Inspection on 27/08/08 for Manorbrooke

This inspection was carried out on 27th August 2008.

CSCI found this care home to be providing an Excellent service.

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

Manorbrooke 27/08/07

Manorbrooke 05/06/06

Manorbrooke 17/01/06

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 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Manorbrooke Bevis Close Stone Dartford Kent DA2 6HB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jenny McGookin     Date: 2 7 0 8 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Manorbrooke Bevis Close Stone Dartford Kent DA2 6HB 01322223628 Telephone number: Fax number: Email address: Provider web address: patricia.isted@kent.gov.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Patricia Joanne Isted Type of registration: Number of places registered: Kent County Council care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 33 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home 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 en-suite 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 Care Homes for Older People Page 4 of 29 Over 65 33 0 Brief description of the care home 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. The maximum current fee payable is £351.91, with additional charges for newspapers, toiletries, hairdressing, chiropody, dentists and opticians. The latest Inspection Report is publicly displayed in the main reception. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection on this service was 27th August 2007. This report is based on an unannounced site visit, which was used to inform this years inspection process; to check progress with matters raised from the last inspection; and to review findings on the day-to-day running of the home. The inspection process took just over eight and a half hours. The manager was not on site that day. So, the inspection involved meetings with the three team leaders on duty and in charge in her absence, a group of three residents over lunch, three visiting relatives and a care assistant. We issued a selection of feedback questionnaires for distribution to residents, staff and visiting professionals (social and health care). Feedback was obtained from four Care Homes for Older People Page 6 of 29 residents, three health care professionals and three staff, in time for the issue of this report. Any others will be used to inform the Commissions intelligence in due course. Consideration was given to the Annual Quality Assurance Assessment (AQAA), which was submitted in April 2008, ahead of its due date. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. The inspection also involved the examination of records, and the selection of three residents case files, to track their care. Personnel files, selected at random, were examined. And interactions between the staff and residents were observed throughout the day. Six bedrooms, selected at random, were checked for compliance with the National Minimum Standards on this occasion, along with some communal areas. What the care home does well: What has improved since the last inspection? The homes AQAA told us about a number of improvements since the last inspection, as a result of listening to people who use its services. Information The Residents Guide and Statement of Purpose were redesigned to make them more user friendly, and both staff and residents were involved in this process. Staff and visitors are actively encouraged to contribute to the homes newsletters. Assessment and Care Planning Prospective residents are more actively involved in their preadmission assessments, and these assessments are now routinely attached to their care plans, for the attention of staff. Team leaders summarise daily records, so that emerging issues can be addressed with health and social care professionals at the earliest opportunity. The residents care plans are in their design also more person centred and are reviewed every month. Regular audits ensure there have been improvements to the standard of record keeping, and they are also used to identify staff training needs. Services and Facilities Menus have been reviewed, in consultation with residents. New activities include a baking session and reminiscence. Audits are carried out of the homes medication arrangements and record keeping, to ensure practice complies with expected standards. Property Residents were consulted over the redecoration of parts of the home, most notably the corridors and five bedrooms. New fixtures, fittings and better lighting have enhanced these areas. 24 beds have been replaced with adjustable models, to facilitate access buy residents and staff. 17 commodes were replaced by more discreet models to accord residents with more dignity. Cleaning schedules have been introduced and these are being monitored by team leaders. Staffing: Residents participated in interviews of prospective care staff. All staff completed Skills for Care induction which included equality and diversity training. Six staff obtained NVQ Level 2 accreditation, and three team leaders obtained NVQ Level 4 accreditation. The manager underwent training in mental capacity legislation and has provided training in this for staff. She has also joined a good practice network on dementia to improve provision. Care Homes for Older People Page 8 of 29 Staff have also had training in administering oxygen, dementia care and care planning. A training plan was set up for the next four years. Staff supervision has been scheduled in for the year ahead. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can feel confidant that their needs will be properly assessed and that they will be supplied with a contract, which clearly tells us about the service they will receive. This home does not provide intermediate care. Evidence: My two sons helped me with all the information about the home. So I could decide what was best for my needs, I was shown around the home by a carer before I made up my mind. I decided to try the home, where I have now lived for four years, Im very settled and happy. Im pleased with the home. My son said I put myself in here. I volunteered to come in. I am happy. Care Homes for Older People Page 11 of 29 Evidence: I just wanted to move where my relative lives, so he can visit me. I booked myself in. Each resident is given a Welcome Pack on their admission, which contains a Statement of Purpose. Residents Guide and a range of other documents, including a Charter of Rights and the homes complaints procedure. These documents, taken in combination, usefully describe the homes range of facilities, services and service principles. This should ensure that prospective residents or their representatives could be confident they have all the information they need to reflect on, in order to make an informed decision. The documents we saw were all written in plain English, in a font size and style likely to be easily read. We thought some further minor improvements could be made. These matters were reported back to the manager separately. The home already has a system to evidence the issue of its Residents Guide. We thought this could usefully be extended to question whether other languages or formats were warranted, which would compensate for residents not being able to recall having received this information with any accuracy when we asked. This would also enable us to see how inclusive this service is. When asked, residents said that the decision to apply to this home was in practice influenced more by its locality (i.e. close to where they or their relatives lived), and by the homes reputation with health or social care professionals, than by any public information produced by the home itself. We found good evidence of initial assessments, which routinely took any preadmission assessments carried out by funding authorities into account. Prospective residents (where able) or their representative can visit the home before the admission, to meet the staff and other residents, but none we spoke to had done so relying on relatives or professionals to choose for them. A trial stay of one month is available. Questionnaires and feedback from all the residents we spoke to confirmed they were very happy with the choice of home. On their admission, the home sets up care plans (see next section) and carries out further assessments and risk assessments, to keep people safe. We saw documents outlining the terms and conditions of each admission on the files we looked at, though in one case it was a more summary version. These documents usefully make reference to the provisions of the National Minimum Standard and Care Homes for Older People Page 12 of 29 Evidence: enable residents to understand the rights and responsibilities of both parties. The home can demonstrate its capacity to meet the needs of prospective residents. See section on Environment; the section on Health and Personal Care for a description of service provision; and the section on staffing for information on deployment and training. This home does not provide intermediate care. Should the home provide rehabilitation and/or convalescence, all the elements of the National Minimum Standard 6 will apply. Care Homes for Older People Page 13 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that the health and personal care, which they receive, is based on their assessed individual needs. And they can also be confident that the principles of respect, dignity and privacy are put into practice. Evidence: I receive the care that I need most of the time very promptly, but there are times when the carers may be busy and I have to be patient and wait, which Im OK about. I like to be treated as an individual as I am now. Very happy to be here. I like it here very much, and get the support I need. Care Homes for Older People Page 14 of 29 Evidence: Three residents files were selected for case tracking on this occasion, to represent the latest admissions (i.e. over the past 12-18 months). The format of the care plans used by this home properly identify a range of health and personal care needs in the first instance, and these are supplemented by daily reports, assessments (including risks generic and specific to each individual) and records of contact with healthcare professionals. See also section on Daily Life and Activities. This home has a keyworker system to ensure a meaningful rapport can be built up between individual staff and residents. We were pleased to see that the format of daily reports should enable good cross referencing to care plans (matter raised for attention by the last inspection). The care plans are subject to monthly summaries by the key workers, and regular audits by team leaders and management, to ensure emerging issues or concerns are picked up and addressed. And the care is subject to periodic formal multi-disciplinary reviews led by funding authorities. When asked, all three residents we spoke to knew they had a care plan, and that these were being reviewed. They recalled being asked questions about their care on a dayto-day basis, and were generally very appreciative of the level of care given. Visiting relatives were also aware of the care plans, but were not in all cases involved in their review. They should be, subject always to the wishes of the residents. Records confirm the residents have access to a range of medical services, according to need e.g. dieticians, psychiatric nurse, district nurse, visiting optician and a choice of chiropodists. Feedback questionnaires from health and social care professionals told us: feel that Manorbrooke and all care staff provide an environment and care as required to the best of their abilities They care for the residents individually. They give their best whatever the circumstances. As a care manager I have always been approached and involved with any problems or queries that may arise with clients in the home. As nurses we visit twice weekly to attend to residents health needs. If the need is greater than our knowledge then we always ask staff to call the relevant GP. Homes staff aware and contact GP as required or DN services for support. We were told that staff training on healthcare issues was being kept up to date, but Care Homes for Older People Page 15 of 29 Evidence: needs continuous investment. And one told us, I would like the care staff to be able to do blood glucose testing if they cannot monitor it themselves. I feel this is vital due to the possibility of hypoglycaemia in diabetes patients. All the bedrooms in this home are single occupancy, which means health and personal care can be given in privacy. The home uses the Kent County Council policy on medication, but also has ready access to the Royal Pharmaceutical Society Guidance on medication and directories on drugs, for reference, to keep people safe. There were no gaps of anomalies in the medication administration records seen on this occasion. Records told us that the last inspection by a pharmacist was in January 2007 (another one was said to be due), but the arrangements are subject to weekly audits in-house, most recently 25th August 2008, to keep people safe. Staff are trained to administer medication, and subject to competency testing. The homes medication is kept properly secured when not in use. Feedback indicated that the daily routines are generally as flexible as healthcare needs and staffing levels will allow. Care Homes for Older People Page 16 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to exercise choices over their daily life style, and social activities, and can keep in contact with family and friends. Residents can be confident that the social, cultural and recreational activities offered by the home will meet their expectations. Residents can be confident that they will receive a healthy, varied diet according to their assessed requirement and choice. Evidence: The homes care planning processes properly identify key elements from residents background as well as their interests and hobbies before coming into residential care. And this element of their social care was being written in the 1st person to keep their perspective central. This was judged very promising. However, there was no evidence in the files selected for case tracking of this being actively taken forward into care plans, and residents and visiting relatives were not individually able to give any examples of any particular interests or hobbies being actively promoted by the home. It is accepted that in most cases this was attributed to Care Homes for Older People Page 17 of 29 Evidence: the residents increased levels of disability. Residents can choose when to go to bed or get up, and what to do during the day, but tend in practice to have their own fairly set routines. They were observed being supported to make some choices and decisions during the day of this inspection. The home does has a programme of activities, applied flexibly, according to individual choice - a copy of this is kept in the reception area, and white boards in lounges display current events. Examples of activities include: Bingo, reading, outings, reminiscence, baking events, art classes, needlework, quizzes, board games, group media discussions, gentle exercises, card games, and crafts. We were told that each member of staff took a lead on aspects of the homes operation - this could include activities such as cooking, reminiscence, and keep fit sessions. This was judged an inclusive approach. The home has its own stock of DVDs, videos etc. There is a Loop system attached to the TV in each of its lounges, for use with hearing aids, and one of the homes communal TVs is connected to Freeview to maximise choice of viewing. Most residents have TVs in their bedrooms. The residents have nail care sessions and a choice of visiting hairdressers. Residents birthdays are celebrated as are seasonal events (funded by the homes amenity fund). There are also quarterly coffee mornings and group meetings, to build up the sense of community in the home. Religious preferences are properly identified as part of the initial assessment and care planning process. There are services on site. The home is reasonably well placed for links with the local community (see also section on Environment). It has open visiting arrangements, though visitors are asked to try to avoid meal times. There is a communal phone at the foot of one stairwell but this is not judged a very private arrangement. We were told that residents can, however, also use the office phone, and that quite a few have their own mobile phones. They can and do ask staff to dial numbers for them. Unless other arrangements have been made, we were assured residents receive their mail unopened. Catering needs are properly identified as part of the preadmission process and updated or amended thereon. There is a five-week cycle of menus, featuring, in each case, a main option and an alternative. The home can cater for some specialized diets. One resident uses a beaker, but we understand adapted cutlery and crockery are not, otherwise, currently warranted. We joined the residents for lunch and judged the meal well prepared and well presented. The residents confirmed this was representative, and that alternatives were readily available. The pace was unhurried and congenial. The dining areas provide pleasant settings. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their complaints will be addressed properly - the homes complaints procedure is judged robust and effective. Residents and their representatives can feel confident that they are protected from abuse and will have their legal rights protected. Evidence: The home keeps a register of complaints, as required, and this is subject to audits during unannounced monthly inspections by senior officers of Kent County Councils Social Services Department, so that KCC is always aware of emerging issues. The range of complaints registered was judged a realistic reflection of communal living, and there was good evidence of the homes responses. Feedback from residents and their representatives confirmed that they have confidence that the homes culture is to take concerns and complaints seriously. The home has information on independent advocacy services on display but families and friends tend in practice to be relied on to provide this. We were told that since the last inspection staff have had training in the new mental capacity legislation, to ensure rights are properly promoted. KCC Social Services Department has procedures to ensure that residents are safeguarded from abuse in all its forms, including police and criminal record checks on prospective staff - and staff confirmed their commitment to challenge and report any incidences of abuse, should they occur. In the event, this has not been warranted. Care Homes for Older People Page 19 of 29 Evidence: We can confirm that no complaints or adult protection proceedings have been raised with the Commission against the home since the last inspection (August 2007). Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a home, which provides a safe, well-maintained and comfortable environment, and which encourages independence. Evidence: This home is a short ride from Dartford, with all the community and transport links (including a main line station) that implies. The nearest bus stop is on London Road about 3-5 minutes walk away. There is a corner shop at the end of the road and a few more shops further away. Bluewater shopping centre is about 10 minutes drive away. So this homes scope for community access is judged good. On-site car parking facilities are also judged good (something like 14 car parking spaces on site - the car park had recently been resurfaced) and visitors could also use the access road, where there are no restrictions. Measures are in place to keep the premises secure against unauthorised access, including an intercom system and a CCTV camera on the inside. There is an exit button, which we were told is used freely by residents. The layout of this home is judged generally suitable for its stated purpose. Although there is a gradient outside the home, there are no steps into it and both floors are fully accessible. All corridors and doorways are wide enough to allow the passage of wheelchairs and mobility aids; and there is a shaft lift and staircase to access the other floor, so that residents can move about as independently as possible. All areas are Care Homes for Older People Page 21 of 29 Evidence: linked with a call bell system. We judged the home safe and generally well maintained. Comfortable temperatures and lighting levels were being maintained throughout. Since the last inspection better lighting has been installed along corridors and external doors and soffits have been repainted. The residents have a good choice of communal areas. Each unit has a lounge and a quiet area, and they are each reasonably spacious. The furniture tends to be domestic and uniform in style and of good quality, and there were homely touches everywhere. Since the last inspection, several areas have benefited from re-carpeting and/or refurbishment (corridors, five bedrooms), with more in prospect. we were told that residents had been involved in the choice of decor. Some specialist provision is in place but it is not overly conspicuous and includes static and lever grab rails, raised toilet seats, and lifting equipment, including hoists. The list is not exhaustive. 24 beds had been replaced with adjustable models, to facilitate access. And 17 commodes had been replaced with more discreet models, to accord residents with more dignity. This home is currently registered to provide care for up to 33 residents, and all the bedrooms are single occupancy, which means privacy can be assured. And all bedrooms are linked to a call bell facility, so that residents could summon help. 6 bedrooms, selected at random, were inspected on this occasion, and judged well maintained and personalised. In terms of their furniture and fittings, however, they did not all show full compliance with the provisions of the National Minimum Standards. And it wasnt always clear whether residents had been offered keys to their bedroom doors. The detail was reported back to the manager separately. The reader is advised that non provision should be justified by a properly documented risk assessment or opt out consultation. This homes communal bathrooms (included adapted baths) and communal WCs are all judged reasonably close to bedrooms and communal areas. 8 bedrooms are en-suite. The home was odour free in most areas, and relatives confirmed this was representative. It has generally benefited from the introduction of an air filtration device, though we thought one communal area will require further odour control. Its carpet was quite stained. Some matters were raised for attention in respect of the homes two medication rooms and a sluice room, to improve their capacity to resist contamination. These matters were reported back to the manager separately. All the maintenance records seen were up to date and systematically arranged, to facilitate access. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care of residents is good because staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet their changing needs. Evidence: I have worked in this home for 21 years and there has never been a day when I havent wanted to go to work - the staff have always worked as a team. Also in the office and that makes a happy home for our residents - member of staff. Staff, team leaders work well, always helping each other make sure the clients are happy in their environment - member of staff. This homes staffing arrangements are designed to ensure that (excluding the manager): There should be 6 care staff and a team leader on duty during the mornings (7am till 1:30 or 2:00pm) 5 care staff, plus a team leader during the afternoons (2pm till 8pm or 9pm) At night (9pm till 7am) there should be 2 waking staff plus a team leader sleeping on site but on call There are additional staff to cover: Cleaning (2-3 at a time). Laundry. Maintenance (Mondays to Fridays, though the member of staff was on sick leave on Care Homes for Older People Page 23 of 29 Evidence: the day of our site visit). Activities (2 staff). Since the last inspection, there have been no concerns raised with the Commission about the homes capacity to maintain these staffing levels. This effectively means that in the absence of the manager there is always someone in charge, with an on-call system as a back up, to keep people safe. And we were pleased with the level of delegated authority to enable our inspection visit to run smoothly. Team working was identified as a key strength. Feedback from staff indicated that this home has a systematic recruitment process to comply with the key elements of the National Minimum Standard, though 3 personnel files, selected at random did show some gaps. New staff are subject to induction training. One told us, I was given plenty of training when I started work at Manorbrooke. I watched videos, learned about each clients needs, such as their diets, personal needs. Staff were very helpful. A large detailed matrix on display in the managers office confirmed what we were told by staff, both in direct discussion and in feedback questionnaires - that there is a sound level of investment in mandatory training, to keep people safe. The homes AQAA told us that 19 of the 22 staff have NVQ accreditation to Level 2 or above, and that all staff have had training in dementia care, to meet the emerging needs of residents. One member of staff told us, Training is very important. We can put our names down for any training we feel we need more experience or understanding in, such as 1st Aid, and training is always updated. The manager is very supportive. Comments from residents relatives showed they were very appreciative. When asked what was good about the home, we were told, I think the staff are very friendly. The ones weve been dealing with seem very caring and listen to what you say. Its friendly - everyone is. When asked what was good about this home, one relative told us, The the care (the staff) give. If they see that someone doesnt like something, they find something else. They are really, really caring. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run for the benefit of residents in that the management and administration of the home are based on a culture of openness and respect. There is an effective quality assurance systems developed by a qualified, competent manager. Evidence: The Commissions registration process established that the manager had the relevant training and experience for her role, and we understand she has since obtained NVQ Level 4 accreditation. There are clear lines of accountability within the home, and KCCs social services department; and staff and relatives have told us that the manager is invariably accessible and supportive. If I had any concerns, the manager always makes me feel comfortable to approach her at any time. She is very understanding, a good listener, and an excellent manager who tries her best to resolve any problems - member of staff. Care Homes for Older People Page 25 of 29 Evidence: KCC has been able to evidence compliance with its duty to carry out formal documented inspection visits every month, and we judged the format of their reports very person centred. Feedback from staff indicated that the National Minimum Standard for formal documented staff supervision sessions was being exceeded, the records were not on this occasion available for inspection. Manorbrooke has a business plan for the current year, which properly makes reference to the social services own corporate business planning processes, objectives and service principles. It usefully profiles its service user group (to test out its own inclusiveness) and sets an agenda for modernisation as well as processes for action planning, monitoring and review. With one exception (Irish), all the current residents are white British. 6 are male, the rest are female. The staff group shows more ethnic diversity - 16 are white British, 2 are Irish, 2 are African and 2 are Asian. 2 staff are male - the rest are female. The manager has had training on diversity matters, to help promote its values. Records confirm that there are regular residents committee meetings, and consultation exercises (individual and group) over a range of operational matters such as bathing arrangements, business planning, redecoration and colour schemes, food and the homes new Service User Guide. This is judged a well rounded approach capable of demonstrating how feedback can influence the way services are delivered. The home makes proper provision for the storage and accounting of personal effects and small sums of pocket money. Each bedroom has a lockable facility. The homes property maintenance certificates seen were up to date and there are regular health and safety inspections around the home, to keep people safe. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 Service User Guide and Statement of Purpose. Some matters have been raised to obtain further compliance with the National Minimum Standard. The checklist already in use to evidence the issue of the Service User Guide could usefully be extended to evidence the issue of the Statement of Purpose and contract; and to question whether other languages or formats (e.g. large print, tape) were warranted. Bedroom furniture and fittings should be checked against the provisions of the National Minimum Standard. This should include the provision of bedroom door keys. Non provision should be justified by documented risk assessment or opt out consultation. As a preacution against the risk of contamination. All surfaces within medication and sluice rooms should be impermeable and capable of being easily cleaned. Sinks should have wrist or elbow operated taps and should not have overflow apertures. External windows should have fly screens if opened. 2 1 3 23 4 26 Care Homes for Older People Page 28 of 29 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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