Inspection on 07/09/07 for Manor Rest Home The

This inspection was carried out on 7th September 2007.

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 14/12/06

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 Lorraine Briggs DRAFT: Key Unannounced Inspection 7th September 2007 09:00 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.V341309.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.V341309.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 thebarnoffice@btconnect.com 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.V341309.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. 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. Fees are individually assessed. Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance process, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. What the service does well: The home continues to offer a high standard of care to the residents. 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 comprehensive and tailored to the individual. 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. 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. Comments from a visiting Health Care Professional received read: Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 Page 6 ‘I think the service do an excellent job of managing the behaviour of some very difficult and demanding clients, usually with grace, kindness and good humour. I think the Manor staff do an excellent job overall, the care provided to the people I work with is first rate.’ 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 be made available in other formats on request. Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 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.V341309.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, standard 6 does not apply. Quality in this outcome area is good. 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. This judgement has been made using available evidence including a visit to this service. Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 Page 9 EVIDENCE: Significant time and effort is spent making admissions to the home personal and well managed. There is a high value on responding to individual needs for information, reassurance and support. The service considers carefully the needs assessment for each prospective service user before agreeing admission to the home. Examples of assessments were within care plans viewed. The manager ensures that a summary of any assessment undertaken through the care management arrangements is obtained and insists on receiving a copy of the care plan. Examples were seen to indicate that the latest admission to the home had been well planned and managed over a period of time, with information from other health care professionals involved in the move into the home notes were seen to support this within the individual’s care notes. Prospective service users and their family, always have the opportunity to visit and spend time in the home prior to agreeing admission. Clearly recorded visits to the home were seen on the care notes for the latest person coming to live at the Manor. Three visits had been recorded which gave evidence that the individual had been welcomed to visit, take meals with other people living at the home and had been given the opportunity to make her own decision as to whether The Manor would be her preferred choice of home. Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. 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 health and personal care, which a service user receives, is based on their individual needs. The principles of respect, dignity and privacy are put into practice. The management of medication is thorough and this helps to ensure the safety of the residents. This judgement has been made using available evidence including a visit to this service. Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 Page 11 EVIDENCE: Discussion with the Deputy Manager and Proprietor indicated that the service believes in the service users’ right to be involved in the planning of care as it affects their lifestyle and quality of life. Each service user has an initial plan that has been agreed with them and where appropriate signed by them or their immediate family. Records were seen to support this. The care plan is written in plain language, is easy to understand and considers all areas of the individual’s life including mental and physical health, personal and social care needs. The plan also includes a risk assessment element. Training programmes provide staff with the skills and ability to support and encourage service users to be involved in the ongoing development of their plan. Key workers are appointed who build up special relationships with service users and work on a one to one basis, they are also involved in the recording of the reviews. The home ensures that each service users plan is reviewed regularly and involves the service user and where agreed their family. The plan is updated and the necessary action taken to respond to any changes. This aspect of the service has improved. Service users have right of access to health and remedial services and the home’s policies, procedures and practice guidance strongly support this. Service users’ personal aids are well maintained and the home provides the necessary aids and equipment to support both staff and service users in daily living. Service users have individual health care plans that give a comprehensive overview of their general health and acts as an indicator to changing health needs. Medication records are maintained within the staff/ carers station. These were seen to be well maintained with medication stored appropriately. The aims and objectives of the home reinforce the importance of treating service users with respect and dignity and these values were seen and heard. Comments from a visiting Health Care Professional received read: ‘I think the service do an excellent job of managing the behaviour of some very difficult and demanding clients, usually with grace, kindness and good humour. Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 Page 12 I think the Manor staff do an excellent job overall, the care provided to the people I work with is first rate.’ Manor Rest Home The DS0000024736.V341309.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. 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. This judgement has been made using available evidence including a visit to this service. Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 Page 14 EVIDENCE: The routines of the home are planned around the service users needs and wishes. Systems enable the service to be flexible and changed to meet individual wishes. The home encourages service users to take control of their life and be actively involved in the running of the home. Service users have the confidence to discuss what makes them happy and comment where improvements can be made. The home takes service users feedback seriously and makes changes where possible. Staff listen to service users and make considerable effort to provide a flexible service, which enables them to enjoy a better quality of life. The home has confidence in its quality assurance system to confirm that practice reflects the policies, procedures and guidance. Sufficient staff resources are provided to allow time for activities and stimulation. Since the last inspection an activities record sheet has been introduced to record individual’s participation in activities. The home has developed a system for displaying information and bringing attention to community events and activities. When service users have particular interests every effort is made by staff to help the service user maintain their interest and keep up any community involvement. Family and friends feel welcome and know they can visit the home at any time. Staff always make time to talk to visitors and share information with the agreement of the service user. The design of the home provides seating areas within the communal areas of the home where service users can entertain their visitors, in addition to the privacy of their own room. The home is able to offer service users information and telephone numbers for contacting independent people who will act as advocates on the service users’ behalf where the service user prefers the help of an independent person. Service users have the choice to bring a limited amount of small goods with them on admission to the home and are encouraged to keep personal items which are important to them in their own room. The home believes that service users should always be aware of any information held and written by the home, and have the right to read any documents they wish and staff promote this. Two experienced cooks are responsible for providing quality nutritional meals that meet the dietary needs of the service users. The cooks, Manager and Proprietor meets regularly with service users, listens to their choices and suggestions for the menu, and encourages them to be adventurous and try Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 Page 15 new tastes as well as traditional foods. Tables are set attractively with the necessary cutlery and aids to help individuals during their meal. They are encouraged to serve themselves and help themselves to drinks. Birthdays and celebration are made special for individual service users. Service users enjoy the flexibility of meal arrangements and enjoyed being able to eat in their own room if they wished. Regular drinks are available and staff will always make a cup of tea at any time when asked. Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 Page 16 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 good. Service users have access to a robust, effective complaints procedure, are protected from abuse and have their legal rights protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has a complaints procedure that is up to date, clearly written, and is easy to understand. A copy is given to each service user. Service users, when asked, were clear that they could speak to staff about any concerns they may have. Service Users have the opportunity to raise concerns / complaints at resident’s meetings. The policies and procedures regarding protection of service users are in place. Training of staff in the area of protection is regularly arranged by the home. Service users surveys stated that they are very satisfied with the service provision, feel very safe and well supported by staff. Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. The accommodation is well maintained, clean and homely, providing residents with a comfortable home where they can have the degree of privacy they choose. This judgement has been made using available evidence including a visit to this service. Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 Page 18 EVIDENCE: The home has a well-maintained environment, which provides aids and equipment to meet the care needs of the service users. They have the choice to bring personal items of furniture into the home as was seen in those rooms entered. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in privacy or in their own rooms. The home is well lit, clean and tidy and smells fresh. The service conducts its own reviews of the premises and a maintenance log has been introduced. Improvements to the environment are ongoing. Improvements since the last inspection include, redecoration of many bedrooms and communal areas, improvement to the garden and patio area, further provision of lockable storage facilities, provision of a staff training room and improvement of flood defence facilities. Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. Staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing needs of service users. This judgement has been made using available evidence including a visit to this service. Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 Page 20 EVIDENCE: Service users have confidence in the staff that care for them. The manager ensures that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the service users. The service clearly defines the roles and responsibilities of staff through accurate job descriptions and specifications. Records show that staff working with service users are skilled in their role, and are consistently able to meet their needs. The service ensures that all staff within its organisation receive relevant training that is targeted and focussed on improving outcomes for service users. There is a designated Training Coordinator available for the Manor and it’s sister home in Hereford. The service uses external providers to deliver this training if they have not got the appropriate skills within the organisation. This training can be small scale and individualised if necessary in order to promote the delivery of person centred services. Since the last inspection the Induction training for staff has been fully revised, comprehensive training and support material was seen during the inspection. NVQ training is high priority with over 50 of care staff having level 2. The service has a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of service users. Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 Page 21 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. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by the provider. This judgement has been made using available evidence including a visit to this service. Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 Page 22 EVIDENCE: The manager has the required qualification to meet he National Minimum Standards and is competent to run the home. She works alongside her Deputy and the Proprietor to continuously improve services and provide an increased quality of life for service users. There is a strong ethos of being open and transparent in all areas of running of the home. The Manager is service user focused and leads and supports a strong staff team who have been recruited and trained to a good standard. Staff are positive in their approach to translate policy into practice. Efficient systems are in place to monitor staff adherence to policies and procedures during their practice. Management processes ensure that they receive feedback on their work. The home works to a clear health and safety policy and regular random checks take place to ensure they are working to it. Records are of a good standard and are routinely completed. Where issues have been identified, for example, in care plans, these have been acted upon successfully to ensure service users care is not compromised. Where the home is responsible for service user’s money it works to a very rigorous system, it maintains very clear records that are routinely kept up to date and can be used to track individual service users finances. The service understands the need to meet external requirements where it acts as agent or appointee for service users. Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 Page 23 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 3 X X N/A 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 3 17 X 18 3 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 3 X 3 X 3 X X 3 Manor Rest Home The DS0000024736.V341309.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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.V341309.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE 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.V341309.R01.S.doc Version 5.2 Page 26 - 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. 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