Inspection on 24/04/07 for Mockley Manor

This inspection was carried out on 24th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Mockley Manor 14/06/06

Mockley Manor 06/09/05

Mockley Manor 19/04/05

Mockley Manor 05/10/04

Mockley Manor 13/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Mockley Manor Forde Hall Lane Ullenhall Warwickshire B95 5PS Lead Inspector Yvette Delaney Key Unannounced Inspection 24th April 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Mockley Manor DS0000004322.V338128.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. Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mockley Manor Address Forde Hall Lane Ullenhall Warwickshire B95 5PS 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) 01564 742185 F/P 01564 742185 www.alphacarehomes.com Alpha Health Care Limited Vacant post Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (52) of places Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th June 2006 Brief Description of the Service: Mockley Manor is a care home providing both nursing and residential care for up to 52 residents. The home is registered to provide care for elderly residents both male and female who are aged 65 years and above. Situated in a small village on the outskirts of Stratford-Upon-Avon and Henley-in-Arden, there is not easy access to local amenities. Access to the home is via a country lane and its location is rural. Accommodation for people who live in the home is divided over two floors. The first floor is used mainly for people who require personal care only and the majority of residents living on the ground floor of the home having nursing care needs. Most bedrooms are single, (5 shared rooms) with views of the surrounding countryside. There are three lounges and three dining rooms available as well as extensive gardens. The buildings are a tasteful combination of old and new build. Parking is available at the front and rear of the home. The current scale of charges for living in this home is set at £370 for residents requiring personal care only and £600 for residents needing nursing care. Other additional charges include the hairdresser, Chiropodist, toiletries, magazines and newspapers. Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and took place on a weekday, Tuesday 24 April 2007 between the hours of 09.30 am and 7.30 pm. The acting manager and area manager were present at the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Before the inspection, questionnaires were sent to the home to be given to residents, relatives/visitors and visiting professionals to seek their independent views about the home. Completed questionnaires were received from five relatives and six residents. Comments received provided mixed views of praise and concerns from people about the service they are receiving. Some of the comments are included throughout this report to evidence outcomes for people who use the service. The registered person of the home completed and returned a pre-inspection questionnaire containing further information about the home as part of the inspection process. Some of the information contained within this document has been used in assessing actions taken by the home to meet the care standards. Four residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting, talking or observing them, discussing their care with staff, looking at their care files, and focusing on outcomes. Records relating to the care of the people using the service, training and health, and safety were examined. Some of the residents were able to make active contributions during the inspection visit. Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: However this report is rated as adequate in six of the seven outcome groups which indicates that there are a number of areas in which the service needs to improve: ♦ To ensure that people who live in the home receive appropriate care all care plans must be sufficiently detailed and updated to reflect their current care needs. Risk assessments must be fully completed and updated. This will ensure that residents are not exposed to risk to their health and wellbeing. ♦ Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 7 ♦ Activities and events in the home need to be reviewed through consultation with people using the service. This will support person centred care and ensure that resident’s needs are met. To ensure that staff have the knowledge and skills to work in the care home a plan of action must be developed to identify how the number of staff with an NVQ 2 qualification is to be increased. The number of staff attending planned training needs to be monitored and measures implemented to ensure that staff are aware of the importance of attending training. To ensure the safety of people who live in the home the number of staff that have attended training related to safe working practices needs to be increased. Supervision of staff needs to involve monitoring working practices to ensure that staff are practising competent to do their work and maintain the safety of residents at all times. ♦ ♦ ♦ ♦ 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. Mockley Manor DS0000004322.V338128.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 Mockley Manor DS0000004322.V338128.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): 2, 3 and 5 Quality in this outcome area is good. The preadmission assessment provides sufficient and suitable information for the home to ensure that the diverse needs of people admitted to home can be met. Residents accept the terms and conditions for living in the home. These judgements have been made using available evidence including a visit to this service. EVIDENCE: Four care files for newly admitted people to the home were examined as part of the case tracking process. The four files show that pre-admission assessments of these residents had been carried out to ensure that the home has the resources and ability to meet their care needs before being admitted into the home. Information available showed that an assessment of each Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 10 person’s physical, health and social care needs and the level of support needed to meet their needs had been assessed. Other assessments of the residents care needs include social care assessments carried out by social services and assessments of nursing care needs by nurses from the Primary Care Trust. Each person and/or a family member had been involved in the assessment process. A family member for a recently admitted resident said that the family had been involved in the assessment before admission to the home. One resident spoken with said that they had been given the opportunity to visit the home before making the decision to move in. Statements of Terms and Conditions for moving into the home were available. These had been signed by the people using the service to confirm their acceptance of the conditions for living in the home. Comments in the questionnaires returned to the Commission by people who use this service include: “The manager at the time…contacted me after the visit to see how I felt about the home.” “We got information from the internet.” One person commented that they felt rushed into the choosing a home but did not say by whom. Mockley Manor DS0000004322.V338128.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 and 10 Quality in this outcome area is adequate. Care plans do not detail the individual care needs of all residents living in the home. This practice does not ensure that the care delivered will be appropriate at all times. Medication practices are not consistently carried out in a manner that ensures the safety and welfare of residents at all times. Residents do not always feel that their privacy is respected at all times. These judgements have been made using available evidence including a visit to this service. EVIDENCE: Four residents were identified from the completed pre-inspection questionnaire returned to the Commission for case tracking. These residents were seen and the interaction between them and staff were observed throughout the day. Examination of the four files showed that the standard of care plan documentation in three of the files was poor. The care plans for three of the residents followed through the case tracking process showed that they did not Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 12 contain clear and concise information describing their range of personal and health care needs. Further examination identified that the information available was not sufficient to support staff in meeting the needs of these residents. For example, information in a resident’s care plan identified that they have high blood pressure, which was increasing. The care plan said that the person’s blood pressure was to be checked weekly. Records showed that the blood pressure had been recorded on four occasions during March and April. A written entry in the care file dated 18 April 2007 states, “Blood pressure to be taken at regular intervals.” There is no indication of how often this should be done. The lack of clear instruction could result in staff not taking appropriate and timely action to prevent deterioration in the resident’s health. The pre-admission assessment for this resident said that they were at risk of falls and a risk assessment was needed. A falls assessment form was available but not completed the only information documented on the form states “Uses aids, needs Zimmer frame.” “Balance poor.” A moving and handling assessment updated in April 2007 does not mention how staff should support the resident when moving or if aids are needed. A care plan identified the resident as having a problem of unsteady gait. The details in the plan of care were not specific to gait but made reference to personal hygiene and pain. The care plan failed to provide staff with accurate and appropriate instructions on how they should meet this person’s needs and therefore could put the resident at risk of harm. A further care plan for one of the residents relates to the risk of falls. Information within the plan of care states: “Offer (resident) assistance with mobilising around the home” and “Ensure aids to mobility i.e. Zimmer frame/sticks are of the correct height.” This resident was observed to be bed bound and the above plan of care did not reflect their current care needs. A moving and handling risk assessment did not provide an outcome as to the level of risk and was not signed or dated. However the content provided explanations as to the level of support and equipment required which include two carers to help the resident in and out of bed, a hoist and slide sheet were the moving aids to be used by care staff. The contents of this care plan showed that staff failed to make an appropriate assessment of this resident’s care needs resulting in an inaccurate plan of care, which could put the resident at risk of harm. Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 13 An assessment of the risk of a resident acquiring a pressure sore had been carried out and the resident was observed to have a pressure-relieving mattress on the bed. Other risk assessments carried out include nutrition and continence as previously identified within this report risk assessments were not always fully completed. Incomplete assessments meant that the level of risk was not clearly identified in order to plan how the risk would be managed and to protect the resident from harm. For example, a nutrition risk assessment indicated that a resident was ‘at risk’ due to poor appetite and weight loss. A review of the assessment on the day of the inspection showed that if the form had been completed correctly the outcome should show that the resident was in fact at ‘high risk.’ A conversation with this resident identified that when first admitted to the home their appetite had fluctuated and they had lost weight. The person had now improved, their appetite had increased and a weight chart showed that they had put on weight. The care plan for this resident had not been updated to reflect their current and changing care needs related to nutrition. One of the four care plans examined did provide detailed and concise information on a residents needs and how these were to be met. The care plan and discussion with the resident demonstrated that they had been involved in planning their care. The resident explained to the inspector reasons for the choices made in their day-to-day life in the home. Evidence of an evaluation of the care given and monthly review of the residents care needs had been carried out. However, risk assessments were also not fully completed in this care file. The contents of the care plans were discussed with the acting manager and the area manager. It was identified that the standard of poor care planning may relate to one member of staff. Discussions took place on the support that may be needed by staff to improve the care plan documentation for residents admitted to the home. For example, using the information gathered in the pre-admission assessments and obtaining life histories would help to demonstrate that staff have a good understanding of the residents they care for and their individual needs. Evidence that residents have been involved in planning their care would also show evidence of good practice and improve care planning. Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 14 Entries in residents’ health records and comments by staff confirmed that people are supported to gain access to relevant health professionals where required, such as the GP, Optician, Dentist and Chiropodist. The management of medicines in the home was examined, practices showed improvements had been made since the last inspection undertaken by the pharmacist inspector. The monthly stock of medicines is safely stored in locked cupboards. Staff receive training in the safe administration of medicines. The medication administration records for the four residents reviewed through the case tracking process show that they are well maintained. There were no omissions on the records. The medicine fridge temperatures are being monitored the recordings show that the maximum temperature is above 8ºC, which may affect the stability of medicines. The area manager advised that the fridge temperature is being monitored together with the temperature in the medicine room, which at times is hot and may be affecting the fridge temperature. The maintenance man for the organisation is currently trialling a system to find out whether it will maintain a suitable temperature in the medicine room. Following this trial period, decisions will be made as to the best course of action to ensure the safe storage of medicines in the home. There are some outstanding requirements from the previous key inspection. Risk assessments for persons self administering their own medication did not provide sufficient information to show that they are safe to take their own medication. A protocol was not available to support the safe administration of ‘when required’ medicines, these are medicines prescribed to be used occasionally. Two new concerns related to the safe storage of medicines were identified at the time of inspection. Nursing staff were decanting controlled drugs into different containers, which carried different batch numbers and expiry dates. The second was nursing staff writing residents first names in big letters on the dispensing label on the medication packaging. The details on the label would be used to cross-reference with the prescribing details on the Medication Administration Record (MAR) chart. This should form part of the procedure when administering medication to residents and ensure that the correct medication is given to the right person. Writing on the label in this way could make it difficult for staff to read the medication instructions on the labels preventing accurate checking of medication before giving it to the resident. Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 15 These are unsafe practices, which could cause errors when administering medications to residents and put them at harm. Comments received from relatives and residents related to meeting the care needs of people who use the service were discussed with the acting manager and the area manager. These include concerns that resident’s physical needs are not met appropriately, as they are not supported to mobilise. “Not encouraged to walk since moving into the home…has not walked unaided for a year.” “Not enough consideration given to immobile residents to help them sit comfortably. Lifting simple equipment e.g. cups.” “Alarm button not within reach.” Discussions with the acting manager and area manager show that they are committed to examining the concerns highlighted above further through the quality monitoring process. This will give the opportunity of ensuring that people are receiving appropriate care and provide feedback for residents and families. People living in the home were well groomed and dressed. Residents’ personal care needs were met in their own bedroom or in one of the communal bathrooms and doors were closed demonstrating that staff respect resident’s privacy and dignity. A comment was made that “Ladies should be showered and bathed by other ladies and not men.” This was discussed with the managers and agreed that it would be examined further to ensure that resident’s preferences would be respected to ensure their dignity. Positive comments were also made supporting staff for the care they are giving. “…Staff in the home are very nice.” “Satisfied with quality of care relative receives.” Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 16 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 and 15 Quality in this outcome area is adequate. Lifestyle in the home does not encourage people who use the service to participate in daily life, meet their diverse needs or support people living in the home to live ordinary lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The approach to activities and events occurring both in and outside the home has deteriorated since the last key inspection. The majority of residents missed listening to a visiting musician to the home because his visit had been forgotten about and residents had not been reminded or informed that the activity was taking place. The notice board used for advertising activities was not accessible to residents, this was placed high on a wall in the reception area of the home. In conversations with the Activities Coordinator, the presentation of the weekly activity programme was discussed as this was not easily Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 17 accessible or reader friendly for residents. The coordinator mentioned a newsletter that is produced for residents but a copy was not made available. Comments received from residents about activities in the home provided mixed views but showed concern about opportunities for social stimulation these include: “Activities: Need more variety ‘Bingo, skittles, bingo, skittles.” “Social side sadly lacking. (Activity Coordinator) – entertainment person provides a range of entertainment from active to just sitting and/or having a quiet chat on a one to one.” “Activities bingo, skittles, snakes and ladders and quizzes well organised. Seasonal craft ideas are well received by both residents and their families.” “Need more stimulation than currently received. Weekend quiet no television or radio in the big lounge.” Observations during the inspection, discussions with staff and people who use the service did not confirm how residents are enabled to make decisions that affect their every day lives. Life histories in care plan documentation were not completed to determine people’s hobbies and life experiences which would help staff to support residents to continue with their interests or could be used to inform activities and events which take place in the home and encourage resident participation in areas that interest them. Most residents continue to have good contact with their relatives and take part in family events outside of the home. These include going out for the day, taking a walk around the grounds or spending the weekend with family. On the day of the inspection, a resident was returning to the home after spending the weekend with their family and another after spending the day out. Visitors were seen to visit their relatives in their bedrooms and in the lounge areas at varying times of the day. Relatives however in their responses to questionnaires sent out expressed concern about the lack of communication and information received from the home. Comments made include: “Home does not help residents to keep in touch with family members and friends.” Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 18 “There was an occasion when (relative) was confused when a phone call to me would have changed the situation.” “Have to make own enquiries, often staff ‘don’t know’ what has happened because of lack of continuity.” “Always have to ask for information, only contact made by home relate to financial matters. Itchy rash over several months could have been scabies. I had to work hard to get information.” “Newsletters periodically distributed advises forthcoming events at the home, essential information posted on notice board. Care manager approachable if further information required.” “Need more stimulation than currently received. Weekend quiet no television or radio in the big lounge.” Food storage areas were well stocked with a wide range of foods. Menus were not easily accessible to residents. All the menus for a four-week period were displayed on a notice board in the main dining room on the ground floor. The menu for the day was written on a blackboard in the corridor at the front entrance to the home. Both displays were not easy to see or read and speaking with residents they were not able to say what was for lunch that day. Observation during lunchtime demonstrated that residents enjoyed their meal. However, some comments received via questionnaires expressed concerns about the standard and availability of food in the home. “When I have asked for more tea or food, sometimes they ignore me and walk off.” “Food deteriorated and is not consistent depending on who is cooking. Things improved slightly but often I am very hungry because what is served is cold or inedible or poorly prepared causing waste.” “Food always looks appetising.” Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 19 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 and 18 Quality in this outcome area is adequate. People who use this service are able to express their concerns and have access to a complaints procedure. Due to the lack of training for some staff in the protection of vulnerable adults, people living in the home are not always protected from the potential risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Policies and procedures are in place to support staff in managing any complaints received by the home. Speaking with four residents and comments received from residents and relatives in the questionnaires received demonstrate that they are aware whom they should speak to if they have a complaint. The Commission has been notified of two complaints since the last key inspection. Six complaints have been received by the home, five of which have been resolved to the satisfaction of the complainant and one investigation is ongoing. Issues in the complaints relate to management of medicines, standard of care, management in the home, poor maintenance of home and weight loss. Comments in questionnaires from relatives in response to the question ‘Do you know how to make a complaint about the care provided by the home?’ include: Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 20 “Contacted head office, got back to them and introduced themselves when in the home.” Staff spoken with were aware of the complaint procedure and was able to comment on the action they would take if they received a complaint. A policy and procedure detailing the action to be taken by staff to ensure the protection of vulnerable adults was examined. Training records show that only ten of forty-four staff had attended training related to the protection of vulnerable adults in the last year. Discussions with two members of staff show that they are aware of their role and responsibility in reporting any suspicion of, or actual harm to residents. Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 21 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, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is adequate. The environment is varied throughout the home in relation to safety, comfort and hygiene, which might reduce the experience of quality of life for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Comments received in questionnaires and discussions with people who use the service state: “Care Home creates a homely atmosphere free from any smell of urine. Staff obliging and friendly all rooms clean and tidy.” “Clean, fresh and bright. Families and dogs made welcome.” Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 22 Some residents and relatives felt that: “Decoration and thorough cleaning needed.” “Garden neglected, paths rough for wheelchair use so bumpy. Narrow paths. Entrance to home is difficult to negotiate with wheelchairs.” “Lack of cleaning at weekend.” A brief tour of the home showed that the home was clean and homely. Maintenance and redecoration of the home is ongoing and bedrooms and lounges have recently been redecorated. Bedrooms are located on the ground and first floor of the home some of the bedrooms have been personalised by residents and relatives. Three lounge areas are available on the ground floor, one offers a quiet area where residents and their visitors can sit freely or in private. There is a separate dining room where residents are encouraged to dine to enable socialising where possible. Some bedrooms have en suite facilities and there are sufficient separate bathing and shower facilities to meet the needs of all residents accommodated in the home. The garden area was well presented at the time of the inspection visit. The area manager confirmed that the garden area had been neglected for a while due to the gardener being absent. During the tour of the home it was noted that one of the lounges where residents were sitting was cold and residents spoken with said that they were cold. This was discussed with the acting manager and area manager and action taken immediately. The home had notified the Commission that they were having problems with one of the boilers. Actions were ongoing to remedy this and temporary heaters were available for use. Staff had failed to turn the heaters on before residents started using the room. The laundry in the home is small for the size of home. Equipment available includes three small washing machines, one of which is out of order. The room is divided into two providing clean and dirty areas. Staff were observed to throw the dirty laundry onto the floor although baskets are available. Care staff carried dirty clothing in their hands when attending to resident’s personal needs. Skip bags to transport dirty linen were not being used. Policies and procedures for the management and control of infection are in place but some staff practices during the visit were seen to be unsafe. There were two chemical products in the laundry room used as part of the washing process. Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 23 Risk assessments were not available for these products, they were not locked in a cupboard, the laundry door had been left open, and no one was in there. The sluice room was also found to be open. Keeping these, rooms unlocked when unattended could present a potential risk for residents if they were to enter the laundry or sluice by mistake. Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 24 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 and 30 Quality in this outcome area is adequate. The increased use of agency staff and the lack of suitably qualified and trained staff does not ensure that residents are in safe hands at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Duty rotas for a four-week period were obtained on the day of the inspection to ensure that working rota’s were examined. On the day of the inspection, the late shift was short by one care staff and a nurse was required to cover the night shift. Before the end of the inspection visit an agency confirmed that a nurse had been found to cover the night shift. Information received with the pre-inspection questionnaire and duty rotas show that there is a high use of agency staff. Comments from residents and relatives in questionnaires received expressed concerns about staffing levels, the quality of agency staff and problems with communication due to language barrier with some staff. “If more staff available at night, staff care would be greatly improved occasionally only 2 staff are at work.” Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 25 “Insufficient staff, language barriers due to poor spoken English.” “Some agency staff are less caring, not fully appraised of resident’s capabilities relative finds this upsetting.” “Permanent staff very good, casual staff can lack experience, commitment and motivation.” “Agency carers/nurses used on a regular basis. Friendly attitude but left wondering if their experience is the same standard as the permanent staff. Language/accent cause communication barriers, sometimes difficult for the elderly and hard of hearing to understand.” “Poor staffing levels at weekends.” The concerns about agency staff were discussed with the acting manager and area manager. The use of agency staff was confirmed to be due to staff leaving and absences. Both managers felt that the number of agency staff working in the home had decreased and that there are plans to reduce this even further. The area manager explained that due to the changing care needs of people living in the home there has been a conscious decision to increase the number of care staff on duty. The services of agency staff will continue while permanent staff are being recruited to ensure that sufficient number of staff are on duty at all times. The files of three recently employed staff were examined and these show that safe recruitment procedures are followed to ensure that residents are protected. Criminal Records Bureau checks are carried out and appropriate references obtained for all potential new staff before staff are employed in the home. Staff training records show that staff had received varied training. In discussions with staff, they said that they had attended mandatory training, which include moving and handling and fire training. A training matrix examined for the past year 2006/07 shows that although training sessions are planned the number of staff that have attended the training is small. For example, ten of forty-four staff (22.7 ), had received manual handling training, ten staff (22.7 ) had received training related to abuse and thirteen staff (29.5 ) training in Health and Safety. Other training undertaken by staff in the past year includes infection control, falls management, dementia and Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 26 drug administration. However, records do show that very few staff attended these training sessions. A new starter induction pack showed that induction training for new staff is linked to the ‘Skills for Care’ induction programme. A discussion with a recently employed member of staff and information contained on the duty rota confirmed that the induction includes ‘shadowing’ an experienced staff member. There was some confusion however on the length of the induction period as this varied between two to three days and three months. It was clear from discussion with staff that they felt that their induction period had been for a few days. The induction pack demonstrates that it is linked to a rolling programme of assessment of care staff towards an NVQ (National Vocational Qualification) Level 2. However, training records in the home show that the number of care staff with this qualification remains low with only currently 7.5 with a recognised qualification. This will increase to 15 as three further carers are currently doing the training. There was also very little evidence that both nurses and care staff had attended specialised training for example dementia care, death and dying, management of falls, diabetes, prevention of pressure sores, management of hypertension (high blood pressure), care of people following a stroke. These topics would all be related to the care of residents currently living in the home. The absence and lack of attendance at training sessions does not demonstrate that staff have the appropriate skills and up to date knowledge to be able to carry out their role to meet the diverse needs of the people living in the home. Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 27 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, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. Management arrangements are not robust to ensure consistency in the quality of service provided to ensure that practices consistently meet the needs of people living in the home to safeguard their welfare and interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager and area manager for the organisation were present at the inspection and both were knowledgeable about the residents living in the home. Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 28 The home does not have a Registered Manager, the previous manager has recently resigned. Comments received in questionnaires returned to the Commission by residents and relatives and discussion with people using the service at the time of the inspection suggest that they were not happy with the then management structure. The concerns were that the home had deteriorated. The atmosphere of openness and respect had declined and people did not feel valued or that their opinions matter. Alpha Health Care Limited is actively trying to recruit another manager. In the interim period, the deputy manager has been asked to manage the home overseen by the management team at Alpha Health Care. Alpha Health Care were aware of many of the concerns raised by residents and relatives in the questionnaires received. A meeting had recently been held to give people who use the service the opportunity to voice their concerns. There is a quality assurance and monitoring process, which is based on ensuring the home is meeting the needs of the people living in the home. This involves an internal audit against identified standards. Quality monitoring covers all areas of the service and includes, infection control, training and development of staff, food provision, staffing levels and complaints. Comments received from people who use the service do not confirm that the service has a commitment to involving people using the service, relatives and friends, health care professionals and staff through seeking their views. Monies are held by the home on behalf of a number of residents for safekeeping and are stored safely and securely. The records of residents followed during the case tracking process were examined. Generally, the system is robust and evidence of good practice was seen. Residents’ money is held separately in individual envelopes. Computer and manual records are held of financial transactions. Residents and or relatives acting on their behalf are sent copies of accounts when monies need replenishing and every six months to show the conduct of accounts. Accounts are audited and reconciliation of all accounts takes place every two months. However, individual receipts are not always held in respect of money spent on behalf of the resident. Individual records detailing financial transactions must be maintained in accordance with the Data Protection Act 1998. The manager confirmed that the majority of residents maintain or handle their own financial affairs either themselves, with the support of relatives or other advocate or representative from outside of the home. Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 29 Staff are supervised at least six times per year this includes an annual appraisal. Staff files showed that the outcomes of supervision sessions are consistently recorded. Topics discussed and action or activity that staff would be undertaking before their next supervision to demonstrate any progress made were identified. Health and safety management in this home are not always of a high standard as unsafe and poor practices were observed in the home. Examples of these include the methods used when care staff were collecting and disposing of dirty clothing and staff were seen to transfer a resident from the lounge to the toilet in a hoist. Records show that safe practice is not promoted by ensuring that all staff attend training in manual handling, food hygiene, first aid, fire safety and infection control. The kitchen was seen to be clean and organised. Records of fridge, freezer and high risk cooked food temperatures are maintained. A cleaning schedule was in place and used to make sure all areas of the kitchen were regularly cleaned. Discussions were held with the cook and area manger about the number of care staff accessing the kitchen when food was being prepared. This practice did not ensure that food hygiene procedures in the kitchen could be maintained at all times. Pre-inspection information received shows that maintenance of fire fighting equipment, electrical appliances and hoists takes place on a regular basis. Fire safety management includes regular testing of fire alarms, emergency lighting, and all records relating to fire safety management were up-to-date and in good order. A record is maintained in the home of any accident or incident that happens to a service user. Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 30 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 3 2 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 2 3 3 2 Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 31 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. Standard 1 OP7 Regulation 15(1) Requirement All persons using the service must have an up to date detailed care plan this will ensure that they receive person centred support which meets their needs. Any identified risk to a persons health and wellbeing must be recorded, assessed, monitored and appropriate care and support provided. This will ensure that all people using the service have their needs met. All staff must be able to follow clear and appropriate guidance when administering ‘as required’ medication to people using the service. This will ensure that people receive the correct levels of medication. All people using the service who wish to administer their own medication must have an up to date risk assessment detailing their capabilities. This will ensure the safety of people using the service. DS0000004322.V338128.R01.S.doc Timescale for action 01/07/07 2 OP8 13(4) 01/06/07 3 OP9 13(2) 01/06/07 4 OP9 13(2) 01/06/07 Mockley Manor Version 5.2 Page 32 5 OP9 13(2) All medicines received into the home must be stored in the containers in which they were dispensed and received by the home. This will ensure that medicines are safely stored and people are not put at risk of harm. All staff working in the home must be appropriately trained in all areas related to the Protection of Vulnerable Adults. This will ensure that people who use the service are protected from harm and abuse. All staff must follow procedures for the safe collection and disposal of dirty laundry. This will ensure that people that use the service are not put at risk of infection. The doors to the sluice and laundry rooms must be locked when unattended. This will ensure the safety of people who use the service. Chemical products used in the home must be stored in suitable and appropriate lockable storage facility. This will ensure the safety of people who use the service. The number of care staff with an NVQ level 2 qualification or equivalent in care must be increased. This will ensure the safety of people who live in the home. This requirement is outstanding from 31/08/06 01/06/07 6 OP18 13(6) 01/06/07 7 OP26 13(3) 01/06/07 8 OP26 13(4)(a) 01/06/07 9 OP26 13(4)(a) 01/06/07 10 OP28 18 01/08/07 Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 33 11 OP30 18 All staff must receive training appropriate to the health care needs of the people in their care. For example: • Management of hypertension (high blood pressure) • Dementia care • Prevention and management of mobility/falls • Care of people following a stroke. • This will ensure the safety of people who live in the care home and that staff are trained and competent to meet their care needs. A suitable person must be appointed to manage the care home. This will ensure that people live in a home that is well managed and considers their best interests. Receipts must be available to demonstrate the purpose for which items or services were purchased on behalf of people who live in the home. Outstanding from 31/08/06 01/08/07 12 OP31 8(1)(a) 01/07/07 13 OP35 9(a) 01/06/07 14 OP38 12(1)(a), 13(3)(4)(5) All staff must be appropriately trained in all areas related to safe working practices this includes: • • • • Moving and Handling First Aid Food hygiene and Infection control 01/06/07 This will ensure that people who use the services have their health safety and welfare protected. Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 34 15 OP38 13(5) All staff using hoists must be appropriately trained in their use. This will ensure the safety of people using the service. 01/06/07 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 OP10 Good Practice Recommendations The wishes and feelings of people who use the service should be considered when staff are attending to their personal care needs. This will ensure that care is provided in a way that respects their privacy and dignity. All people using the service should be consulted about their social interests to help maintain links with community life. This will ensure that they receive person centred care that meets their needs. The views of people who use the service should be sought when making decisions about activities that take place in the home. This will ensure that their needs are met. All people using the service should be supported in maintaining contact with their family and friends. This will ensure that links with family life is maintained. Arrangements should be in place to keep the family of people who use the service informed of any changes that affect their health and wellbeing. This will ensure that links with family life is maintained. Clear arrangements should be in place to demonstrate how people who use the service are enabled to make choices in their daily life in the home. This will ensure that individual independence is maintained and encouraged. DS0000004322.V338128.R01.S.doc Version 5.2 Page 35 2 OP12 3 OP12 4 OP13 5 OP13 6 OP14 Mockley Manor 7 OP15 Details of the choice of food available in the home should be in a format that people living in the home can easily read or relate to. This will ensure that they are able to make choices about what they eat. The views of people who use the service should be sought on the quality of food provided in the home. This will ensure that they receive person centred care that meets their needs. When carrying out a review of the quality of care provided in the home the views of people, who use the service should be sought. This will ensure that they receive person centred care, which meet their needs. Suitable heating must be provided in all parts of the home. This will ensure that people living in the home have their needs related to comfort, health, and well-being met. The qualifications and experience of agency staff working in the home should be confirmed to ensure that people who live in the home are in safe hands at all times. Newly appointed staff should be aware of the length of their induction period and what it involves. This will ensure the safety of people who live in the home and staff are well prepared for their role. Arrangements should be in place to ensure that people who use the service and staff are involved and consulted on the day-to-day running of the home. When carrying out a review of the quality of care provided in the home the views of people, who use the service must be sought. This will ensure that they receive person centred care, which meet their needs. Access to the kitchen by care staff should be discouraged when food is being prepared. 8 OP15 9 OP24 10 OP25 11 OP27 12 OP30 13 OP32 14 OP33 15 OP38 Mockley Manor DS0000004322.V338128.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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