CARE HOMES FOR OLDER PEOPLE
Manor Rest Home The Bullingham Lane Lower Bullingham Hereford Herefordshire HR2 6EP Lead Inspector
Wendy Barrett Unannounced Inspection 28th February 2006 09:30 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.V285272.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Manor Rest Home The DS0000024736.V285272.R01.S.doc Version 5.1 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.V285272.R01.S.doc Version 5.1 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. 13th October 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.V285272.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 9.30am and 3.30pm. There were a number of previous requirements arising from an inspection undertaken on 13th October 2005 and a specialist inspection by the Commission’s pharmacy inspector undertaken on 30th November 2005. The main focus of this inspection was to look at action taken to respond to these previous requirements. The rest of the work addressed a number of key National Minimum Standards that have not previously been inspected in the current inspection year. The Care Manager designate was at work and assisted throughout the day. Feedback cards had been left at the home during the last inspection. These were intended for residents and relatives to have an opportunity to let the Commission know about their views on the service provided. No responses have been received. The Care Manager designate agreed to check if these were actually distributed. A Senior Care Assistant spent a little time discussing her work at the home. Residents were met during a tour of the home although none were formally interviewed on this occasion. What the service does well:
The Care Manager designate is an experienced professional who understands how to manage a service in the best interests of the residents. The home is maintained well to ensure the comfort, privacy and safety of the residents. There is an open management approach and this practice helps in making sure the residents are as safe as possible. The Provider takes notice of the findings of inspections and takes appropriate action to improve the quality of the care. The Commission is kept informed of events at the home in between inspections and staff are prepared to consult the Commission and other health and social care professionals so that the best possible outcome for the residents can be achieved. Residents are treated with respect and their right to make choices, and control the way they live is protected. This attitude is applied even when the residents have communication difficulties arising from their mental health difficulties. When there are risks associated with the residents’ abilities the staff take appropriate action to protect them. Manor Rest Home The DS0000024736.V285272.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Manor Rest Home The DS0000024736.V285272.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Manor Rest Home The DS0000024736.V285272.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The staff recognise the need to make sure they have full information about potential residents’ care needs so that they only admit people who can have these met at the home. The written evidence of this work will be inspected when the new care planning documentation has been fully implemented. EVIDENCE: The method of recording care offered to each resident is currently being reviewed. The Commission has received a copy of a proposed format and this addresses pre-admission assessment work. The Care Manager designate is continuing to develop this aspect of the service and it will be easier to assess progress once there has been an opportunity for staff to apply the new system. Manor Rest Home The DS0000024736.V285272.R01.S.doc Version 5.1 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 and 9 The care planning documentation is being developed well although the work is still ongoing. There are already new systems in place to help staff assess risks due to residents’ personal activities. Medication management has been improved to ensure the safety of residents. EVIDENCE: There was evidence of improvements to written care plans since the last inspection. A sample of records showed regular assessment and evaluation of residents’ needs. There were also examples of consultation with other health and social care professionals as part of this work. The Care Manager and Inspector discussed the best way to arrange care records so that staff had the information they need from day to day but are not overloaded with paperwork that is not needed on a day to day basis. There was obviously ongoing attention to this work and the Care Manager demonstrated sufficient knowledge and experience to achieve an effective outcome. The Provider’s action plan arising from the last inspection included a commitment to introduce a method of ‘falls risk assessment’ and a sample of the document intended to be used for recording this work. This will be a valuable tool for staff to use. The Care Manager designate also demonstrated
Manor Rest Home The DS0000024736.V285272.R01.S.doc Version 5.1 Page 10 a good awareness of the way to cope with challenging behaviours in order to protect the individual and other residents and staff. The Commission’s pharmacy Inspector visited the home after the Commission received notification from the home of two incidents that indicated shortfalls in the medication management. The home acted appropriately in promptly informing the Commission of these incidents because this enabled the Commission’s pharmacy Inspector to assess the situation and offer further advice to ensure the safety of residents. The evidence confirms that the Provider and Care Manager designate have taken effective action in response to this specialist inspection. Stock balances have been considerably reduced. All staff who handle medication have received accredited training, staff competence is subject to internal assessment with any identified weaknesses subject to further training and support. New, written guidance has been given to staff and the senior staff undertake regular audits of the medication stock and records. The balance of stock detailed in the controlled drugs register was checked during this inspection. It correctly reflected an actual balance of stock. Two recommendations to further strengthen the overall situation are made in this report. Manor Rest Home The DS0000024736.V285272.R01.S.doc Version 5.1 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): 13 and 14 Residents are treated with respect and their right to control their lives is protected. The staff support residents who enjoy getting out and about. There are some residents who receive few visitors and who may benefit from contact with someone like an independent advocate. EVIDENCE: An activity programme was displayed in the home and a group of residents were observed playing bingo with staff during the afternoon. Observations made during the inspection reflected a sensitive approach to the residents’ rights and dignity e.g. the Care Manager designate dealt courteously and patiently with a resident who came into the office twice and requested money for a taxi. Despite having to deal with the demands of an inspection the request was dealt with promptly and time was taken to advise the resident to wear her coat, as it was a cold day. During a tour of the home it was noted that some residents were using their bedroom door locks to protect their private space. When the Care Manager designate considered that residents may not approve of an inspection of their unoccupied room, this was respected. No room was entered until an occupying resident had been given an opportunity to respond to a knock at the door. This is, of course, good practice.
Manor Rest Home The DS0000024736.V285272.R01.S.doc Version 5.1 Page 12 The visitors’ book indicated that a few residents received regular visits but many probably received few, if any visits. Although some residents may be happy with their situation it is recommended that further consideration is given to the introduction of independent advocates for any residents who miss having contact with people from the wider community. Manor Rest Home The DS0000024736.V285272.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Complaints are dealt with thoroughly and openly. Residents are protected from abuse by staff who have information to help them deal with any issues of concern. EVIDENCE: A complaints procedure was displayed in the home. Records at the home provided details of thorough attention to the management of regular complaints made to junior staff by a relative. Other health and social care professionals had been consulted as part of the investigation of the concerns. This reflects an open approach to complaints that best protects residents’ interests. The Commission has not received any complaints about the service. The Provider monitors complaints raised at the home as part of monthly visits required by regulation. The Senior Care Assistant was aware of the home’s policy and procedures relating to adult protection and whistle blowing. She was also aware that these are reviewed regularly to be sure they reflect up to date legislation and good practice guidance. A copy of the local protocol for the protection of vulnerable adults was seen on display in the office. The Senior Care Assistant was not sure if she had met the Co-ordinator of this scheme. The Care Manager designate described a current piece of work that involves assessment of the capacity of a resident to make decisions about significant life plans. The local Co-ordinator would be able to brief staff on new legislation relating to ‘mental capacity’ as well as general adult protection issues. It is, therefore, recommended that a training session be requested.
Manor Rest Home The DS0000024736.V285272.R01.S.doc Version 5.1 Page 14 Manor Rest Home The DS0000024736.V285272.R01.S.doc Version 5.1 Page 15 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): EVIDENCE: The home was clean, warm and tidy when this inspection took place although an outside laundry room would benefit from high cleaning and redecoration. A requirement is made relating to this finding. Although there is little need for sluicing facilities at the moment, a large sink is available in the laundry room for this purpose. It would be advisable to ensure any new washing machine has a sluicing programme. There were notices around the home that indicated good attention to hygiene and safety. The home accommodates a number of residents who smoke. This potential risk was being managed well with designated ‘smoking’ areas. Although residents should not smoke in their bedrooms the staff had a colour coded chart to increase their awareness of potential higher risk bedrooms. This is a particularly useful tool for night staff reference. Manor Rest Home The DS0000024736.V285272.R01.S.doc Version 5.1 Page 16 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): EVIDENCE: Manor Rest Home The DS0000024736.V285272.R01.S.doc Version 5.1 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): 35 There is a thorough and transparent system of accounting for the way residents’ personal money and valuables are handled by staff. EVIDENCE: Records were seen to show how residents’ personal money and valuables are managed when held in the safekeeping of staff. A company accountant audits these records each month and minor corrections to balances demonstrated the value of this practice. Cash and a few valuables were stored in a secure manner and additional supervision was being provided for those individuals who find it difficult to live within their means. The Care Manager designate was advised to be careful in describing jewellery so that articles were not inadvertently afforded an excessive value. This could be relevant in any subsequent claim for compensation. Manor Rest Home The DS0000024736.V285272.R01.S.doc Version 5.1 Page 18 The Provider employs a Health and Safety executive who conducts regular risk assessment of premises, work and residents’ personal activities. This arrangement offers additional expertise and support to the home’s staff. Manor Rest Home The DS0000024736.V285272.R01.S.doc Version 5.1 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 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 4 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x 3 x x x Manor Rest Home The DS0000024736.V285272.R01.S.doc Version 5.1 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 OP26 Regulation 23(2)d Requirement The laundry room must be high cleaned and/or redecorated. Timescale for action 30/04/06 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 OP7 OP9 OP9 Good Practice Recommendations The ongoing work in developing care records should address ways to streamline the amount of paperwork staff have to handle on a day to day basis. Staff should be advised to ensure liquid medication is poured with the instruction label uppermost so that the detail on the label does not get damaged. When medication is prescribed ‘as required’ there should be additional detail to help staff decide when it is necessary to administer. This may be achieved by more specific information about the type of behaviours that the individual resident displays at these times. It is recommended that opportunities for independent advocates/befrienders be explored for those residents who have little contact from families and who may benefit from this type of support. The local Co-ordinator for the protection of vulnerable
DS0000024736.V285272.R01.S.doc Version 5.1 Page 21 4 OP13 5 OP18 Manor Rest Home The adults should be invited to provide a training session for staff. This may be particularly helpful in supporting staff with current work that addresses a resident’s ‘mental capacity’. Manor Rest Home The DS0000024736.V285272.R01.S.doc Version 5.1 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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