Inspection on 30/04/07 for Manton House

This inspection was carried out on 30th April 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 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

Manton House 02/03/09

Manton House 12/02/08

Manton House 03/05/06

Manton House 15/11/05

Manton House 14/04/05

Manton House 18/11/04

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 Manton House Nursing Home 5 Tennyson Avenue Kings Lynn Norfolk PE30 2QG Lead Inspector Mrs Geraldine Allen Unannounced Inspection 30th April 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 Manton House Nursing Home DS0000061111.V338178.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. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manton House Nursing Home Address 5 Tennyson Avenue Kings Lynn Norfolk PE30 2QG 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) 01553 766135 01553 766135 Mrs Lai-Wah Collin Mr Raju Ramasamy, Mr Inayet Patel Mrs Margaret Anne Beale Care Home 22 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (22) of places Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Twenty-two (22) Older People, not falling into any other category, may be accommodated. Two (2) Service Users, over the age of 65 years, who have dementia may be accommodated. Total number accommodated not to exceed twenty-two (22). Date of last inspection 3rd May 2006 Brief Description of the Service: Manton House is a care home, providing nursing and residential care for up to 22 older people, two of whom may have dementia. The home has been owned by Mr Inayet Patel, Mrs Lai-Wah Collin & Mr Raju Ramasamy since October 2004. The home is located near to the centre of King’s Lynn and is close to all local amenities including shops, pubs and post office. The building is a large end of terrace house of traditional design. The accommodation is on the ground and first floor. There is a small garden at the front of the home, and a lawn and car park at the rear of the home. Eleven bedrooms are single, 3 of which have en-suite facilities and 4 are double occupancy rooms, 1 of which has en-suite facilities. The bedrooms are located on the ground and first floor. Ms Beale said that the fee range provided to the Commission is for the financial year 2006/2007. She is aware these rates have increased but was not able to advise of the new rate in time for inclusion in this report. Ms Beale said that prospective service users or their representatives were advised verbally of the relevant fee rate at the time they were viewing the home. The service provider confirms the fee rate in writing when the contract of residence is sent shortly after admission. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place during the morning and afternoon of 30th April 2007. Information was obtained from a variety of sources. Before the inspection took place, Ms Beale had provided information about the day-to-day running of the home. The Commission sent out questionnaires, and a total of 7 visitors/relatives and 1 resident completed and returned them. On the day of inspection, a range of documents and records were looked at; 3 visitors and 4 residents were spoken to in private and 5 staff were also spoken with. Ms Beale also provided information. A tour of the home was also conducted. Overall, people who use this service felt they had a good experience although there were some concerns about the availability of staff at key times. As a result, people were left waiting to be assisted to the toilet or to eat their meals. People spoke positively about Ms Beale and the staff at this home. They feel well cared for by staff who are doing their best and are friendly and kind. There are concerns about the overall management of this home. Key elements of good management practice are missing and the service providers need to ensure robust quality monitoring is in place. This will ensure that any short falls in the service are identified quickly and improvement implemented. The service providers are not complying with regulations that require them to visit the home each month and send a report of that visit to the Commission, together with any action that will be taken to improve the service. There is also concern that Ms Beale is allowed only 8 hours per week to fulfil her management responsibilities. A total of 9 requirements and 5 recommendations about good practice were set. Two of the requirements are repeated from the last inspection and must be complied with within the timescale set at the end of this inspection report. What the service does well: Staff at the home were well trained about abuse awareness. This ensures that people using the service are safe from abusive practice. There was also a complaints procedure in place that is well known by people living at and visiting the home. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 6 People receive good healthcare support that is well recorded. Residents felt confident that their health concerns were well known by staff and GP’s were contacted quickly if they needed them. The home is well maintained, clean and free of unpleasant odours. Stained carpets in some bedrooms are due to be replaced very soon. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 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 Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have an assessment of their needs before they move into the home. This ensures that people are confident the staff at the home can meet their needs. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 9 EVIDENCE: Three care plan folders were looked at in detail. Each contained a preadmission assessment, together with supplementary information from social services, the hospital and other agencies as necessary. In each case the assessment carried out by the home was not fully recorded but it was supported by relevant information received from other agencies in each case. The assessment completed by the home should be signed and dated in all cases so that it is clear when the assessment took place. The information held about the physical needs of each person was good but there was little or no information about the social, emotional and spiritual needs of people at this stage in the admission process. This means that staff would have little understanding about the way the person would want to live their life. This home does not provide intermediate care. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have a plan that sets out what their care needs are and how they should be met. These are good but need to be developed so that the social and emotional needs of people are understood and met also. People receive good and timely healthcare. There are good practices in place regarding medicines, although staff need to be reminded to lock medicines away in the trolley if they are leaving the trolley unattended so that risk of unauthorised people removing medicines from the trolley is reduced.. People said that staff treated them with respect and staff were seen ensuring the dignity of people. EVIDENCE: Three care plans were looked at in detail. In addition to pre-admission assessments, other needs and risk assessments were in place. Daily records were also kept within the care plan file. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 11 Each of the care plans gave good information about individual physical care needs and how they should be met. Each care plan folder needs more information about social and emotional needs. There would also be benefit to the development of life histories for each person. These developments would give staff a better understanding about the individual, the way they like to live, and the important people and events in their life. Each file contained good information about healthcare needs and how they should be met. There was evidence of regular and timely reviews of care. Arrangements for the safe storage, administration and recording of medicines were looked at. On 2 separate occasions, the nurse dispensing medicines from the trolley left blister packs containing medicines unattended. This represented a risk that an unauthorised person may remove medicines from the trolley. Good administration procedures were seen otherwise and the administration records were properly completed and legible. Controlled medicines were stored within an appropriate cabinet within the locked treatment room. This ensured they were safe. The stock held was checked against the register and was correct. There was good evidence obtained through observations that people’s privacy and dignity was respected. For example, 1 person was being hoisted in a communal space but this was done behind a mobile privacy screen. Staff spoke to residents in a friendly and respectful way. There were some concerns, raised as a result of discussions with residents and some visitors to the home. These were around the availability of staff to assist residents when they needed to use the toilet. Three residents gave examples of how they had been told by staff they would have to wait for assistance either because they were unable to help them at that time, or the hoist was already in use. This is unsatisfactory as the situation clearly causes distress to people when this occurs. There were also concerns based on observations made during this inspection around the arrangements for assisting residents at mealtimes. Please see standard 15. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service are able to spend their day how and where they wish. They described a lifestyle that matched their expectations. Visitors are welcomed at the home at any time. People are able to make choices about the food they eat and enjoy a varied diet. However, there is some concern about the arrangements in place to support those people who need assistance at meal times. EVIDENCE: Four people who use the service were spoken to in detail and 3 visitors to the home were also spoken with. One person said he likes to watch television or to listen to music. He had a television and music centre in his room and was seen at various times enjoying both. Another person said how happy she was that she had now moved into a single room and could entertain her great grand-children in private. Staff said that they always try to respect people’s wishes and gave examples o9f how they do this. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 13 It was noted during the day that televisions were on in each lounge and there was also a radio on in the dining area by the kitchen. This made the home sound very noisy at times. Two of the televisions had picture problems and they were difficult for people to look at. Ms Beale said this would be dealt with without delay. Quite a few people were asleep in chairs in the lounges during the morning. In the afternoon, staff joined residents with a game of bowls that seemed to be enjoyed by all. The home currently has an activities organiser who is very enthusiastic and motivational. Visitors to the home were spoken with. One said she does not always see staff about when she visits and assumes they are busy elsewhere in the home. She said that most staff are welcoming when she does see them. Another visitor said she gets on well with the staff and enjoys having a laugh and joke with them. She said she is often offered refreshment when she visits. Most residents said they enjoyed the food and that it was varied and plentiful. Another resident confirmed that they are always offered choices. The cook was spoken with. She described the menu for the day and also the special diets provided. She was aware of the preferences of each person. The kitchen was well organised. The dry food store was seen and also well organised, ensuring good stock rotation took place. Food supplies are delivered weekly, with additional purchases of fresh fruit and vegetables taking place more frequently. Lunchtime arrangements were observed. People were sitting in each lounge or in their own rooms. Most remained sitting in their armchairs with a table in front of them. Only 2 people were seen sitting at a dining table. Observation was concentrated on 1 lounge, where all residents remained in their armchairs. There were 4 residents in the room and only 2 were able to eat without assistance. The other 2 people had their meal placed in front of them. It was approximately 10 minutes before a member of staff returned to offer assistance. However, she did not remain to assist either person to finish their meal, and after 30 minutes of receiving her main course, 1 person had still not finished her meal and she was not eating. A carer arrived and spooned some more food into her mouth and again left. It must be assumed that these meals were cold and unappetising when assistance finally was given. For many people, food is the highlight of their day and it is disappointing that people needing assistance did not enjoy a better experience. Ms Beale said eight people in total need help to eat their food. Given the number of staff on duty at lunchtime, urgent consideration needs to be given to how staff are deployed and how assistance is given so that meals can be enjoyed by all. All residents had jugs and glasses of drink in front of them but no staff were observed encouraging people to drink during the course of the day. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 14 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 This judgement has been made using available evidence including a visit to this service. People who use the service know how to complain and are confident their concerns will be taken seriously and acted upon. People are protected by good practice and by staff who have been trained about abuse awareness. EVIDENCE: The complaints procedure was seen displayed on a notice board in the entrance hall. This document needs updating, as the name of the allocated Commission inspector is incorrect. Those people spoken to knew about the complaints procedure and who to speak to if they were unhappy about the service. People said they were confident Ms Beale would deal with any concerns they might have. In addition to a complaints procedure, there was also a comments book kept in the main entrance. This included comments such as relatives being made “very welcome” and also comments about the kindness of staff. Staff had a good understanding of abuse awareness and practice seen during the day was supportive and appropriate. Staff have received training about abuse awareness and receive regular updates on this matter. Recruitment practices include Criminal Records Bureau disclosures for all new staff. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 15 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 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean, well maintained and free of unpleasant odours. There was a lack of storage space and some thought should be given as to how this can be resolved so that the environment is pleasing and domestic. People were protected by the good infection control measures in place. EVIDENCE: One requirement was made at the last inspection regarding the fitting of privacy curtains and this has been met in full. A tour of the premises was undertaken with Ms Beale. All bedrooms have been redecorated and were clean. Some carpets were stained but Ms Beale confirmed that these rooms had been measured up for replacement carpets to be fitted. Some bedrooms have been highly personalised by the resident. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 16 There was a lack of storage space, resulting in continence wear, wipes and aprons being stacked in bathrooms and wheelchairs in the lounge corners. This practice made these areas untidy. The appearance of the bathrooms would be improved if cupboards were installed and some elements of domestication such as pictures and plants were put in them. There needs to be a review of the space available for storage throughout the home so that clutter does not detract from the homeliness of the environment. The laundry was well organised. The laundry person said that all laundry is done on site. Both washers have sluicing facilities and were able to thoroughly disinfect soiled laundry. The home uses the red dissolvable bags to maintain good hygiene and infection control standards. The kitchen was also well organised. The home has a shaft lift that is subject to a maintenance contract. The lift was working smoothly when checked. The home was well maintained and all areas were clean and free of unpleasant odours. The signage on people’s doors was discussed with Ms Beale. Currently, the bedroom doors do not have the person’s name on them and it was agreed that there was no reason why their name should not be put on the door if the person was in agreement. This would certainly aid orientation for those people who have some difficulty finding their way about and are independently mobile. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 17 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 adequate This judgement has been made using available evidence including a visit to this service. Staffing levels were to be reduced on the day of inspection. The ability of staff to meet all care needs in a timely and appropriate way must be kept under review. Staff at the home are committed to gaining qualifications in care and are supported by the home’s management to do this. There are good recruitment procedures in place but care must be taken to ensure 2 written references are obtained in all cases. Staff receive training that is relevant to their role. EVIDENCE: One requirement was set at the last inspection regarding staff qualifications and this has been met. On the day of inspection, staff were advised that staffing levels were being reduced due to the current lower levels of occupancy. The home is required to comply with a staffing notice, issued by the Health Authority, that states 1 qualified nurse and 3 carers must be employed between 08:00 and 15:00, 1 qualified nurse and 2 carers between 15:00 and 22:00 and 1 qualified nurse and 1 carer between 22:00 and 08:00. These staffing levels are minimums and must be adjusted to reflect the needs of the people living at the home to ensure needs can be met in a timely and appropriate manner. It should also be borne in mind that these staffing levels do not include the manager’s hours. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 18 Subsequent to the inspection, Ms Beale forwarded the revised staff rotas and these show compliance in part. Please see standard 31. On the day of inspection and in addition to Ms Beale, there was 1 qualified nurse and 4 carers on duty in the morning. Despite these staffing levels and has previously been stated, people did not receive assistance with their meal in a timely or appropriate way. There have also been expressions, reported earlier in this report, of dissatisfaction about the time people are sometimes required to wait before staff are available to assist them to the toilet. The management of the home must keep the dependency of residents under constant review and may also need to consider how staff are deployed if a good level of service delivery is to be made and maintained. Ms Beale was able to confirm that good progress has been made in regard to staff training to National Vocational Qualifications at levels 2 or 3. This means that once the current group of staff complete their training, the home will have almost 60 of its care staff qualified to this standard. This will have an impact of the quality of the care people may expect. Three staff files were looked at in detail. Each file was well laid out and information easy to retrieve. All relevant information was in place. However, only 1 of the files contained 2 written references (the most recent appointment) and 1 had only 1 verbal reference on file that had not been supported in writing. Completed criminal records bureau disclosures were seen on 2 files, with the most recent applied for. In this case, the carer was working supervised until the disclosure was received. Each staff file included evidence of training, all of which was certificated and the staff training profile was seen. There was evidence that staff receive training that is appropriate to their role. The induction training record however was brief and was recorded on 1 side of A4 paper. The record had been ticked but not signed or dated. The requirement for thorough and fully recorded induction and foundation training was discussed with Ms Beale and she was advised to seek guidance from Skills for Care to ensure the training provided by the home meets the common induction standards. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 19 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, 26 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Ms Beale is now registered with the Commission as manager of this home. She has not yet enrolled on the required qualification course for managers. No evidence was available at this inspection to demonstrate that the home seeks the views of residents, relatives and visitors and then acts on its findings. The service providers are failing to send completed visit reports to the Commission. Good practice is in place with regard to people’s money and valuables looked after by the home. A start has been made on formal staff supervision, but this needs to be carefully monitored to ensure each nurse and carer receives formal supervision 6 times a year. People are protected by good health and safety practices. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 20 EVIDENCE: Five requirements were set at the last inspection. Only 2 have been met in full. Ms Beale is now registered as the manager of this service and the requirement made about this has been met. Although she has the necessary nursing skills and experience to undertake this role, she has not yet enrolled on a Registered Manager’s Award training course. This was made a requirement at the last inspection and is repeated as a result. It is the expectation of the Commission that a home of this size requires not less than 44 management hours per week to be employed. Because of the reduced occupancy levels, this may be less, but the minimum should not drop below 32 hours. This figure must rise as occupancy increases. The newly revised staff rotas show that Ms Beale is employed to work only 8 hours per week in her management capacity. This is inadequate and will impact on her ability to undertake all her management functions to a satisfactory level. The Commission is not aware of any management input from the service providers that would compensate. Another requirement made at the last inspection was about a quality assurance process for the home. Ms Beale confirmed that the service provider is dealing with this. However there was no evidence that this process has commenced beyond the development of a satisfaction questionnaire that was seen in the entrance hall for relatives or friends to complete. The document does not have a return date and gives no space for additional comments to be made. Ms Beale said she has not been involved in the development of a quality assurance process and was unable to give any further information about progress. The requirement made at the last inspection is deemed to be not yet met as there is no evidence to suggest progress has been made to seek the views of residents, relatives and all others who use or visit this service. The Commission has not received any visit reports required to be undertaken by the service provider each month. Enquiries made to Ms Beale revealed that she has not received any written reports of visits either. These visit reports are required to be sent to the Commission under current legislation. The arrangements for the safe keeping and recording of people’s money and valuables were looked at. All monies were kept in a safe in the manager’s office. Only specified senior staff know the safe code. The money held was checked randomly against the records and was found to be correct. The records were well kept and legible but need to have 2 signatures for all transactions. Good practice was in place. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 21 The requirement made at the last inspection regarding formal staff supervision has been met in part and full compliance will not be evident until the next inspection. The staff files provided evidence that formal staff supervision and appraisal is taking place although Ms Beale acknowledged that this process has only recently started. Ms Beale is currently doing all the formal supervision herself and is mindful that this must be provided to all care and nursing staff 6 times per year. There was some evidence seen that she may have difficulty in achieving compliance unless this task is delegated amongst the senior staff. The requirement made at the last inspection has been met in regard to health and safety documentation. A range of health and safety documents was looked at including accident records, risk assessments, fire safety, the use and storage of chemicals and accident referrals. In each case the records were properly completed, with reviews and monitoring in place. Ms Beale spoke about how she monitors accident records to see if patterns emerge that need to be addressed. She described the action taken to refer one person to the falls team for further advice as a result. The weekly fire checks were up to date, with the last fire training taking place in March 2007. Portable Appliance Testing was also in place with records available for inspection. The records held in compliance with Control of Substances Hazardous to Health were looked at. Assessments were in place and up to date. Data sheets were seen and Ms Beale confirmed these reflected the products in use. Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 2 X 3 Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 (2) Requirement Staff must ensure that when the medicine trolley is to be left unattended, that all medicines are locked away inside. This will ensure that unauthorised people do not remove medicines. Arrangements must be put in place at mealtimes so that people are not expected to wait for staff to be available to assist them. This will ensure they enjoy their food when it is hot and appetising. A review and improvement of storage space needs to be undertaken so that bathrooms and lounges are not used to store items such as continence wear and wheelchairs. This will improve the homeliness of the environment for people. The number of staff needed on duty each day must be kept under constant review so that the full range of people’s needs are met in a timely and appropriate way. Staff must receive induction and foundation training that complies DS0000061111.V338178.R01.S.doc Timescale for action 28/05/07 2 OP15 16 (i) 28/05/07 3 OP26 23 (2)(l) 28/05/07 4 OP27 18 (1)(a) 28/05/07 5 OP30 18 (1)I(i) 25/06/07 Manton House Nursing Home Version 5.2 Page 24 6 OP31 10 (3) 7 OP31 18 (1)(a) 8 OP33 24 9 OP33 26 with the common induction standards. This will ensure that new staff receive a good level of knowledge at the start of their employment The Registered Manager must enrol on a recognised management course so that she is properly qualified to fulfil her role. This requirement is repeated. Sufficient management hours must be employed so that all management functions can be dealt with effectively and in a timely way. This will ensure the smooth running of the home. The service providers must develop and introduce a quality assurance process that seeks the views of people who use the service, relatives and visitors to the home. An action plan must be put in place that will demonstrate improvements to this service. This requirement is repeated. The service providers must ensure that monthly visits are carried out to the service and that a copy of the report of each visit is held at the home and a copy sent to the Commission. This will demonstrate that there is regular monitoring of the service. 25/06/07 28/05/07 25/06/07 25/06/07 Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 25 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 OP3 Good Practice Recommendations The assessment made for each person before they move into the home should include their social and emotional needs in addition to their physical needs. This will ensure that staff better understand how each person chooses to live their life. The care plans should include more information about the social and emotional needs of people so that staff can better understand these needs and how they can be met. The manager must ensure that staff are only recruited once a minimum of 2 satisfactory written references are received. This will help to safeguard people living at the home. It is recommended that 2 signatures are obtained for all financial transactions carried out on behalf of residents. This will help to protect people from financial abuse. The manager needs to keep the formal staff supervisions under review to ensure she is able to provide formal supervision to each member of staff 6 times per year. This will mean that staff feel well supported. 2 3 OP7 OP29 4 5 OP35 OP36 Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Manton House Nursing Home DS0000061111.V338178.R01.S.doc Version 5.2 Page 27 - 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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