Inspection on 16/04/07 for Nettleton Manor

This inspection was carried out on 16th April 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Nettleton Manor 08/06/06

Nettleton Manor 07/02/06

Nettleton Manor 06/05/05

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

CARE HOMES FOR OLDER PEOPLE Nettleton Manor Moortown Road Nettleton Caistor Lincs LN7 6HX Lead Inspector Mr Ken Hague Key Unannounced Inspection 16th 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 Nettleton Manor DS0000064035.V335712.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. Nettleton Manor DS0000064035.V335712.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nettleton Manor Address Moortown Road Nettleton Caistor Lincs LN7 6HX 01472 851230 01472 852015 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) Hapee Care Ltd Mrs Elizabeth Maude Alexander Smith Care Home 41 Category(ies) of Dementia - over 65 years of age (41), Old age, registration, with number not falling within any other category (41), of places Physical disability (4) Nettleton Manor DS0000064035.V335712.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service users in the category of Physical Disability must be aged 50 years and over. The Home is registered to provide personal care, with nursing, for service users of both sexes whose primary needs fall within the following categories: Old age, not falling within any other category (OP) - 41 Dementia - over 65 years of age (DE(E)) - 41 Physical disability ({PD) – 4 The registered manager undertakes training to obtain the Registered Managers Award, and should enroll on the training within three months of registration. The registered manager undertakes a recognised training course in the management of dementia needs within three months of registration. The maximum number of service users to be accommodated is 41. 3. 4. 5. Date of last inspection 8th June 2006 Brief Description of the Service: Nettleton Manor is a two-storey, Victorian manor house, property standing back from the road in four acres of woodland and gardens. In the village of Nettleton near the towns of Caistor and Market Rasen. There are no shops within walking distance although the home is on a bus route to Caistor and Market Rasen. The home consists of twenty-one single and ten shared rooms, thirteen of which have an ensuite toilet or bathroom. The home has three residents’ lounges and one dining room. A ‘chapel’ is being created as a quiet area for communal or individual use. There are three bathrooms and several toilets situated near to residents rooms and communal areas. A passenger lift gives access to the upper floor although some rooms upstairs are only available to residents without limited mobility. There is a large garden to the rear of the property, which is accessible for residents, and a large car park for visitors. The range of fees is between £335 and £464 each week. Nettleton Manor DS0000064035.V335712.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 6.0 hours. A tour of the premises was undertaken. The registered manager was provided with feedback at the end of the inspection. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and tracking the care they receive through the checking of their records, discussion with them and the staff, and where more appropriate observation of interaction between staff and residents and related care practices. A sample of care records was inspected. Two members of staff were interviewed and the opinions of four residents were sought. A Pre-inspection questionnaire was supplied by the care home to the Commission for Social Care Inspection prior to the site visit being made. Six have your say documents completed by residents were also sent to the Commission for Social Care Inspection. This document asked residents 12 questions and provides an opportunity for them to comment on the quality of care being provided to them by the care home. Their views and opinions are reflected within this inspection report. The registered manager makes available to all potential new residents a copy of the statement of purpose of the care home when they visit the home for the first time. A copy is displayed in the care home reception area. A copy of the last Commission for Social Care Inspection report is included in the statement of purpose. What the service does well: What has improved since the last inspection? Staff have been provided with training in the management and recognition of abuse since the last key inspection. The registered manager has ensured that fire safety tests are carried out, as set out in the fire safety officers instructions. Extra work is being carried out on an extension to the care home which will improve facilities for residents. Nettleton Manor DS0000064035.V335712.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Nettleton Manor DS0000064035.V335712.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 Nettleton Manor DS0000064035.V335712.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): Standard 3 & 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are satisfactory procedures for the introduction and assessment of people to the service, ensuring that all of their personal care needs, health care and social needs can be met. EVIDENCE: Three individual residents files were examined as part of the case tracking process. They all contained a full assessment including a risk assessment for each individual resident. The assessment sets out care needs social needs and health needs. Residents stated that they have been involved in the initial assessment with their families. The registered manager confirmed this statement to be correct. Nettleton Manor DS0000064035.V335712.R01.S.doc Version 5.2 Page 9 The registered manager stated that the home does not offer a dedicated intermediate care service. Nettleton Manor DS0000064035.V335712.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): Standards 7,8,9,10 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans identify all areas of need and provide detailed care instructions for staff; this enables staff to provide appropriate care. Residents’ health needs are being met. The medication policy of the care home is not been followed consistently by staff this places residents at risk. EVIDENCE: The care plans of three residents were studied in detail. They all contained the health care needs, personal needs and social needs of each resident. Care plans included details of how the health care needs of each resident were to be met and detailed involvement of community health care services. The details of visits by GPs, chiropodist and district nurses were recorded in care records. Residents confirmed that their individual health care needs were being met. Nettleton Manor DS0000064035.V335712.R01.S.doc Version 5.2 Page 11 Staff were found not to be following the medication procedure of the care home. A member of staff was found to have given out medication but not completed the medical administration record (MAR sheet ). This issue was raised during the last inspection as well. Residents are not safe as a result of how the service delivers this outcome area. Discussions with residents, staff, the registered manager and observations during the site visit provided evidence that the privacy and dignity of the resident is respected. Staff were seen to knock on doors to speak courteously to residents and to give help in a sensitive and respectful way. In the formal interviews staff referred to the rights of residents and stated it was important to take into account their wishes, choices and maintain their dignity and privacy. Evidence was recorded on file of resident’s wishes in relation to the action to be taken when they have passed away. Nettleton Manor DS0000064035.V335712.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): Standards 12,13,14 &15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to keep in contact with their family and friends. All visitors are made welcome by staff at the care home. Catering arrangements for the home reflects the residents choices, preferences and personal dietary needs. EVIDENCE: The registered manager listed, in the Pre-inspection questionnaire a number of activities offered to residents, including opportunities to take part in events in the community. Staff and residents confirm these activities do take place during the site visit. The home provides religious services for residents who wish to take part and pursue their individual religious beliefs Staff stated that the care home has a visiting policy, which is flexible to meet the choices and wishes of the residents. Residents confirmed that family and friends are made welcome when they visit the care home. Nettleton Manor DS0000064035.V335712.R01.S.doc Version 5.2 Page 13 Staff stated however that most residents start to go to bed at 6 p.m. and most if not all residents will be in their bedrooms by 8 p.m. The inspector was concerned thats some residents stated they were not given a choice as to when they went to their bedroom in the evening. The explanation given by staff for residents retiring so early was stated to be staffing levels. Staffing levels are reduced at 8 p.m. each evening. In the morning the residents and staff stated residents are not enabled to get up until staffing increases at 8 am. A residents spoke to during the site visit stated “staff get me up about 10 10:30 a.m. I am back in my bedroom by just after 6 p.m. I would like to spend more time in the public lounge area. A second residents stated “people do go to their rooms early in the evening. I believe I could stay up if I wished but I havent asked”. Staff discussed in the formal interviews the choices and wishes of the individual residents being case tracked. Residents stated that they felt their wishes and opinions are considered by the home. One resident stated “staff are very good here”. The menu had a variety of options from which the residents could choose. The inspector observed staff asking residents at lunchtime what choice of meal they required. The dietary needs of individual residents, was found recorded on their care plan. Nettleton Manor DS0000064035.V335712.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): Standards 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home listens to resident’s views and wishes and acts on them. There are procedures in place to protect residents from any possible abuse. Staff have received appropriate training to protect residents from being harmed. EVIDENCE: The registered manager and staff said that they had received training in adult protection, which was also reflected in the staff training records. Staff were aware of the home’s and Lincolnshire County Council’s Adult Protection procedures. They also demonstrated a clear understanding of what the key issues are. They confirmed that they would not hesitate to report any concerns. Residents said that they knew how to complain and would if they needed to.The complaints policy is on display in the entrance hall and residents have their own persoanl copy in the service user guide. No complaints have been received since the last key inspection. Nettleton Manor DS0000064035.V335712.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): Standard 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable, homely, clean environment with a choice of communal areas and personalised bedrooms. The up-to-date infection control policy is followed and maintains a safe environment. EVIDENCE: A tour was made of the care home during the site visit. Pre- inspection information states details of improvements which have been made to the care home since the last inspection. Roof repairs have been carried out, two new boilers have been installed, some areas have been re-decorated. Extensive work to a lounge area is to be carried out on the 21st April 2007. A major extension is to be completed at the home in May 2007. Nettleton Manor DS0000064035.V335712.R01.S.doc Version 5.2 Page 16 Residents spoken during the site visit stated their satisfaction with the bedrooms provided and the facilities of the care home. One resident stated “my bedroom is lovely”. The rooms seen during the tour of the care home are well maintained and had been personalised. No health and safety issues were identified during the site visit. The home was clean and smelt fresh. Nettleton Manor DS0000064035.V335712.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): Standards 27, 29, 30 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The home could not demonstrate that the deployment of staff is carried out effectivly to meet the needs of the residents at all times The registered manager is following the recruitment policy of the home to ensure that residents are protected. Staff have received training including specialised training to enable them to meet the needs of service users. EVIDENCE: The registered manager stated that eight residents needed help with the food. On the day of the site visit four staff were on duty. The registered manager was unable to explain how staff had been deployed to ensure that the eight residents were being assisted to eat their lunch. Residents were seen to be eating lunch in the dining room, lounges and individual bedrooms without supervision. One resident was being helped by a relative to eat her lunch in the bedroom. The dining room only allows 18 people to sit and eat their meals. The care home is registered 41 residents. Staff stated residents cannot be their given their food in an organised planed manner. The number of the residents who Nettleton Manor DS0000064035.V335712.R01.S.doc Version 5.2 Page 18 require liquidise food and require aid and supervision to eat safely cannot be met by present staffing levels. The registered manager stated that the recruitment policy of the home was being followed at all times. The inspection of the recruitment records for new staff confirmed this statement to be correct. All appropriate documentation was on individual staff members files. This included POVA , CRB, references and proof of identity. Staff said morale was low due to issues regarding their employment contract. Discussions with the registered manager, and the inspection of training records produced evidence that staff are being provided with training opportunities including specialised training. A long-term training plans is in place. Nettleton Manor DS0000064035.V335712.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, 32, 33, 34, 35, 36, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an experienced manager in post who provide leadership, guidance and direction to staff to ensure residents receive consistent quality care. Many good working practices promote the health and safety of residents. The deployment and provision of care staff however does restrict residents choices and puts them at risk. EVIDENCE: There is a problem relating to communication and the professional relationship between the proprietor, the residents and employed staff particularly qualified staff. The registered manager was unaware of the long-term development Nettleton Manor DS0000064035.V335712.R01.S.doc Version 5.2 Page 20 plans for the home including the use of the new extension. It is essential that staff feel that all members of the management team are approachable and feel confident in being able to voice any concern for the benefit of the company and the residents. The home has a registered manager who staff describe is supportive and approachable. Supervision has been provided in accordance with the National Minimum Standards. As detailed in the comments for the staffing standards 27-30 management have failed to deploy staff at appropriate times and in sufficient numbers to ensure that residents needs are always met. This restriction on staffing numbers limits the choices and wishes of the residents particular relating to the times they get up and go to bed. The registered manager and some members of staff stated that there are some disputed areas related to employment contracts. . Nettleton Manor DS0000064035.V335712.R01.S.doc Version 5.2 Page 21 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 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 3 3 3 3 3 Nettleton Manor DS0000064035.V335712.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement Staff must follow the medication policy of the home this places residents at risk. Resident’s must be given choices. This directly effect the quality of life of the individual resident. Staff must be deployed effectively at meal times to meet the needs of all residents. Residents do not receive the 1:1 support identified on their care plans A open and positive atmosphere must be developed to ensure quality of life and care for residents and staff . The must be run in the best interests of residents. Limitations are placed on resident’s lifestyle which affects the quality of their life. Timescale for action 08/06/07 2 OP14 12-3 01/06/07 3 OP27 18 (1) (a) 30/06/07 4 OP32 12-5 (a) 30/06/07 5 OP14 12 30/06/07 Nettleton Manor DS0000064035.V335712.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Nettleton Manor DS0000064035.V335712.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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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