.doc Version 5.0 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 The DS0000024736.V260393.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Manor Rest Home The Address Bullingham Lane Lower Bullingham Hereford Herefordshire HR2 6EP 01432 274732 01432 761466 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) Mr Narendra Nauth Mrs Sheila May Nauth Care Home 23 Category(ies) of Dementia - over 65 years of age (5), Mental registration, with number disorder, excluding learning disability or of places dementia (5), Mental Disorder, excluding learning disability or dementia - over 65 years of age (23), Old age, not falling within any other category (23), Physical disability over 65 years of age (4) Manor Rest Home The DS0000024736.V260393.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 1. Those admitted under the category Mental Disorder MD(5) must be over 50 years of age and have assessed social needs that can be met within a service primarily for older people. 2. Those admitted under the category Physical Disability PD(E) (4) must be accommodated on the ground floor in bedrooms that have at least 12 sq.m of useable floor space. 3. The Home can continue to accommodate one named current service user who is under 50 years of age as long as her social needs can continue to be met within a service primarily for older people. 1st February 2005 2. 3. Date of last inspection Brief Description of the Service: The Manor Rest Home is situated on the outskirts of Hereford with easy access to local facilities, including public transport to the city centre. Parts of the house are Elizabethan and the building has been adapted and extended for use as a care Home over many years. In recent years the scope of care the Home sets out to provide has been narrowed and currently the Home caters primarily for people over the age of 65 who have needs relating to their mental health. Manor Rest Home The DS0000024736.V260393.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place during the late afternoon and early evening on a weekday. The findings of the report are based mainly on observation, a discussion with a group of three residents and with one person in private. One member of staff was interviewed and there was discussion with two other staff and briefly with the newly appointed manager designate. Comment cards for residents and relatives were left at the Home to be given to people; any replies received will be used to help plan the next inspection and to provide information for the next report. What the service does well: What has improved since the last inspection?
Manor Rest Home The DS0000024736.V260393.R01.S.doc Version 5.0 Page 6 The medication system has been changed and recording and storage arrangements improved. Additional bathing equipment in the form of a new bath hoist has been provided. 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 The DS0000024736.V260393.R01.S.doc Version 5.0 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 The DS0000024736.V260393.R01.S.doc Version 5.0 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): These standards were not inspected. EVIDENCE: Manor Rest Home The DS0000024736.V260393.R01.S.doc Version 5.0 Page 9 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 overall standard of attention to health and personal care needs is good and safeguards residents; this can be enhanced by some further developments to the care planning documentation. EVIDENCE: The care records seen provided a number of examples of staff observing, reporting and acting upon residents’ health problems, for example by arranging for residents’ doctors or community nurses to visit. There was also evidence of instructions left by health professionals being passed on to staff through entries in the care records. The care plans contain lots of information to guide staff in the care they give and the excellent daily records show that they are conscientious and attentive in following these through. The senior on duty at the start of the inspection was able to provide information clearly about the number of residents living at the Home and any current health problems. Some of the care plans have not been formally reviewed as often as expected and some contain so much historical information that they could confuse staff; these need to be sorted out to ensure that current information is readily to hand and not mixed up with out of date details.
Manor Rest Home The DS0000024736.V260393.R01.S.doc Version 5.0 Page 10 A new medication system had recently been adopted and all the staff had received initial training from the pharmacy chain. Medication storage is secure and the records of administration seen demonstrated good recording practice. Staff doing the early evening medication were observed to be careful and professional in their approach to this task. Residents spoke to knew what medication they take and what it is for. A list of sample staff signatures needs to be put into the medication chart folder. A male member of staff explained that he primarily assists the men living at the Home and only provides personal care for the female residents if they have said they are happy for him to do so. A resident spoken to confirmed this. An example was seen where the follow up action following a resident having a fall was not clear. Similarly, when a conflict between residents or an incident of aggression towards staff has happened new information is not always put into the care plan. For example, the daily record for one person identified that a resident may have been aggressive because she wanted peace and quiet in certain circumstances – this would be valuable information to go into the care plan but had not been included. Manor Rest Home The DS0000024736.V260393.R01.S.doc Version 5.0 Page 11 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, 15 The Home provides a good quality of life to residents who were particularly positive about the enjoyable food provided. EVIDENCE: Three residents spoken to as a group said they think the Home is good. They described one of the cooks as follows “ she is a marvellous cook – she puts it so nicely on the plate – it looks like in the cookery books. She is also a very nice kind person – motherly and loving” A resident explained that the vicar from the local church comes regularly to hold a service and that there are other activities. Recently, she and another resident had been to town shopping with the owner who had taken them for tea and cakes at a café while they were out. A member of staff later gave as an example of the activities that he had played dominoes with two residents earlier that afternoon. Manor Rest Home The DS0000024736.V260393.R01.S.doc Version 5.0 Page 12 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): These standards were not inspected in sufficient detail to make an informed judgment. EVIDENCE: A member of staff explained that if they were concerned about mistreatment of a resident they would report this to the manager. They were aware that if necessary they could contact CSCI or social services. Manor Rest Home The DS0000024736.V260393.R01.S.doc Version 5.0 Page 13 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, 26 The accommodation is well maintained, clean and homely providing residents with a comfortable Home where they can have the degree of privacy they choose. EVIDENCE: Residents said that the Home is kept “exceptionally clean – except the toilets sometimes” this was put down to occasional accidents by some residents rather than staff not doing the cleaning properly. During the inspection the rooms seen (including the toilets) were all clean. Paper towels and liquid soap is provided in the toilets – this is good practice and helps to minimise the risk of cross infection. Residents all have their own individual toiletries this is good practice as communal toiletries present an increased risk of cross infection. Residents’ bedroom doors are fitted with suitable locks and residents may have the key for their room if they wish and are able to manage this. During the inspection one person was seen to make use of her key whilst another said she didn’t want to have hers.
Manor Rest Home The DS0000024736.V260393.R01.S.doc Version 5.0 Page 14 Radiators are fitted with covers to protect residents from contact with hot surfaces. A fire door on the first floor was open. This may present a security risk as it provides a way in to the Home to an intruder who may not be noticed. Manor Rest Home The DS0000024736.V260393.R01.S.doc Version 5.0 Page 15 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 EVIDENCE: There were three care assistants and a senior care assistant on duty until 6pm and after this there was one care assistant, the manager designate and a member of staff doing the ironing. From observation of the attention given to residents during the inspection, this arrangement seemed adequate to meet people’s needs. Staff spoken to had either done or knew that they would soon be doing training in core health and safety related topics. A recently appointed staff member explained that they are working through a structured induction course that would take 13 weeks. This person also described the process they had gone through in being recruited including the expected CRB and POVA checks and being fully supervised at the start of their employment. Another person said they had completed the TOPSS induction course. A resident said that they know staff have a lot of training and described seeing trainers coming into the Home. Residents spoken to were generally positive about the manner of staff towards them although did say that some have “good days and bad days”. One person described how caring staff have been about her fear of thunderstorms by sitting with her to reassure her.
Manor Rest Home The DS0000024736.V260393.R01.S.doc Version 5.0 Page 16 During the inspection staff were observed dealing with residents in various situations; without exception conversations with residents were polite and caring in tone. It was also evident that staff speak to residents ‘on equal terms’ and do not speak down to them. Manor Rest Home The DS0000024736.V260393.R01.S.doc Version 5.0 Page 17 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, 32, 33, 37, 38 The Home has a history of stable management arrangements that have helped the Home to improve standards year on year. Initial signs are that staff are all working together to help the current change of management go smoothly so that residents’ care continues to be good. There is good attention to health and safety in the Home to the benefit of staff and residents. EVIDENCE: The Home has recently had a change of manager and deputy after several years stability under the previous post holders. It has taken some time to recruit a replacement during which the previous manager and deputy have assisted the Provider in minimising the impact of this on the residents. This has been helped by the fact that both are still employed at the Home in other capacities. The new manager had been at the Home for two weeks when this inspection was done. During the evening it was observed that she has got to know the residents and that they know who she is. The Commission is awaiting an application for registration to be submitted.
Manor Rest Home The DS0000024736.V260393.R01.S.doc Version 5.0 Page 18 A recently appointed staff member said they liked it at the Home and had been made to feel welcome by the owner and staff. Another said she loved it there and that also said staff had made her welcome. The previous registered manager of the Home has remained in employment as a relief member of staff and a resident explained they have been told that she is also going to become a ‘visitor’; to the Home to talk to residents to check how things are. The resident said that she will be able to “use her as a channel” if there are things she needs to raise, although she already feels able to speak direct to the owner and to staff who she described as “kind”. A resident said that the fire alarm is tested regularly and that staff get training about what to do if there is a fire. Staff traing was not examined in depth but staff spoken to were aware that they are expected to do health and safety related course such as first aid, fire, moving and handling and medication. Stickers on equipment showed that appropriate LOLER testing (eg of a hoist) has been done. Staff said that cleaning materials were kept in locked storage and this was confirmed by observation during the inspection. The Home is very good about reporting incidents under Regulation 37 as required; the reports would be improved by giving more information about the action taken (or planned) to resolve a situation or to minimise the risk of this happening again. Similarly, the Provider is conscientious about sending monthly reports on the conduct of the Home as required under Regulation 26; it would be helpful to the Home and to the Commission if these confirmed that action has been taken regarding shortcomings mentioned in previous reports. Manor Rest Home The DS0000024736.V260393.R01.S.doc Version 5.0 Page 19 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 x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 x x x 2 3 Manor Rest Home The DS0000024736.V260393.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Timescale for action 31/12/05 2 OP8 13,15 3 OP9 13 There must be an audit of care plans to make sure they are all up to date and that current information is separated from old details to prevent confusion. This will form a good foundation for subsequent reviews. There must be evidence in the 31/10/05 form of an updated falls risk assessment and care plan that consideration has been given to the changing care e.g. when residents fall or when there has been an incident of challenging behaviour. A list of specimen signatures 31/10/05 must be inserted in the administration of medication file. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Manor Rest Home The DS0000024736.V260393.R01.S.doc Version 5.0 Page 21 1 2 3 OP7 OP19 OP37 4 OP33 Although the daily records provide information about changes in residents’ needs it is important that the care plans are also updated to include new information. Care should be taken when exterior doors are kept open due to the possible risk of intruders coming in to the building unnoticed. Information about the follow up action taken (or planned) should be included in the reports made to the Commission under Regulation 37. It would be good practice to undertake an internal audit of such incidents to identify possible ways to prevent further occurrences. It would be good practice to utilise all sections of the Home’s Regulation 26 report format and to include information about action taken in respect of matters identified in previous reports. Manor Rest Home The DS0000024736.V260393.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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