Inspection on 03/11/05 for Manor Road (96)

This inspection was carried out on 3rd November 2005.

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

Other inspections for this house

Manor Road (96) 22/05/06

Manor Road (96) 11/05/05

Manor Road (96) 07/09/04

Manor Road (96) 16/04/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Manor Road (96) 96 Manor Road Wallasey Wirral CH44 1BZ Lead Inspector Beate Roth Unannounced Inspection 3rd November 2005 02:00 Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 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 Road (96) DS0000035511.V263325.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 Adults 18-65. 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 Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Manor Road (96) Address 96 Manor Road Wallasey Wirral CH44 1BZ 0151 639 0401 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) Metropolitan Borough of Wirral Mrs Lynda Nelson Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 11th May 2005 Date of last inspection Brief Description of the Service: Manor Road is registered to accommodate 4 adults with a learning disability. Manor Road is a two storey, mid-terraced property, situated on a main road. On the ground floor there is a lounge, dining room, kitchen, bathroom and a laundry room. On the first floor there is a bathroom, a separate toilet and four single bedrooms. The home has a garden which has a seating area. Access to the front and back of the home is via a step. Parking is available on the main road. Manor Road is located within a half-mile of Liscard town centre. There is easy access to a bus service from the home. Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over an afternoon. During the inspection time was spent in the office examining records and policies and procedures and talking to the manager. A tour of the home took place. Service users and staff were spoken with. What the service does well: What has improved since the last inspection? What they could do better: The way in which the contracts/statement of terms and conditions are drawn up could better support service users, as at present relatives/advocates are not involved. Service users would benefit from more of the homes policies and procedures being made available in a more suitable format. Steps need to be taken to ensure that where the home looks after service user’s money, this is appropriately managed at all times. An up to date certificate indicating that the electrical wiring at the home is safe needs to be made available to ensure the safety of the service users. A programme of planned maintenance and renewal for the fabric and decoration of the premises would ensure that a good standard of decoration is maintained throughout the home at all times. Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 6 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 Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 and 5 A full assessment would take place to ensure that a service user’s needs could be met. The way in which the contracts/statement of terms and conditions are drawn up could better support service users. EVIDENCE: Although no new service users have come to live at the home in the last 10 years, the assessment paperwork that is available and the assessment process described by the manager at previous inspections, would ensure that a full assessment of a service users’ needs would be made. The statement of purpose indicates that service users would be able to visit the home to meet the current service users and staff before making a decision as to whether the home is suitable for them. A sample of service user contracts/statement of terms and conditions were seen and provide the information that is needed. The contracts/statement of terms and conditions were drawn up over 12 months ago, information relating to the changes of fees payable since then was available. Relatives/advocates have not been involved in the completion of the contracts. It would be good practice for an appropriate individual, who is independent of Wirral Borough Council, to be involved in supporting service users when drawing up the contract/statement of terms and conditions. Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Care planning reflects the assessed and changing needs of service users. Service users are consulted with and encouraged to take part in life at the home. Service users’ need for independence is balanced with any risks to their wellbeing. EVIDENCE: Information in the service user plans is detailed and easy to understand. The plans seen have had a recent review. The staff spoken to could clearly describe the needs of the service users and how to meet them. The records, observations and a discussion with service users indicated that they are assisted to make decisions about their lives in accordance with their abilities. Records of service users likes and dislikes and preferences around daily living, such as what time they like to get up and the activities they enjoy assists in making sure service users choices are respected. Records show that service users are asked their opinion about the day to day running of the home at meetings and through questionnaires. In addition the staff spoken to said that they frequently ask the service users for their views. Records show that service users take part in the running of the home as their Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 10 needs allow. A service user spoken to said that she is asked about what she would like to eat and goes shopping to choose new clothes. Another service user said she is asked about where she would like to go on holiday. Some of the homes policies and procedures are suitable for the service users at the home. It continues to be recommended that more of the homes policies and procedures and the service user guide be made available in more suitable formats. A sample of risk assessments indicated that service users’ needs are assessed and their need for independence is balanced with any risks to their wellbeing. Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 16 and 17 The daily routines of service users and their involvement in the local community ensure that their preferences are provided for. The food provided offers variety and caters for service users tastes and any special dietary needs. EVIDENCE: The records show that service users take part in community life. Service users are supported to use local facilities such as shops and public transport. A service user spoken with said that she gets enough opportunities to go out in the local area. Discussions with the manager, records and observations confirmed that the home’s routines are flexible as much as possible. The records inspected indicated the support service users need in their daily lives in order to make choices and encourage independence. The service users and staff reported that service users are involved in the planning of meals. The service user plans detail likes and dislikes and any dietary requirements. The service users reported that they enjoy the food provided. Meals are planned on a four weekly basis. A menu is maintained. Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 12 The menus indicated that a variety of different foods are provided. A record of foods provided is also contained in the communication book. It would be good practice for this information to be recorded in each service users individual records. Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 19 The physical and emotional health needs of service users are met. EVIDENCE: The care plans examined indicate the support service users require around their personal care. Individual preferences regarding personal and health care support are recorded in the service user plan. Service users are provided with support around their personal care by staff of the same gender. The key worker system promotes continuity of care for the service users. Observations indicated that staff promote the dignity of service users. Staff interviewed were aware of the support needs of service users. Records show that service users are supported to attend healthcare appointments and have access to health care services when they are needed. The accident record was available for inspection and was appropriately maintained. Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Staff training and policies and procedures are in place to ensure that service users views are listened to. In general, the practices at the home provide service users with protection from abuse. EVIDENCE: There is a complaint procedure that is suited to the needs of service users with a learning disability. Staff reported that they elicit the views of service users. Information is available to enable a complaint to be made on behalf of a service user by an advocate. The complaint procedure describes the stages of the complaint and that the complainant will get an answer to their complaint within a maximum of 21 days. At the last inspection the staff were aware of the content of the complaint procedure and how to respond to complaints. CSCI has not received any complaints about this service. An adult protection and a whistle blowing procedure are available. The whistle blowing procedure contains the contact details of CSCI. The manager and all staff have had recent training around the protection of vulnerable adults. The home manages the personal allowance for one service user. The records of this were examined. On the whole these records are appropriately maintained with systems in place to keep a check on the accuracy of the records. It was identified that a small sum of money had been borrowed to give to another service user following permission being sought form the service user to whom the money belongs. This is not appropriate practice and does not protect the wellbeing of the service user who needs staff support to manage her finances. The manager reported that this will be addressed without delay. Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 The home is clean and in general provides a safe and comfortable environment for service users. Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 16 EVIDENCE: The home is in general satisfactorily maintained. Since the last inspection the kitchen has been repainted. At the time of this inspection a new boiler was being fitted which has resulted in some damage to the decoration in this room. The manager reported that arrangements have been made for this to be attended to. The kitchen flooring continues to need attention, the flooring is showing signs of wear and there is a gap between the carpet runner and the start of the kitchen floor tiles. It continues to be recommended that the pipes in the downstairs bathroom be boxed in, as this will improve the appearance of the bathroom. The manager has reported that these pipes do not become hot. It continues to be recommended that a maintenance and renewal programme for the fabric and decoration of the premises be put in place as this would ensure that a good standard of decoration is maintained throughout the home at all times. Service users bedrooms are personalised. The decoration in some rooms is showing signs of wear. The manager reported that all four bedrooms have been identified for re-decoration. The progress of this will be assessed at the next inspection. Furniture and fittings are of a satisfactory quality. It continues to be recommended that when bedroom furnishings are replaced they are replaced with furnishings that have a lockable area. Service users are able to lock their bedroom doors in accordance with a risk assessment. Records of fire tests and drills were seen and found to be in order. An up to date electrical wiring certificate was not available. This expired in November 2004. Evidence that the electrical wiring at the home is safe is to be forwarded to CSCI within one month. A tour of the home showed that the home was clean. It is clear the staff are working hard to ensure good standards of cleanliness are maintained throughout the home. There are procedures for staff to refer to about hygiene. Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 There are sufficient numbers of staff to meet the needs of service users. Staff are competent to meet the service users needs. EVIDENCE: The staffing rota shows that in general there are sufficient staff to meet the needs of the service users. During the day there are between one and three staff available. There is one member of staff available most evenings. The manager reported that extra staff are made available for planned activities. Having one member of staff may limit the opportunity for service users to undertake unplanned activities or separate activities. The service users and staff reported that service users go out as much as they would like to in the evenings. The manager reported that when additional staff are employed there will be two staff available in the evenings. There are currently three staff vacancies. These posts will be advertised following Wirral Borough Council’s workforce review, which is nearing completion. Relief staff and the current staff team cover staff vacancies and absences. The same relief staff are employed who know the service users and how the home works. Records and a discussion with staff showed a team meeting had been held recently. No new staff have been employed since the last inspection. There are satisfactory recruitment procedures and policies available to ensure that Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 18 service users would be supported and protected by the home’s recruitment processes. Training records and staff indicated that training is provided to ensure service users are being cared for properly and that their needs are being met in accordance with current good practice. Two out of four staff hold an NVQ in care of adults with a learning disability. Work is taking place to make sure that further staff have the opportunity to obtain this qualification. The induction and foundation training programmes have been developed in accordance with the National Training Organisation training targets. Training around equal opportunities is provided to staff. Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 39 Service users benefit from the management arrangements and quality assurance systems in place at the home. EVIDENCE: The manager has undertaken a preparatory course for the Diploma in Social Work and is currently undertaking the NVQ level 4 in care and management. The manager has been in post for 6 years. Prior to this the manager worked as a deputy manager for 6 years in a similar setting. Records indicated that the manager has undertaken periodic training to maintain and update her knowledge, skills and competence while managing the home. Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 20 An annual development plan is produced each year. The most recent plan was not looked at, at this inspection. Feedback is sought from service users at service user meetings and through individual discussion with their key workers. The service users were encouraged to meet with the inspector at this inspection. A client consultation questionnaire is in use at the home. A consultation questionnaire for relatives is also in use. The representative of the registered provider makes visits to the home on a monthly basis in accordance with Regulation 26 of the Care Homes Regulations 2001. A copy of these reports are forwarded to the CSCI. There is evidence that a review takes place of policies and procedures and that these are updated accordingly. Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X 3 2 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 2 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X 2 X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Manor Road (96) Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X X X DS0000035511.V263325.R01.S.doc Version 5.0 Page 22 No Are there any outstanding requirements from the last inspection? 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 YA23 Regulation 13 Requirement The registered person must ensure that the home’s practices with regards to supporting service users to manage their finances safeguard the wellbeing of service users at all times. The registered person must ensure that attention is given to the maintenance work needed to the kitchen floor (previous timescale of 11/08/05 not met). The registered person must provide evidence that the electrical wiring at the home is safe. Timescale for action 03/11/05 2 YA24 23 03/02/06 3 YA24 23 03/12/05 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 Refer to Standard YA5 YA8 Good Practice Recommendations A representative of the service users should be involved in the completion of service user agreements. More of the homes policies and procedures and the service user guide should be made available in more appropriate DS0000035511.V263325.R01.S.doc Version 5.0 Page 23 Manor Road (96) 3 YA24 4 5 6 YA24 YA25 YA32 formats. A planned maintenance and renewal programme for the fabric and decoration of the premises should be in place in order to ensure that a satisfactory standard is maintained in these areas. It is recommended that the pipes in the bathroom downstairs be boxed in as this will improve the appearance of the bathroom. It is recommended that when bedroom furnishings are replaced an item of furniture with a lockable area is provided for each service user. It is recommended that two members of staff be deployed on more evening shifts as having one member of staff may limit the opportunity for service users to undertake unplanned or separate activities. Manor Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 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 Road (96) DS0000035511.V263325.R01.S.doc Version 5.0 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. 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