Inspection on 14/12/06 for Manor Rest Home The

This inspection was carried out on 14th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Manor Rest Home The 09/12/09

Manor Rest Home The 07/09/07

Manor Rest Home The 28/02/06

Manor Rest Home The 13/10/05

Manor Rest Home The 01/02/05

Manor Rest Home The 23/08/04

Manor Rest Home The 08/03/04

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Inspirations

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

CARE HOMES FOR OLDER PEOPLE Manor Rest Home The Bullingham Lane Lower Bullingham Hereford Herefordshire HR2 6EP Lead Inspector Philippa Jarvis Unannounced Inspection 14th December 2006 08.30 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.V315759.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 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 Miss Julie Ann Minett 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.V315759.R01.S.doc Version 5.2 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. 28/02/2006 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.V315759.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that looked at how the home is performing in respect o the core national minimum standards. This visit to the home took place between 8.30am and 6.45pm. The home supplied a pre inspection questionnaire and other information a few weeks before the inspection. It also distributed comment cards to residents, relatives and health and social care professionals. Responses were received from sixteen residents, four relatives and two social care professionals. During the visit, the inspector spoke with the deputy manager, the service provider, some service users and some staff. There was a tour of some areas of the building and time was spent observing how people spent their time and the arrangements for a medication administration. At times there were opportunities to observe and hear staff contacts with residents. Certain records were examined, including the records of some service users and some staff files. Copies of certain policies and procedures were read and a copy of the new Statement of Purpose and Service User Guide supplied to the commission. Information provided in the pre inspection questionnaire showed that the weekly fees range from £335.20p to £426.10p. Additional charges are made for some items such as hairdressing, newspapers and some chiropody. What the service does well: The care manager is an experienced professional who understands how to manage a care service in the best interests of the people using it. Relevant information about the home is available to prospective residents and other interested people. The assessment and admission processes are suitable. There is also a robust approach to ensuring that residents personal and health care needs are met appropriately. Staff are caring and respectful towards the people living in the home. They understand the importance of treating them as individuals. They promote their right to make choices and to control the way they live. This approach is applied even when residents have communication difficulties arising from their mental health problems. Examples of sensitive care practice were observed during the course of the inspection. The residents all indicated that they felt safe within the home and that the staff listened them to. Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 6 The residents all appreciate the meals provided for them, which are based on based on good quality home cooking. The approach to the management of health and safety within the home is thorough. This helps to ensure the safety of both residents and staff. The home is also careful in the way that it supports residents with the care and management of their personal money. The comments received from residents, their relatives and professionals were overwhelmingly positive about the service, for example “Staff very helpful and kind when I go to see ……..I can only say TOP MARKS.” 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. The summary of this inspection report can Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have good information about the home to allow them to make an informed decision about whether the service is right for them. A care needs assessment is carried out on each prospective service user so that their needs are understood and planned for before they are admitted to the home. EVIDENCE: Copies of revised Statement of Purpose and Service User Guide were provided at the inspection. These are available for service users to read in the entrance hall. The Service User Guide serves as an information pack with information about the style of living in the home. Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 10 The files for three service users were examined and there was a contract of residence on two of these. There is a care needs assessment carried out on each service user before they are admitted. The home also strongly encourages prospective service users to spend at least one day in the home before they come to live there. This provides them with an opportunity to get a feel for the style of living in The Manor. It also affords the staff a further opportunity to understand something of their needs. The care needs assessments are not signed and dated. They form the basis for an initial care plan, which is written shortly after the assessment. Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The planning and delivery of care are carried out well and mean that service users can be sure that their health and personal care needs will be met appropriately. The management of medication is thorough and this helps to ensure the safety of the residents. EVIDENCE: The files for three service users were examined. These each had a plan of care to provide staff with information about the care to be provided. There is a detailed evaluation of service users needs including falls risk assessments and skin care risk assessments. Whilst there is evidence that the care plans and the assessments are reviewed, this has not happened on a monthly basis as expected. There is careful daily recording that shows that staff are conscientious and thorough in their attention to service users personal and health care needs. In particular there is clear evidence of attention to ensuring that pressure area care needs are monitored carefully and dealt with promptly Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 12 and appropriately. In the comment cards received from service users all but one person said that they always received good support with their health care needs. The service provider was of the view that they have developed good working relationships with health and social care professionals. One comment received from an outside professional was “ The manor provides excellent care for some of our more challenging clients.” Part of a medication round was observed. Care was taken with the administration and recording. The medication cupboards were kept tidy and there was no excess stock kept in the home. Senior staff undertake regular audits of medication stock and records. All staff who administer medication have received accredited training and a list of signatures is held at the front of the medication log. There is also clear information about the indicators for the administration for as required medication for each service user needing this. Service users spoken with confirmed that their privacy and dignity was respected and upheld. Staff were observed to promote dignity for those who were unable to do this for themselves for example by replacing their clothing promptly and discreetly. There are two shared rooms where screening is provided. Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a good quality of life for residents with provision of a range of group activities and some individual activities. Meals are an enjoyable social activity for the residents. EVIDENCE: The home has a daily routine and this suits the needs of most service users who have needs arising from mental health issues. Residents who prefer a different routine are enabled to follow this. There are a number of activities provided in the home and several residents commented on how much they enjoyed them. For example in their comment card one service user said “I like the bingo and music man and singing and exercise. I enjoy the church services.” There is information about each persons interests in their care plan but it was difficult from the information seen to know what had been done to spend time meeting the needs of each person in this area. On the day of the inspection one person was taken out on an individual basis to do some Christmas shopping. It was noted that each person was asked whether they Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 14 wanted their medication and not assumed that they would take it automatically. The doors to all service users rooms are locked at all times and no room was entered before an occupying resident had time to respond to a knock at the door. From the visitors book it was noted that the residents do not have many visitors. The home has approached the independent advocacy scheme and a representative has been to talk to the residents. No one expressed an interest in having an advocate at the present time. Service users expressed appreciation of the food provided. They said meals were very good and that there was a genuine choice if they let the cook know by 10am that they did not like the main meal of the day. One service user said that they were very careful to promote her diabetic diet. The cooks have not received training in the dietary requirements of older people. There are some booklets available in the kitchen for them to refer to about specialist diets. The food provided on the day of inspection was home cooked and looked appetising. There was evidence of residents having a choice to suit their preferences. The dining room provides a pleasant environment where mealtimes can be taken in a relaxed manner. Assistance with eating is offered in a discrete manner. Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users feel safe, listened to and able to use the homes complaints procedure. There is information and training available for staff to help them protect the residents from abuse. This needs some development to ensure this is comprehensive and understood by all staff. EVIDENCE: There is a complaints procedure available in the hall for service users to refer to. Some residents told the inspector about it and how it is available for them to use. A complaints log is maintained. There had been one complaint made since the last inspection and this had been taken seriously and looked into appropriately. The residents said that they would feel happy about talking to the staff or the manager if they were not happy about something to do with their care. One person commented, “I don’t need to make any complaints as I don’t have anything to complain about.” The home has a policy in relation to adult protection. This would benefit from development into a more comprehensive document. The home arranged a training course in Adult Protection for staff. Not all attended the training. A further session has been planned in the New Year for those who did not attend this mandatory training on the first occasion. Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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: The home was clean warm and tidy when this inspection took place. Christmas decorations created a festive feel in the communal rooms. A number of rooms were seen and these were all in a good state of repair and decoration. The residents said that the home was always clean except the toilets were sometimes dirty. The service provider said that they were cleaned twice daily and that this problem was down to occasional accidents rather than staff not cleaning them properly. There is a cleaner on duty both morning and afternoon. Paper towels and liquid soap are provided in the toilets. This is Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 17 good practice as it helps to minimise the risk of cross infection. Residents have their own toiletries that they take with them when they have a bath or shower. Again this is good practice because it reduces the risk of cross infection and also promotes their sense of individuality. Areas have been redecorated since the last inspection. This includes the laundry. There is now a washing machine with a sluicing facility. Residents bedroom doors are fitted with locks and they have the key to their room if they are able to manage it. Residents were observed to use their keys. Bedrooms are personalised to suit individual taste. Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff recruitment procedures need a little attention to ensure that they provide the required safeguards against unsuitable staff being recruited. Staff training needs to continue to develop to ensure staff have the knowledge and skills to meet the full range of needs of the client group. Staff give residents the individual attention that they need. EVIDENCE: There is a rota available although this does not detail when the managers are on available in the home. The staffing arrangements on the day of the inspection were in accordance with the rota. At the start of the inspection there were three members of care staff, one designated at a senior level, a cleaner and a cook on duty. The deputy manager arrived soon after and the service provider was also in the home for the day. The residents spoken with felt that the staffing was adequate to meet their needs. From observation staff appeared to have time to spend with residents, to talk, comfort and to attend to their personal care without being rushed. The staff were seen to be supportive, kind and helpful. They dealt with various behaviours in a calm, Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 19 caring and efficient manner. From observation of the handover, the staff had kept an awareness of each person and how they had been that day. Three staff files were examined. Recruitment was generally satisfactory except for one gap in employment where a written explanation had not been kept and one instance where a reference had not been taken from he last employer. The evidence of induction and shadowing following employment was not well detailed and it was not possible to determine what the staff had done from the records. The service provider said that they followed the common induction standards from Skills for Care and that all staff completed at least two shadow shifts before being rostered on shift. There is a training and development plan. This is not specific about what training staff are expected to take. The home has provided a good range of mandatory training but some staff have not attended the courses and have therefore not completed required training for their role. Basic food hygiene training was scheduled for the day after the inspection and adult protection and care planning training were planned to take place shortly into the New Year. There has been little training in the specialist mental health needs of the client group. The home has achieved the target of 50 staff with an NVQ training qualification. Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements meet the needs of the service and ensure that the home runs in the best interests of the residents. There are robust systems for helping them to handle their personal monies and valuables. There is also good attention to the management of health and safety to the benefit of the staff and service users. EVIDENCE: The manager, Julie Ann Minett, has been registered in this capacity since the last inspection. She has completed appropriate management training and is intending to take further training in fire safety management and First Aid at Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 21 Work to further supplement her knowledge and skills. The staff and service users expressed confidence in the way that the home was run. The service provider is conscientious about undertaking formal monthly visits to the home and reporting under the requirements of Regulation 26. This contributes to the quality monitoring systems for the home. She considers that she has a good understanding of the way the home works and action that needs to be taken to correct shortfalls in service provision. All service users were aware of the forthcoming inspection and, if they needed help, were assisted to complete a comment card. Records were seen to show how residents’ personal money is managed when held in the safekeeping of staff. A company accountant audits these records each month. The records are well detailed and accountable. There are secure facilities for the safe storage of money and valuables. Each resident has their own lockable provision. A sample of areas relating to health and safety were examined. Based on the information contained in the records it was evident that matters relating to health and safety are taken seriously and good systems are in place for risk assessment, monitoring, recording and maintenance. Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 22 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 4 3 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 23 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 The registered person must ensure that the plans of care are reviewed at least once a month and updated. The registered person must develop systems to ensure that all staff attend mandatory training. Timescale for action 31/01/07 2. OP30 18 31/01/07 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 Refer to Standard OP18 OP30 OP15 Good Practice Recommendations The registered person should develop the Adult Protection Policy so that it is fully comprehensive. Consideration should be given to providing specialist training specific to the care needs of the client group. Consideration should be given to ensuring that there is a sound knowledge base about the dietary requirements of older people. Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Manor Rest Home The DS0000024736.V315759.R01.S.doc Version 5.2 Page 25 - 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!