Inspection on 17/01/06 for Manorbrooke

This inspection was carried out on 17th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Manorbrooke 27/08/08

Manorbrooke 27/08/07

Manorbrooke 05/06/06

Manorbrooke 15/08/05

Manorbrooke 15/09/04

Manorbrooke 22/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Manorbrooke Bevis Close Stone Dartford Kent DA2 6HB Lead Inspector Elizabeth Baker Announced Inspection 17th January 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 Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Manorbrooke Address Bevis Close Stone Dartford Kent DA2 6HB 01322 223628 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) patricia.isted@kent.gov.uk Kent County Council Mrs Patricia Joanne Isted Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2005 Brief Description of the Service: Manorbrooke is a care home providing personal care for 33 Older People. Kent County Council (KCC) is the registered provider. Manorbrooke was opened in the 1960s as a purpose built local authority home. All bedrooms are for single occupancy, with 19 rooms situated on the ground floor. Nine bedrooms have ensuite facilities. All bedrooms are connected to the call bell system and have a television point. None of the bedrooms have a telephone point. There is a passenger lift to all rooms on the first floor. The home is divided into three units. The first floor unit has a large/dining room. The two units on the ground floor have their own day lounge, but share a large dining room. The home is situated in Stone, off the main road between Dartford and Gravesend. Buses, shops, post office, church and pubs are within easy walking distance for able-bodied residents. Gravesend and Dartford are about 5 and 2 miles away respectively. Darent Park Hospital and the Bluewater Shopping Centre are nearby as is access to the main A2/M25 interjunction. Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place over six and a half hours on the 17 January 2006. Lead Inspector Elizabeth Baker carried out the inspection. A partial tour of the home was undertaken. Some residents were spoken with including three who were interviewed in private. One visitor was spoken with. A number of staff were also spoken with and two were interviewed in private. At the time of the visit 32 residents requiring personal care were residing at the home. The inspection was carried out with full assistance from Registered Manager Mrs P Isted. Some judgements about the quality of care, life and choices were taken from conversations with residents, as well as direct and indirect observations. Some records were seen as part of case tracking and to assess work on the requirements and recommendations made at the last inspection. In response to the announcement of this inspection the Commission received a total of 48 comment cards from residents (29), relatives/visitors (10), care managers (7) and GPs (2). Some of their comments have been incorporated into this report. This is the second inspection of this home for the year 2005/06. Not all key standards have been inspected on this occasion, where they were met at the first visit. This report should therefore be read in conjunction with the inspection report dated 15 August 2005. What the service does well: Returned comment card from relatives/visitors included additional comments such as “We cannot speak highly enough of the staff. Their support and dedication to their duty is much appreciated”; “I get the impression that my [relative] is loved and cared for to the highest standard. As the relative of a much loved [parent] I feel (they) are at home”; “We visit my [spouse’s relative] on a regular basis and are always made most welcome by a kind and caring staff who we consider to be like an extended family”; “[Resident] very well looked after, [their] every need is catered for”; and “We have total confidence in Manorbrooke staff and admire their tenacity”. Nine of the 15 requirements made at the last inspection have been complied with. A number of others have been partially met and action is being taken to complete the remainder. Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 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. Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 and 5 Prospective residents are assessed prior to admission and again after a trial period to ensure the home can provide appropriate care and support. EVIDENCE: Standards 1, 2 and 3 were inspected and met at the last inspection. They have not been reassessed on this occasion. The home is not registered for intermediate care Standard 6 is not applicable. The home is registered for personal care only, although some residents have medical problems resulting from conditions such as strokes. The two care staff interviewed said they had not received training for caring with residents with this condition. The manager said other staff have been trained for this care need and more training is being arranged for those who have not received it. In addition to this, diabetes and dementia training is also being arranged. The visitor interviewed indicated the family had good knowledge of the home and were confident their relative’s care could be met. New residents are initially admitted on a trial basis. A re assessment of the resident’s needs is then carried out, before a permanent place is offered. Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 11 The maintenance of care records has improved although some shortfalls were again noted, which could potentially place residents at risk. Medicine storage is not sufficiently robust to maximise security. EVIDENCE: For case tracking purposes, four care records were inspected. The residents had been provided with a care plan, which they had signed. The model of plan has changed since the last visit, allowing for more detail to be recorded and one plan was particularly reflective of the need details described during an interview. Plans are supported by risk assessments including moving and handling. A separate form is used to record details of residents’ weights and other personal care needs such as nail cutting. However it was difficult from one form inspected to establish whether a particular resident had had their finger nails cut since September 2005, as the form had not been completed as was required. The resident’s nails were noted to be long. Daily records are maintained. These varied in content in that some provided a holistic picture of the resident’s day and others did not. One daily record referred to a resident having “a large sore on bottom” and E45 cream being applied. This information had not been transferred to the resident’s care plan. The Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 10 resident’s medication administration record chart did not state this preparation had been prescribed and needed to be administered. For a resident with impaired hearing, there was no evidence in the care records that the matter had been investigated and whether both ears were affected. During a visit to a particular resident, a walking stick and glass case where seen in the bedroom. The care records made no mention of the resident requiring a walking stick or indeed glasses. The care records for another resident with a particular communication/behaviour problem were not reflective of the actual situation as observed during the inspection. The resident’s care records referred to Sudacrem being applied for a particular condition. There was no corresponding medication administration record chart for this preparation. A new night checking form has been introduced. Although staff record on the daily records that they have visited the resident in the night as per the number of visits required on the form, precise details of the visit findings are not recorded. Correction fluid was noted to have been used on the care plans inspected. As care records may be required to be provided for legal purposes, this practice must cease. Standard 37 refers. The standard of cleanliness in the two medical rooms has much improved since the last inspection. Fridge and room temperatures are monitored to ensure medications are stored in accordance with manufacturers’ instructions. The sample of medication administration record (MAR) charts inspected had been completed appropriately, although correction fluid was seen on one particular chart. The manager said the dispensing pharmacist had done this. It was also noted that the charts do not contain actual administration times, but refer to morning, noon, tea and bed. As the timing of administration of medicines is paramount for effective treatment, this practice may reduce the expected benefits. This inspection established that medication security is compromised because medical room doors have not been fitted with British Standard 5 lever locks, which are the type required for rooms storing medications. It was also established that the arrangements for storing controlled drugs have been compromised because one of the locks on the metal cupboards used for such storage has been removed and the construction and lock of the outer cupboard is not of the standard required under the Misuse of Drugs (Safe Custody) Regulations for the storage of controlled drugs. At the last inspection it was identified that it had not been the home’s practice to record controlled drugs administered separately in a bound book or register. Details were only recorded on the normal medication administration record chart records. This resulted in a requirement being made. On this visit it was identified that controlled drugs are now being administered from the medical rooms on both floors. The book inspected in the medical room on the first floor was an exercise type book and was not paginated, as is required for security purposes. The manager said the book acquired and in use for the other floor is a proper bound book, with numbered pages. To maximise Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 11 security a robust bound book or register with numbers must also be provided for the first floor in order that a full audit trail can be carried out in the event of administration or stock errors being discovered. The Royal Pharmaceutical Society Great Britain guidelines The Administration and Control of Medicines in Care Homes and Children’s Services (June 2003) provide further information on storage, recording and administration of medicines. The manager discussed the problems associated with trying to obtain details of residents’ preferences and wishes in the event of death and dying. Whilst recognising this is a delicate matter, not having this information readily available could result in unnecessary distress at an already difficult time. Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 12 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): N/I EVIDENCE: All the above standards were inspected and met at the last inspection. They have not been re assessed on this occasion. However six of the 29 residents who responded to the comment card questionnaires prior to this visit indicated they do not think the home provides adequate activities for them and four indicated they do not like the food. Nevertheless one respondent indicated the food is very good and this opinion was confirmed in discussions with other residents during the visit. Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 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 Systems are in place for residents and others to make a complaint. EVIDENCE: A visitor and resident described what they would do if they had a complaint. Both indicated this course of action had resulted in the matters being satisfactorily resolved. The two care staff interviewed described appropriately the action they would take if they witnessed an incident against a resident constituting adult abuse. One carer said they had received adult protection/abuse training. To date, the home has not needed to make any referrals to the Protection of Vulnerable Adults register. Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Much work has been done on improving the home’s environment and making it a cleaner and nicer place to live and work in. EVIDENCE: The home was considerably cleaner and hygiene standards had greatly improved on this visit. Indeed apart from one area on the first floor the home was odour free. So far improvements to the home’s environment include the redecoration of some bedrooms, all the bathrooms and the first floor lounge/dining room. The flooring in this dayroom has been renewed. All replacement doors are now appropriately painted; ceiling cracks repaired; both laundry rooms, medical and sluice rooms redecorated and re-arranged; hand wash sinks installed in those areas previously identified as not having them and seventeen new armchairs have been purchased. External building work has commenced although not yet completed. To date the fascia board on the front of the home has been replaced, gutters have been cleaned out and quotations sought from contractors in respect of repairing the tarmac drive and repainting the roof soffits. Because the pathway paving slabs have not yet Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 15 been adequately re-seated, and still present potential trip hazards, residents’ access is now restricted. However, until the matter is properly rectified residents can go into the grounds if accompanied by staff. A fire risk assessment audit was carried out at the home by Kent County Council Technical Services to ensure the home complies with Workplace Fire Precautions Legislation on 3 August 2005. This resulted in a number of recommendations being made. The manager confirmed these have been complied with. The home is designed with wide corridors, which enables mobile residents to move safely around the home. A loop system has been installed in all three lounges, to assist residents who have a hearing impairment. Although not all bedrooms were inspected radiators seen in these rooms are of a type, which are protected to minimise potential hazards of residents burning themselves. However a visit to one of the home’s communal bathrooms identified that the radiator is not protected and is kept at a high surface temperature to ensure the room is kept suitability warm. There was no record the matter had been identified and appropriately risk assessed, thereby potentially placing residents who use this bathroom at risk. Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 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): 27, 28 29 and 30 Staff turnover is low resulting in residents receiving continuity of care. Although systems are in place for recruiting and vetting staff, they are not always rigorously followed to maximise the protection of residents. EVIDENCE: Care staff were seen carrying out their duties in an unhurried manner. In addition to care staff, staff are employed for administration, catering, cleaning and maintenance. Dependency assessments are used to ensure staffing levels match the current needs of residents. The home continues to strive to ensure 50 of the workforce is trained to NVQ level II care. To date 37 of staff have successfully attained this. A review of two staff files indicated that systems are in place for recruiting and appointing staff. However the inspection identified in one case that a complete employment history had not been provided and there was no evidence that the gaps had been investigated. The file also contained one “to whom it may concern” reference and the other reference was an “open” one. Neither reference was written on care home or business letterhead paper to which the previous employment referred. Indeed both references had been written from the referees’ private addresses on plain paper. Staff interviewed said they had received various training including moving and handling training, COSHH, bereavement and food hygiene. Current training Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 17 includes safe handling of medicines. A carer said they hope to attend infection control training in September 2006. Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 18 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): 34, 35, 37 and 38 The manager has a clear development plan and vision for the home. EVIDENCE: Standards 31, 32, 33 and 36 were inspected and met at the last inspection. They have not been reassessed on this visit. Resources have been made available for improving the home’s environment. A new programme of works has been compiled and resources requested to carryout this work. The home maintains monies for residents where this is requested. Each resident is provided with an identity number, as monies are held collectively, together with the providers, in one bank account. This is Kent County Council’s normal practice. Handwritten individual personal property cards are maintained. However it has not been the home’s practice to include precise Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 19 details of the actual source of the funds on these cards, which could present a difficulty if an investigation into the mishandling of residents’ monies was required to be carried out. Residents and or their advocates are informed, usually verbally, when balances of monies held on their behalf go into debit. Instigating a system in which residents and or their advocates are provided with regular statements of account would prevent residents going into debit as well as reminding them of any credit balances which may have accrued. Receipts are provided for purchases made or supplied on behalf of residents. Cash is supplied to residents on request out of the home’s general petty cash supply. This situation does not promote residents’ individuality or independence. The provider audited the home against its financial standards in July 2005, in accordance with their normal practice. As stated previously, correction fluid had been used on residents’ records to make changes. As these records are evidence of care required and that delivered, this practice must cease. The returned pre inspection questionnaire form indicates five members of staff are trained in first aid. Accident record log sheets are maintained in accordance with the provider’s procedure. Maintenance records were not inspected on this visit. Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 20 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 3 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 3 2 X 2 X Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 Care plans must be complete of all current needs and support. (Timescale of December 2004 not completely met) Pressure area deterioration must be appropriately recorded in the care plan and appropriate risk assessments developed. (Timescale not completely met) Details of controlled drugs administered must be recorded in a bound book. (Partially met) The paths and driveway must be repaired. (Timescale 31/10/05 not met although quotations being obtained) The home must be kept in a good decorative order both internally and externally. (Partially met - this refers to corridors and roof soffits) The laundry room must be made good to allow for effective cleaning. (Partially met – this refers to the flooring) Treatment emoluments must be applied as per medical instructions. Residents must receive DS0000037766.V268148.R01.S.doc Timescale for action 30/09/05 2 OP8 17, Sch 3 p3(n) 15/09/05 3 4 OP9 OP19 13(2) 23(2)(b) 31/08/05 30/06/06 5 OP19 23(2)(d) 30/06/06 6 OP26 13(3) 30/06/06 7 8 OP9 OP9 13(2) 13(2) 31/01/06 31/01/06 Page 22 Manorbrooke Version 5.0 9 10 OP25 OP29 13(4)(a) 19(1)(b) prescribed medications at specific times to ensure treatment efficacy. All heating appliances in rooms 30/06/06 used by residents must be protected. Full employment details must be 31/01/06 sought and gaps investigated; references must evidence they have been provided by the actual employer to which the employment refers 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 4 Refer to Standard OP8 OP11 OP28 OP35 Good Practice Recommendations Forms used to instruct and monitor residents’ personal care must be accurately maintained. Care records should contain details of residents’ preferences in respect of death and dying. Fifty percent of unqualified care workers must be trained to NVQ level II or equivalent by 31 December 2005 Residents and or their advocates should be regularly informed of their current balance of account; precise details of the source of residents funds should be recorded for auditing purposes Correction fluid must not be used to amend records relating to residents. 5 OP37 Manorbrooke DS0000037766.V268148.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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