Inspection on 26/02/07 for Manson House

This inspection was carried out on 26th February 2007.

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

Manson House 22/11/07

Manson House 08/05/06

Manson House 13/01/06

Manson House 21/10/05

Manson House 17/03/05

Manson House 13/01/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Manson House Manson House 111 Northgate Street Bury St Edmunds Suffolk IP33 1HP Lead Inspector Deborah Kerr Unannounced Inspection 26th February 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manson House Address Manson House 111 Northgate Street Bury St Edmunds Suffolk IP33 1HP 01284 753106 01284 763553 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) The Royal Agricultural Benevolent Institution Mrs Delphine Yvonne Bonas Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th May 2006 Brief Description of the Service: Manson House is registered as a care home providing care and accommodation for a maximum of 24 older people. The Home is owned by the Royal Agricultural Benevolent Institution (RABI) and has been providing care and accommodation to older people from the farming and agricultural community for approximately 28 years. The Home operates a waiting list and welcomes applications from those with farming and agricultural backgrounds, however the waiting list is open to other people, from around the East Anglian region. The Home is located in the residential area of the market town of Bury St Edmunds and is a few minutes walk from the town centre, the Abbey Gardens, shops and amenities. The building spans three floors and is served by a shaft lift and two stair lifts. All bedrooms benefit from en-suite toilet facilities with one bedroom also having a bath en-suite and five other bedrooms having an en-suite shower. The Home also has an assisted bathroom on the ground floor, two assisted bathrooms on the first floor and a walk in shower on the second floor. In addition to the en-suite toilets, the home provides three other toilets. The bedrooms to the front of the house face the street, whilst the bedrooms to the rear have a pleasant outlook over the gardens, summerhouse, green house, seating and an aviary of Cockatiels, which were donated to Manson House. The RABI also own 19 sheltered flats, which are also, located in the grounds of Manson House. Service users have access to a range of communal rooms (lounge, library, hobbies room and summer house). The home has a statement of purpose and a ‘Residents Handbook’ providing information for prospective service users, which is available on request. The fees are calculated as part of the pre assessment process prior to moving into the home. Current fees range from £388.75 to £420.00 per week, which are reviewed annually. Each resident is informed in writing by the chief executive of RABI. People from the farming community may after financial assessment through RABI be entitled to a contribution towards the cost of the fees. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over seven hours during a weekday. This was the second key inspection for the year 2006/7, which focused on the core standards relating to older people and a review of the progress of the requirements made at the last inspection in May 2006. The report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from 10 residents ‘Have your say about’ comment cards and 1 relatives/visitors comment card. Time was spent talking with five residents, two staff and the registered manager. Additionally a number of records were inspected including those relating to residents, staff, training, medication, quality assurance and a selection of policies and procedures. What the service does well: What has improved since the last inspection? At the previous inspection five requirements were made. Evidence obtained during today’s visit found the home have met three of the requirements. One of these was for pre admission assessments to be undertaken prior to any resident moved into the home to ensure they are able to meet that residents needs. Files of three residents that have recently moved into the home confirmed these are now being completed. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 6 Concerns were raised last time relating to water temperatures, which did not meet the recommended close to, 43 degrees and cleaning materials, which were potentially hazardous, were being left in bathrooms. A tour of the environment confirmed that these safety issues were no longer an area of concern. Building work has been completed to extend the dining area and to create a storeroom. The extension of the dining room means the home has lost two of the ground floor bedrooms. The plans originally included an extension to the rear of the property to create two additional rooms. The Royal Agricultural Benevolent Institution (RABI) decided to focus on extending the dining room and have postponed the extension for a later date. The manager was informed they must inform the Commission for Social Care Inspection (CSCI) prior to the building of the extension to ensure the rooms meet the National Minimum Standards. (NMS) What they could do better: A previous requirement related to the development of residents care plans to include more detail about the support they required. Although there has been some improvement these need to be further developed to ensure all parts of the care plan are completed. These should also provide details of how staff supports residents so that all aspects of the resident’s health, personal and social care needs are met. A requirement was made to make alternative arrangements for the storage of shower chairs and commodes when not in use, to avoid cluttering up bathrooms. Although additional storage has been created with the new extension, the downstairs bathroom contained a mobile hoist, a selection of commodes, the base to the bath chair and equipment for the hairdresser. For a resident to safely access the bath they would require all of these items to be moved. Serious concerns regarding the recruitment of staff were identified. Two staff files conformed that they had been employed prior to the manager obtaining a satisfactory Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks. Both of these staffs’ application forms had gaps in their career history, which had not been explored. One file contained only one written reference. An immediate requirement was made for the manager to obtain a POVA for the most recent employee and risk assessments to be completed on both member of staff and forwarded to the CSCI within 48 hours. A check of the Medication Administration Record (MAR) charts reflects that staff need to be more vigilant when recording and administering medication. Where residents choose to be responsible for their own medication this should be managed within a risk assessment framework which regular monitors the resident’s ability and monitor’s their condition. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 7 The home needs to further develop the palliative care and end of life needs of residents and record the outcomes in the residents’ care plan, so that at the time of their death, dying or serious illness staff will treat them and their family with care, sensitivity and respect. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 8 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 Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,6, Quality in this outcome area is good. Prospective residents can expect to receive information about Manson House and the service they provide. They can also expect to have a full needs assessment undertaken to ensure the home can meet their specific needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a statement of purpose and a ‘Residents Handbook’ providing detailed and relevant information about the home. The ‘Resident’s Handbook’ includes the contract setting out the terms and conditions of residence with the Royal Agricultural Benevolent Institution (RABI). The contracts include the method of payment, the resident’s current fee and what is/is not included. Files also contained where applicable a Suffolk County Council Individual Placement Contract which identified where and how much the resident was required to contribute. A resident who had recently moved into the home confirmed they had been provided with information about Manson House including the complaints procedure. They had been issued with a contract, which they had read and signed and returned to the office that morning. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 10 A previous requirement was made for a detailed assessment of prospective residents to ensure the home could meet the individual’s needs. Three residents’ personal files were inspected and confirmed that each resident had a pre admission assessment completed prior to admission. These were very detailed and provided information about the resident’s previous history, current health, personal care and general well being. The home does not provide intermediate care. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11, Quality in this outcome area is adequate. Residents can expect to have access to healthcare professionals, however they cannot expect to have care plans, which adequately reflect their health, personal and social care needs or be protected by the home’s procedures for administering medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A previous requirement was made for care plans to be improved to contain information about the resident’s individual needs and the level of assistance they required. Three plans were reviewed and only one had been fully completed. Although there had been some improvements made to the content of the care plans several sections contained limited information or had been left blank, for example, the life history and aims and objectives sections. What had improved is the addition of a section covering the personal daily routine of each resident covering 24 hours. This provided information about the individuals preferred routine including the time they chose to get up, where they had their meals, how they chose to spend their day/evening and the level of assistance they required throughout the day. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 12 Information in residents’ care plans confirmed that residents are supported to access health care services including hospital appointments and visits from the general practitioner (GP) on request. Care plans highlighted that two residents had conditions, which affected their diet and eating. A leaflet seen suggested that one of the residents had seen a dietician and had been given advice on how to manage their condition. According to their weight charts both residents had initially lost weight, however the weight charts were not being completed regularly making it difficult to monitor. The use of nutritional screening such as the Malnutrition Universal Screening Tool (MUST) was discussed with the manager to monitor the residents weight and where weight loss or increase is significant appropriate action is taken. Moving and handling assessments are being completed and evidence was seen that these were being reviewed regularly. They identified the resident’s capacity to remain mobile and independent and identified where staff support, aids and equipment were needed to help them achieve this. Incident and accident report forms identified that there continues to be a high level of falls. These relate to a small number of residents with re-occurring incidents mostly due to loss of balance when transferring from their bed, commode or armchair. This has been discussed with the manager at the previous two inspections. They had contacted a falls co-ordinator who visited the home to discuss the risks of slips, trips and falls with the residents, relatives and staff. The falls co-ordinator arranged to return to support the home to help them identify actions they could take for the prevention and intervention of falls, however they have been on long-term sick leave and therefore this has not taken place. Time was spent with a senior member of staff to review the home’s procedure for administering medication. The home uses the Monitored Dosage System (MDS). Medication Administration Record (MAR) charts seen for the period of 29th January to the 25th February identified a number of gaps. The MAR chart for one resident showed that they were prescribed morphine sulphate capsules twice daily. On seven occasions their MAR chart had not been signed, however the number of stock of the controlled drug was seen to be accurate indicating the medication had been administered. MAR charts of three other residents reflected missed signatures on ten different occasions. It was not possible to check to see if the medication had been administered as the blister packs were in the process of being returned to the pharmacy. The deputy informed the inspector that odd tablets are taken out of the blister packs and placed into a soiled container to be returned to the pharmacy. These had not been accounted for in the returns book. Discussion with the manager about the missed signatures highlighted that one of the MAR charts related to a person living in the sheltered flats. Staff are supporting this person to take their medication. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 13 Concerns have been raised in the past about how involvement and support is provided by the home to people living in the flats. This is reported on in more detail in the management section of this report. The home holds a small amount of controlled drugs (CD), which are locked in a separate secure cupboard. The home currently has six residents prescribed CD’s and a random check of three resident’s medication against the CD register was found to be correct. One resident stated in their pre admission assessment “I like to care for my own medicines”. They confirmed they were being supported to order and collect their medication and showed the inspector a lockable cabinet in their room where they were kept. Risk assessments had been completed for residents who choose to administer their own medication. However there was no evidence to show that these are reviewed to assess the resident’s ability to continue to manage their medication. An entry in the daily records for one resident who is assessed as competent to manage their own medication had been storing co-codamol in a separate pot, refusing to take them. The management team and staff were observed engaging in positive interactions with residents. Their approach was positive, polite and supportive and relationships were seen to be warm and friendly. Residents’ spoken with felt that staff respected their privacy and dignity. Residents were observed being called by their preferred name as identified in their care plans. The pre admission assessment had details of resident’s wishes regarding their death in relation to cremation or burial and permission to be resuscitated should circumstances arise. However, the palliative care and end of life needs of residents need to further explored to determine the residents choice to remain in the home or be admitted to hospital at their time of death, dying or serious illness. This information must be recorded in the residents care plan so that staff will treat them and their family with care, sensitivity and respect in accordance with their wishes at the end stages of their lives. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is excellent. Residents can expect to live in a home that supports a lifestyle that matches their expectations and can expect to receive a good standard of fresh and appealing food with a wide variety of choice as part of their daily diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are able to enjoy a full and stimulating lifestyle. They were observed freely moving around the home. All residents are offered a key to their room and the front door and were observed coming and going as they please. One resident advised the inspector there was a sale on in a clothes shop in town, which they had been to on Saturday and brought some new clothes. They have their own scooter, which enables them to go out and about in Bury St Edmunds whenever they choose. Another resident was seen going out to meet relatives for lunch. Staff are allocated times on the roster to spend time with residents that are less mobile so that they can engage in meaningful activities of choice and to assist residents to healthcare appointments. A notice board was seen in the hallway advertising ‘What’s on’. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 15 There is a range of in-house age appropriate activities that residents are encouraged to take part in, which include art; handicrafts, nail care and hand massage, armchair exercises and a ‘knit and knatter’ session. One resident explained what it was like for them to have moved into the home. “I knew the time had come for me to move into residential care, it was my decision”, “I have the nicest room in the house and it is beautiful”. “The care staff are wonderful, how they put up with me I do not know”. “There is always something to do”. “I intend to resume art classes to continue painting with watercolours and enjoy a game of bridge”. “Unfortunately these games cannot be spontaneous as not enough people in the home can play. We have to organise meetings with people from outside the home”. The visitor’s book in the hallway showed that relatives were seen to visit frequently. Time was spent with residents and a visitor who spoke positively about the care and service provided. Minutes of meetings confirmed that residents and relatives are invited to share, discuss and feedback their views about the home and how the service should operate. A recent meeting took place in February 2007 to discuss future activities and outings. A charity walk to raise money for RABI and other special needs had been discussed and was advertised to raise sponsorship for a trek over the Great Wall of China. Residents are supported to manage their financial arrangements themselves and are provided with lockable facilities in their rooms. Other residents have the support of a power of attorney, solicitor or family member. Residents were observed entering the office with cheques to pay for their newspaper bill. A number of residents choose to have small amounts of spending money held in the manager’s office. The home has good procedures in place, which protect residents from financial abuse. Records are kept of all entries and withdrawals with receipts attached. Meal times are a social occasion at Manson House. The extension to the dining room has created more space and light and is a nice environment for residents to enjoy their meal and conversation. Residents had a choice of salmon, broccoli and potato bake or quiche with tomatoes and peas, followed by bread and butter pudding or cheese and biscuits. The food is all freshly prepared and cooked using fresh ingredients. Meals looked appetising and appealing, which prompted discussion about the food in general. Residents confirmed that the food was of a high standard. One resident commented, “The food is everything I could possibly wish for, always changing with lots of variety, I have gained weight, which I am very pleased about” and “Food is excellent, it is all home cooked, there is a wide variety which is nicely cooked especially the vegetables”. The food stores were seen and held a wide range of home baked cakes, dry goods, fresh and frozen foods. All were being stored appropriately and in line with food safety regulations. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, Quality in this outcome area is good. Residents and their relatives can expect to have their concerns or complaints listened and responded to and are protected by the home’s adult protection procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: These standards were inspected and found to met at the previous key inspection on the 8th May 2006. The complaints log confirmed that one complaint had been made about the home since the last inspection. The home had followed their complaints procedure and a representative from Royal Agricultural Benevolent Institute (RABI) undertook a full investigation. The chief executive of RABI had responded by letter in full to the complainant with no further outcomes required. The home has detailed and robust policies and procedures that deal with the management of allegations of abuse, which link to the Suffolk Adult Protection Committee inter agency policy of June 2004. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20,22,2425,26, Quality in this outcome area is excellent. Residents can expect to live in a home that is decorated and presented to a high standard, which is comfortable and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Manson House is decorated to an excellent standard, retaining many of its old features. The décor is in keeping with the period of the house and is bright, clean and well maintained. Large tubs had been planted with spring flowers along the front of the home and around the gardens making an attractive display. The grounds are nicely landscaped and well kept providing a nice environment for residents to walk and sit in the nicer weather. The manager is currently trying to obtain a grant from Social Services to re-develop a patio area outside the extended part of the dining area with raised beds so that residents can take part in gardening. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 18 On entering the home there is a noticeably happy, relaxed and homely atmosphere with a real sense of community. The environment was found to be clean and tidy and had no unpleasant odours. Air fresheners have been fitted which give off a nice fragrance throughout the home. The home spans three floors and has access by a passenger lift and two stair lifts. There is a range of communal facilities available including a large sitting room situated to the rear of the house overlooking the garden. Additionally there is a spacious library and conservatory, which is a designated smoking area for the residents of the home. The library had a selection of daily newspapers and a range of comfortable easy chairs and a table and chairs. The dining room has been extended and redecorated providing a large and spacious room for residents to meet socially and enjoy their meals. All bedrooms are single occupancy and have en-suite toilet facilities. Residents’ rooms seen were clean and tidy and personalised to meet their needs and tastes and some had brought their own items of furniture and ornaments. Residents are offered a key to their bedroom door and have lockable storage space provided for personal items. A previous requirement was for the home to find alternative storage areas for equipment when not in use. The manager agreed the equipment being stored in the downstairs bathroom was unacceptable. This included a mobile hoist, a selection of commodes, the base to the bath chair and equipment for the hairdresser. For a resident to safely access the bath they would require all of these items to be moved. Water temperatures were checked at random times during the day and were found to be close to the recommended 43 degrees centigrade and provided hot water throughout the day. There are two laundry rooms situated on the first and second floors, each have a washing machine with a sluicing facility. The home uses red dissolvable bags for the soiled laundry, which are put directly into the machine for sluicing. Each bathroom had hand washing facilities and a good supply of liquid soap and paper hand towels. Following an incident where two intruders had been found on the premises improvements have been made to the security of the home. The front door has been fitted with a new intercom and door bell for visitors which is linked into the call system and pagers held by staff. Residents and tenants from the flats have been issued with a key fob that scans the lock so they can access the building at any time. The manager is in the process of obtaining quotes from several companies to install a similar security system to all external doors. In the mean time all external doors are kept locked. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Quality in this outcome area is poor. The home has an established staff team, that are trainied to meet the specific needs of older people and are available in sufficient numbers, however recruitment porcedures are not robust and could put reisdents at risk of harm, poor practice or abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff roster confirmed that there is sufficient staff on duty to meet the needs of the residents. The home operates with 1 senior and 2 carers on duty between the hours of 7.30am to 2pm and 1 senior and 3 carers between 2pm and 9pm. The home has 2 cooks and a team of 5 domestic staff and 1 full time maintenance person. There are 2 waking night staff on duty between 9pm and 7.30am with a senior on the premises during the night who is on call in case of emergencies. Additionally the manager and deputy manager take it in turns to be on call at night. Records seen confirmed that staff receive regular training, which includes fire safety, protection of vulnerable adults, moving and handling first aid and food hygiene. Other training which related directly to the needs of the residents included causes and management of pain, dementia awareness, continence and the ageing process which covered topics of common aliments of the elderly. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 20 Seven staff have a National Vocational Qualifications (NVQ) at level 3 and another seven have NVQ at level 2. The deputy is near completion of level 4 in care. These figures confirm that the home meets the minimum ratio of 50 of staff are trained with a recognised qualification. Serious concerns were raised with the manager about the recruitment process of staff. These areas of concern need to be urgently addressed to comply with the regulations and safeguard residents living in the home. Three staff files were inspected. The files of two staff recently recruited reflected that they had been employed and commenced working at the home with no Protection of Vulnerable Adults (POVA) or Criminal Records Bureau (CRB) checks. The application forms of both members of staff had significant gaps in their career history, which had not been explored. Only one written reference had been obtained for one of the staff. One of the staff ‘s CRB obtained identified there was a number of convictions. Although they had declared these on their job application form there was no evidence recorded by the manager to suggest these incidents had been discussed and explored to ensure that residents were not at risk by employing this member of staff. The manager was left an immediate requirement to obtain a POVA first check on the most recent employee and to complete risk assessments for both members of staff to ensure residents were not at risk. This information was received in the Commission for Social Care Inspection (CSCI) office within a week of the inspection. Staff files confirmed that new staff undertake induction training, which meets the Skills for Care Common Induction Standards (CIS) through Suffolk County Council training and educational department. Documentation was seen on two of the staff files of dates where they had completed each of the modules, these had been completed with in two months of their employment. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37,38, Quality in this outcome area is adequate. To ensure the health, welfare and safety of the residents the manager must manage the home in line with the Care Homes regulations 2001 and the National Minimum Standards. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has forty-one years experience in the care of the elderly and holds a National Vocational Qualification (NVQ) level 4 in management. Feedback from relatives and residents about the manager is very good. A relative’s survey described the manager “as a treasure, they always have a warm and pleasant manner, nothing seems to much trouble any time day or night”. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 22 A requirement was made previously for the responsible individual from the Royal Agricultural Benevolent Institute (RABI) to make monthly-unannounced visits to comply with Regulation 26 of the Care Home Regulations 2001. Copies of these visits have been received on a regular basis at the Commission for Social Care Inspection (CSCI). However it is no longer a requirement for copies of these visits to be forwarded to the CSCI. The home’s certificate on display is incorrect as it still shows the previous responsible individuals name and needs to be updated by the CSCI to reflect the name of the chief executive. The manager must make sure that they address re-occurring issues relating to day-to-day management of the home. Previous reports have identified concerns about the recruitment process, which have been highlighted again at this visit. Concerns have also been revisited with regards to the care and support provided to people living in the 19 sheltered flats provided by RABI at the rear of Manson House. Residents living in the home were consulted and agreed that people from the flats were welcome to visit the home to join in activities and social occasssions. However, concerns have been raised in the past about how much support is provided by staff from Manson House to people in flats. During the inspection it was noted that staff are supporting a person in the flats with their medication. Staff are employed at Manson House to meet the needs of the people living in the home and the manager must be clear about the services being provided to people in the flats and how this impacts on the residents in the home. At the inspection in January 2006, the manager informed the inspector that they had found intruders in the home on the 30th November 2005. Although they had informed the police and the incident investigated, the Commission for Social Care Inspection (CSCI) had not been informed, which is a requirement under Regulation 37 of the Care Homes Regulations 2001. At today’s’ inspection the manager advised of an incident where a member of staff had been dismissed for gross misconduct. Although the actions that lead to their dismissal took place in the flats, the member of staff was employed by the home and this incident should have been reported to the CSCI under Regulation 37. The home has a good quality assurance system in place for residents, relatives and visitors to give feedback about the services provided. Satisfaction questionnaires are issued to residents annually and relatives and visitors questionnaires are available in the front hallway. The results of a recent survey were seen. Seventeen residents had completed questionnaires, which confirmed they were very satisfied with the service they received. One resident commented, “I am so very grateful to have the opportunity to stay here”. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 23 Six relatives and visitors surveys were completed, one expressed “ This is the nicest home in the town for older people, it is easily accessible and I appreciate the wonderful care and kindness shown to my relative, it is a very pleasant place and I would recommend it to anyone”. Resident’s financial affairs are safeguarded by the homes policies and procedures. The home do not act as appointee for any of the residents. This has been discussed in more detail in the daily life and activities section of this report. A previous requirement was made for all cleaning materials potentially hazardous to be locked away in line with the Control of Substances Hazardous to Health (COSHH) regulations. A tour of the environment confirmed no cleaning products had been left unattended in any parts of the home. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 24 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 X 2 X 4 4 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 2 3 Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 25 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 Sch 3 (1) (b) Requirement All residents care plans must set out the residents needs in respect to their health and welfare with staff guidance and the details of how these are to be met including long and short term goals. This is a repeat requirement from 08/05/06 The registered manager must make sure that records are kept which determine the residents diet is satisfactory and a plan which monitors their nutritional needs including weight gain or loss and ensure appropriate action is taken. The registered manager must make arrangements for the recording and safe administration of medicines in the care home. The registered manager must ensure that residents who are risk assessed to self administer medication, are regularly reviewed to ensure their on going ability to self-administer medicines. DS0000032883.V332075.R01.S.doc Timescale for action 06/04/07 2. OP8 Schedule 3 (3)(m) Schedule 4 (13) 27/02/07 3. OP9 13 (2) 27/02/07 4. OP9 13 (2) 06/04/07 Manson House Version 5.2 Page 26 5. OP11 12 (3) The home needs to further 06/04/07 develop the palliative care and end of life needs of residents and record the outcomes in the residents care plan so that at the time of their death, dying or serious illness staff will treat them and their family with care, sensitivity and respect. All parts of the home must be free from hazards for the safety of the residents and suitable provision made for storage of wheelchairs and equipment. 06/04/07 6. OP22 13 (4) (a) 23 (2) (l) 7. OP29 19 (1) 2 Schedule 2 The registered manager must 26/02/07 not employ a person at the home unless they have obtained in respect of that person the information and documents specified in paragraphs 1 to 7 of schedule 2. The registered manager must conduct the home in line with the Care Homes Regulations 2001 and the National Minimum Standards to promote and make proper provision for the health, welfare and safety of the residents. 27/02/07 8. OP31 12 (1)(a) 9. OP37 37 The registered manager must 27/02/07 inform the CSCI of any event in the home which adversely affects the well being or safety of any resident. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 27 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. Refer to Standard OP29 Good Practice Recommendations In line with good practice a programme of renewal of CRB checks every three years should be undertaken, which includes a Protection of Vulnerable Adults (POVA) check. Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Manson House DS0000032883.V332075.R01.S.doc Version 5.2 Page 29 - 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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