Inspection on 08/05/06 for Manson House

This inspection was carried out on 8th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found 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 26/02/07

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 Seddon Unannounced Inspection 8th May 2006 10:00 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.V293367.R01.S.doc Version 5.1 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.V293367.R01.S.doc Version 5.1 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.V293367.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th January 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 communal areas are comfortably furnished in keeping with the style and design of the building. The home has a statement of purpose and a ‘Residents Handbook’ providing information for prospective service users, which is available on request, however this needs to be updated to reflect the current fee for each service user, which currently range from £388.75 to £420.00 per week. The fees are calculated as part of the pre assessment of the residents needs prior to moving to the home. Fees are reviewed annually and 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.V293367.R01.S.doc Version 5.1 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. This was a key inspection, which focused on the core standards relating to the older people. The report has been written using accumulated evidence gathered prior to and during the inspection. This included reviewing the progress of the requirements made at the last inspection in January 2006, and other documents required under the Care Homes Regulations. Additionally a number of records held at the home were looked at including those relating to residents, staff training and medication. Time was spent talking with the registered manager, ten residents, relatives of a service user visiting and four staff. What the service does well: What has improved since the last inspection? A requirement made at the last inspection was for all residents to have a moving and handling assessment in place. These have been completed. The home has had a meeting with a Falls co-ordinator and are in the process of implementing risk assessments detailing the prevention and intervention of falls for residents identified as a risk. The adult protection procedure has been amended and now directs staff to report all allegations or concerns of abuse to the Customer 1st team in line with the Suffolk Vulnerable Adult Protection Committee (VAPC). Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 6 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. Manson House DS0000032883.V293367.R01.S.doc Version 5.1 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 Manson House DS0000032883.V293367.R01.S.doc Version 5.1 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): 1,2,3,4,5,6, Prospective service users can expect to have information about the home and have the opportunity to visit prior to making a decision where to live. However, a pre admission assessment must be fully completed to ensure the home can meet the needs of the resident. EVIDENCE: The home has a detailed statement of purpose and a ‘Residents Handbook’. These are well presented and provide relevant information about the home. Contracts were discussed with the manager and the administrator who provided evidence that contracts are being completed between the resident and the Royal Agricultural Benevolent Institution (RABI). One completed contract was seen which gave clear guidelines of the service the home provides and the terms and conditions for residents living in the home. The contract of another resident that had recently moved into the home was unavailable for inspection, as their relative had taken the contract home to read and sign. Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 9 The home’s statement of purpose recognises that every prospective resident should have the opportunity to choose a home, which suits their needs and abilities, by ensuring that they have their needs expertly assessed before a decision on admission is taken. However, the plans of two residents were inspected to track their care and the level of support they required. In both cases the pre admission assessment had not been fully completed and was completed on or after arrival. This has been a repeat requirement from the inspections in October 2005 and January 2006. At the rear of Manson House the Royal Agricultural Benevolent Institution (RABI) provide 19 sheltered flats. Residents living in the home have been consulted and have agreed that tenants from the flats join in with some of the social activities and festive occasions. Concerns have been raised in the past about how much support is provided by the home to the flats. The manager advised the inspector that people in the flats are independent, however they do have night staff available on an on call basis. Evidence was seen that one tenant had taken the decision to move into the home from the flats as they felt they were finding it increasingly difficult to meet their own needs. As they were already aware of the service and a vacancy had arisen and after discussions with their family and the manager they made the decision to move into residential care. They told the inspector “care staff are one hundred percent and an absolute joy, I couldn’t be in a better place” The home does not provide intermediate care, however one resident spoken with who lives in the flats was staying in the home for a two-week respite period following a recent period of ill health. Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11, Residents can expect to be treated with dignity and respect and supported to have access to healthcare services. They cannot expect to have the needs fully assessed and have a care plan that reflects how staff are to assist them and the level of support they require. EVIDENCE: Two residents care plans were inspected. Each had a ‘plan of care’ assessment; these were not fully completed, signed or dated. A member of staff or a relative on the resident’s arrival is completing these assessments. The inspector and manager discussed the requirements of the National Minimum Standards (NMS) to complete an assessment of the residents needs prior to moving into the home. This is to ascertain that the home is able to meet the individual’s needs. These assessments also need to be completed by the manager or a designated trained person. As the pre admission assessments have not been fully completed, the care plans do not reflect the level of support residents require to meet their needs. For example one resident, whose file was seen, was assessed as needing help with personal hygiene and dressing. There was no detail of how staff should assist this resident or what level of support the resident required. Other Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 11 examples of where the residents needs had not been fully identified was under the heading mental state, ‘gets confused at times’, had been recorded and an entry of ‘sometimes’ had been written against history of falls. In both cases there was no additional information what support the resident needed. A senior’s book is used to keep a record of resident’s healthcare appointments, treatments and changes in medication. These details were not always being reflected in the daily recording notes in the residents care plans. The seniors have a separate diary, which provided evidence that residents are supported to attend healthcare appointments. For example, one resident was scheduled to visit their the general practitioner (GP) to have an electro cardio gram (ECG). A chiropodist and a hearing aid specialist are scheduled to visit residents at the home. One resident spoken with had requested and was waiting for a GP to visit as they were experiencing severe pain in the hand and was unable to move their fingers. A senior member of staff told the inspector that currently none of the residents have pressure sores. One resident had recently had a pressure area, which was treated by the district nurses and has now healed. A plan of care including regular changes of position and monitoring fluid intake had been implemented. Equipment for the promotion of tissue viability and prevention of the pressure sore re-occurring had been provided. A requirement made at the inspection in January 2006 that all residents must have a moving and handling risk assessment completed and held in their care plan on admission into the home has been actioned. One resident who recently moved into the home had an assessment completed and had been identified as a low risk. They are able to mobilise around the home independently with the aid of a walking frame or stick. A requirement was made at the inspection in October 2005 for the home to keep a separate record of falls. There was evidence at this inspection that the home contacted a falls co-ordinator who has visited the home to discuss the risks of slips, trips and falls with the residents, relatives and staff. Following this meeting the manager and deputy began the process of implementing assessments detailing the prevention and intervention of falls for residents identified at risk. The inspector observed a senior member of staff administering medication. The home uses a monitored dosage system (MDS). All medication administration record (MAR) charts were completed accurately. The medication was kept in a lockable portable medicine trolley. The blister packs are kept locked in the staff office when not in use. The home holds a small amount of controlled drugs that were locked in a separate secure cupboard. The controlled drugs book was seen and a random check of two resident’s drugs and amount of medication held was correct. Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 12 The senior was observed signing for medication prior to administering it to the resident. This practice was discussed with the senior that they must observe the resident take the medication and than sign the MAR chart as the resident may refuse to take the medication. If the MAR chart has already been signed this gives a false account of the administration of medication. Evidence was seen that residents who choose to administer their own medication have had a risk assessment completed to assess their ability to take their medication as prescribed. During the inspection staff were observed addressing residents by their preferred names. Their preferred name was recorded in their care plan. Staff were observed respecting residents privacy knocking on doors and waiting to be invited in prior to entering their rooms. Residents spoken with felt that staff treated them with dignity, one resident told the inspector that the “staff don’t step in or interfere unless necessary” when helping them with their personal care so that they were able to maintain their independence as much as possible. Evidence was seen in residents care plans that they are supported at the time of their death in accordance with their wishes. One resident’s care plan reflected that they did not wish to be resuscitated. The inspector was shown a letter from relatives of a resident that had recently passed away thanking the home for the support and care that the home had provided in the last stages of their relatives life. They described the care of their relative as “lovingly and inexplicably looked after”. Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, People living in the home are supported to make decisions, choices and have control over their daily lives and a lifestyle that matches their expectations and preferences. EVIDENCE: Residents were observed sitting in the lounge having general discussions about issues in the daily papers and the weather. The inspector spoke with a tenant from the flats who had joined the residents for morning coffee. There is a real sense of a community and friendships within the home. The inspector spoke with a resident who described their daily routine; they generally get up early out of choice and have breakfast in bed. They later spend their day reading the papers, talking with other residents, watching television or walking in the lovely gardens. Another resident spoken with described Manson House as delightful, couldn’t find fault, they couldn’t do anything better. They talked of their life and how they had risen through the ranks in the forces, and considered the standard provided by the home to be equivalent to living in the officer’s mess. A list of forthcoming outings was pinned to the notice board, which included clothes for real women party, a visit to Monks Eleigh, Anglesey Abbey, Hidden Gardens, a Summer Fayre and strawberry teas. Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 14 A range of places to visit for pub lunches were listed with dates including Shotley, Ely and Bressingham Gardens. Two residents spoken with confirmed they had been on the visit to Monks Eleigh ‘Corn Craft’ Tearooms. A ‘What’s on this week’ notice advertised activities with two sessions of handicrafts, a librarian visit, holy communion and a prayer meeting. Residents were also invited to have sherry in the lounge before Sunday lunch. Residents were seen receiving visitors in the privacy of their room. The visitor’s book showed that relatives were seen to visit frequently. The inspector was introduced to one resident and their visitors and spent time talking about their experience of the home. The resident had recently moved into the home from the flats as they were finding it more difficult to manage on their own. Both the resident and the relative were very complimentary with the way the home had supported the resident to make the move into residential care. Evidence was seen during a tour of the home that resident’s rooms are nicely furnished and discussion with residents confirmed that had brought some of their own furniture and possessions. All residents are offered the choice to hold a key to the door to their room. The manager discussed with the inspector the process for residents to manage their financial affairs. Some residents are able 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. A recommendation from the last two inspections was to re-instate regular residents’ meetings, this was at the request of the residents. The manager informed the inspector this has not yet happened but will be held quarterly as a coffee morning. Residents and relatives will be invited to share, discuss and feedback their views about the home and how the service should operate. Residents were observed entering the dining room for lunch, the tables were nicely laid out which invites residents to engage in discussion during their meal. The food seen looked appetising and as one resident commented food was served in “nice size portions, not to big”. The menu consisted of gammon with parsley sauce or Cornish pasties, accompanied by leeks and broad beans, new potatoes in their skins, followed by lemon meringue pie or yogurt. The teatime menu provided residents with a choice of jacket potatoes and cheese or ham sandwiches or toast. Residents spoken with were very satisfied with the food with comments “Food is very good, all home cooked” and “food is extremely good”. Residents choose their meals from a menu that is circulated the day before. The food is all home cooked using fresh produce. The cook was observed grating and squeezing real lemons for the meringue pie. The food stores were seen and held a wide range of dry, fresh and frozen foods. All were being stored appropriately and in line with food safety regulations. Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 15 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): 16,17,18, Residents and their relatives can expect to have their concerns or complaints listened and responded to, have their legal rights protected and can expect to be protected by the home’s adult protection procedures. EVIDENCE: Neither the home nor the Commission for Social Care Inspection (CSCI) have received any complaints since October 2005. The complaints book was seen and evidence was seen that previous complaints had been logged and action had been taken to investigate the complaints and the outcomes feedback to the person making the complaint. The complaint’s procedure had been reviewed in March 2006. At the back of the complaints log was a section for compliments. Several compliments had been made by relatives and by the chairman for the Royal Agricultural Benevolent Instittue (RABI). A relative had written conveying their deep appreciation and thanks for the care of their relative and the cleanliness, brightness and efficency of the home. Evidence was seen that residents are supported to exercise their civic right to vote. A postal vote request form was seen in one residents file for the last two years. The home has a detailed policy that deals with the management of allegations of abuse. In line with the requirement from the last inspection the policy has been reviewed and amended to reflect that all allegations of abuse should be referred to the Customer first team in line with Suffolk Social Care policy as an adult protection matter who will take the lead on the incident and advise the home accordingly. Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 16 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, 23,24,25,26, Residents can expect to live in a home that provides a welcoming and friendly atmosphere, however environmental issues need to be addressed to protect their health and safety. EVIDENCE: The manager informed the inspector that the architect’s plans have new been approved for alterations to extend the dining room and to create a storeroom. The work has been put out to tender. The manager will forward a copy of the plans and the fire officer’s report to the Commission for Social Care Inspection (CSCI) to ensure that they meet the requirements of the National Minimum Standards (NMS) prior to work commencing. A tour of the environment was made. The home is nicely decorated throughout and is bright, clean and fresh looking providing residents with a safe and comfortable 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. Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 17 There is a spacious library and a dining room. Additionally there is a conservatory, which is a designated smoking area for the residents of the home. All bedrooms are single occupancy and have en-suite toilet facilities. Resident’s rooms seen were clean and tidy and personalised to meet their needs and tastes. Residents are offered a key to their bedroom door and have lockable storage space provided for personal items. There are three assisted bathrooms and a walk in shower. The home has three other toilets in addition to the en-suite facilities. 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 grounds outside are well maintained providing a nice environment for residents to walk and sit in the nicer weather. The majority of the residents living at the home are mobile and can move around independently, although all corridors, bathrooms and toilets had grab rails positioned to provide additional support for residents to help them maintain their independence. Bathrooms were cluttered with commodes and shower chairs not being used. There was also a collection of folded up wheelchairs in the front entrance. Arrangements need to be made for aids and equipment to be stored elsewhere when not in use. All windows above ground floor have been fitted with window restrictors, but still open enough for the resident to air their rooms. To protect residents from the risk of burns or scolds all radiators are guarded. During the inspection of the building a number of fire doors were tested to ensure that they opened in an emergency, all were found to be functioning properly. Water temperatures are being tested and recorded. Records seen showed that the water is between 36 and 38 degrees centigrade, these temperatures are slightly cooler than the recommended 43 degrees centigrade and needs to be investigated. The home has 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. Staff have access to hand washing facilities with liquid soap and paper hand towel dispensers situated in every bathroom. One resident has contracted Methicillin Resistant Staphylococcus Aureus (MRSA), discussion with the senior carer reflected that the home has good infection control procedures in place to prevent and control the spread of infection. Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 18 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): 27,28,29,30, The home has an established staff team, available in sufficient numbers that are trainied to meet the specific needs of older people. EVIDENCE: Staffing levels were discussed with the deputy manager; 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. Three staff files were seen. All the necessary paperwork and recruitment checks were in place. All three staff have been employed at the home for a long time. Their Criminal Record Bureau (CRB) checks were completed between 2000 and 2003. The inspector discussed with the manager that it is good practice to have a programme of renewal of CRB checks every three years, which includes a Protection of Vulnerable Adults (POVA) check. A requirement made at the last inspection in January 2006 was for the manager to check employment records and explore any gaps prior to appointing a member of staff. Files seen reflected that application forms did reflect the working history of the employee. Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 19 Training records seen reflected that core training is taking place and being reviewed annually which included moving and handling, communication, food hygiene, adult protection, rights and discrimination, individuals rights and stereotyping and fire safety. 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. Staff have recently attended advisory sessions on the risks of slips, trips and falls and the management of Methicillin Resistant Staphylococcus Aureus (MRSA). The manager was observed arranging training sessions in July 2006 for four senior staff to attend a community study day on diabetes. Moving and handling training was taking place on the day of the inspection. The manager has arranged three separate days for all staff to attend. Two staff were spoken with who had attended the training. They had found the course very informative, particularly about the use of equipment available. For example the use of hoisting equipment, handling belts and slide sheets. They had been provided with an information pack, booklet and had completed a quiz during the session to help refresh their knowledge of moving and handling legislation and remind them of good practice. The home continues to offer staff the opportunity to undertake National Vocational Qualifications (NVQ). The deputy has completed their Level 3 and is currently working through the level 4 in care. Once they have completed this they will commence on the Registered Managers Award (RMA). The two other staff files reflected that they had completed NVQ level 2. Manson House has an established staff team with very small turnover. There have been no new staff employed in the home therefore it was not possible to inspect evidence of new staff induction in line with the new skills for care induction. This will be reviewed again at the next inspection. Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 20 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): 31,32,33,35,36,38, The home is well run in the best interests of the residents by an experienced and approachable manager. However there must be an established line of accountability with a Resonsible Individual from the Royal Agricultural Benevolent Institute (RABI) to monitor the standard of care provided in the home. To protect residents welfare and safety security arrangements have been assessed and a new security system is to be installed. EVIDENCE: The manager of the home has forty years experience in the care of the elderly and holds a national vocational qualification (NVQ) level 4 in management. They are supported by a deputy manager who is responsible for the running of the home in their absence. The deputy is currently working to achieve their NVQ 4. Relatives and residents spoken with during the inspection spoke very highly of the manager, that they were always approachable and helpful. One resident commented, “ the office door is always open, you always get a smile and a welcome”. Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 21 During discussion with the manager they informed the inspector that the previous Responsible Individual for the home had left the Royal Agricultural Benevolent Institute (RABI) and a new chief executive had been appointed. The Commission for Social Care Inspection (CSCI) has not been notified of this change, which is a requirement under the Care Home Regulations 2001. The discussion involved the frequency of the Responsible Individual visiting the home to conduct monthly unannounced visits to comply with Regulation 26 of the Care Home Regulations 2001. These visits are to inspect the home, and interviews with staff and residents should take place. A written report must then be forwarded to the manager, all directors of the organisation and the CSCI. 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. Residents surveys were last issued in June 2005, samples seen were very complimentary about the home, the staff and the approach of the manager. Comments seen in the surveys were “Excellent, staff try very hard to make it homely” and “long serving happy and loyal staff who benefit the residents and provide a high quality of care”. The manger has plans to revise the questionnaires to send out to obtain the views of all family and friends and other people who have contact with the home, for example general practitioners, district nurses and chiropodists. Residents are encouraged to look after their own financial affairs. A number of residents have a solicitor, power of attorney or family to help them manage their money and affairs. Eleven residents choose to have their monies held in the manager’s office. A recommendation was made at the previous inspection in January 2006 where the money of an individual resident is handled, the manager should make sure that appropriate records and receipts provided an audit trail of all financial transactions. Evidence was seen at this inspection that the home has purchased new pocket-sized books and plastic wallets. All entries and withdrawals are recorded and receipts attached. The wallet of one resident was checked with the manager, which showed money paid in and out of the wallet; the balance was checked and found to be accurate. Staff files showed that supervision is taking place, but not on a regular basis. One staff’s file had no evidence of recorded supervision since June 2005. The supervisions seen were based on observing staff undertake a task and then feedback given on their performance. A general discussion took place with the manager on the purpose and process of supervision as set out in standards 36 of the National Minimum Standards (NMS). At the last inspection in January 2006, the manager had informed the inspector of an incident where they had found two intruders on the premises. A crime prevention officer has since visited Manson House and made recommendations to improve the security of the home. The manager informed Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 22 the inspector they have obtained quotes from several companies to install a new security system. A company has been agreed who have produced a risk assessment of the home and will install a new entry system to all external doors which will be operated by a card entry system. Only residents, staff and tenents from the flats will be issued with a card to have access to the home. Members of the public will only be able to gain access via the front entrance. The front door will have a new inetrcom fitted which will be linked to a pager held by a senior member of staff. The management and staff are applying stricter and more vigalent checks of the home until the new security measures are installed. In each of the bathrooms there were several toiletries belonging to individual residents as well as cleaning materials. Resident’s toiletries need to be taken back to their room and not used for communal use. All cleaning materials are potentially hazardous and must be locked away in line with the Control of Substances Hazardous to Health (COSHH) regulations. Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 1 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 2 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 2 X 3 Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 24 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 OP3 Regulation 14 c Sch 3(1)(a) Requirement Each service user must have an assessment of need undertaken which is fully completed, signed, agreed and dated prior to admission. The manager or a suitably trained member of staff must complete the assessment. Timescale for action 16/06/06 This has been a repeat requirement from inspections in October 2005 and January 2006. 2. OP7 15 Sch 3 (1) (b) 3. OP22 13 (4) (a) 23 (2) (l) 4. OP25 13 (4) (a) 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. 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. Records show that the water is between 36 and 38 degrees centigrade, these temperatures are slightly cooler than the recommended 43 degrees centigrade and must be investigated. DS0000032883.V293367.R01.S.doc 16/06/06 16/06/06 08/06/06 Manson House Version 5.1 Page 25 5. OP31 30 (c) (iii) 26 RABI must notify the CSCI of the change to the responsible individual and conduct regular monthly visits to the home and produce a written report to the manager, the organisation and the CSCI. 30/06/06 5. OP38 13 (4) All cleaning materials are 08/06/06 potentially hazardous and must be locked away in line with the Control of Substances Hazardous to Health (COSHH) regulations. 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. Supervision sessions should be undertaken with a proper agenda providing an opportunity for staff to discuss their work role, any concerns they may have, future development and training needs. Supervisions should take place at least six times a year. 2. OP36 Manson House DS0000032883.V293367.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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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