Inspection on 06/05/05 for Nettleton Manor

This inspection was carried out on 6th May 2005.

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 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

Nettleton Manor 16/04/07

Nettleton Manor 08/06/06

Nettleton Manor 07/02/06

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 LN7 6HX Lead Inspector Vanessa Gent Unannounced 6 May 2005 10.00 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 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 C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Nettleton Manor Address Moortown Road Nettleton Caistor LN7 6HX 01472 851230 01482 852015 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) SSS Care Limited Care Home 41 Category(ies) of DE(E) - Dementia over 65 - 41 registration, with number OP - Older Persons of both sexes aged 65 years of places and over - 41 PD - Physical Disability - 4 Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service users in the category of Physical Disability must be aged 50 years and over. 2. Registered Manager to be determined within three months of this registration. Date of last inspection 08/12/04 Brief Description of the Service: Nettleton Manor is a two-storey, Victorian manor house property in the village of Nettleton near Caistor and the town of Market Rasen. It has recently been purchased by the present owner. 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 double rooms. There are three bathrooms and toilets are situated near to residents rooms and communal areas. The home has a passenger lift although some rooms on the upper floor are only available to residents without limited mobility. There is a garden which is accessible for residents and a car park for visitors. Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over seven and a half hours with one inspector. The files (care plans) of three residents were examined; three residents and one relative were spoken with and three staff were interviewed. The home is clean, tidy and fresh smelling. Safety equipment such as grab rails are in place for the safety of residents. There is a passenger lift which gives access to the upper floor. Some residents’ rooms on the upper floor can only be accessed by short flights of stairs. All residents and relatives are happy with the standard of care. Many positive statements were received. The home has a calm, relaxed atmosphere. The new owner discussed his plans for extending and improving the home and connecting rooms, which are at present outside and away from the main building, to make the home safer and more accessible. What the service does well: What has improved since the last inspection? Some decoration and maintenance work has been done to improve the appearance of the home and some bedrooms have been decorated. Contracts of the terms and conditions of the home are now signed by the resident or his/her representative and kept in the residents’ files. Medicines given to the residents are signed for after they are given to ensure safe practice. All food that is not used immediately on opening is covered, labelled, dated and kept in the fridge. The faulty gas cooker has been replaced with a new one. Two signatures and a receipt are obtained for all financial transactions undertaken on behalf of the resident. Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 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. Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 4 New residents are aware of the conditions of their occupancy at the home. New residents are admitted following thorough assessments by the nursing staff. Consultation with the person and their representative is undertaken to ensure the home can meet the needs of the individual. EVIDENCE: The care plans seen contained contracts of Terms and Conditions for the resident, including the number of the room occupied and fees payable. The terms and conditions were signed by a representative of the resident where the resident was not able to sign. A nursing member of staff visits the prospective resident in their previous environment, as confirmed by a relative spoken with. Pre-admission assessments based on the Activities for Daily Living ‘tool’ were seen in each resident’s care plans and these and the social worker’s Community Care Assessment (CCA) are used as a basis for the creation of the care plans themselves. One resident stated that she was asked lots of questions when she was admitted but wasn’t told if these were used for the care plans. Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 Page 9 A relative stated that the home had informed them by letter, prior to admission, that the home could meet the needs of the resident. Contact with healthcare professionals, as confirmed in care plans examined, ensures that guidance and advice is sought for the adequate care of the residents. Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10 Care plans contain a sufficient amount of information and are reviewed regularly to give a current picture of the resident, their needs and how the home is able to meet those needs. Healthcare professionals are accessed as necessary and the healthcare needs of residents are provided for. Privacy and dignity is respected and residents look comfortable with and in their surroundings. EVIDENCE: The care plans of three residents were examined. A life history has been completed and detailed recording of all aspects of the resident’s life are welldescribed in all care plans seen. Care plans do not show evidence of resident or relative involvement although one relative stated that she could have had involvement but is happy for the home to “carry on” as she is confident that the staff will look after her relative very well, having looked after another relative previously. Care issues are described well but would be clearer to see and act upon if each issue was given a separate sheet so that each could be reviewed as necessary Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 Page 11 and it would be easier to evidence resident or relative involvement. Care plans seen are reviewed monthly by staff. A well-documented life history was seen in each of the care plans examined which gave a full picture of the resident to enable staff to understand them and their needs more fully. Each resident has a keyworker who monitors and makes sure his or her needs are met. Body-mapping charts are used for residents who are admitted with any sores or bruises and these ‘tools’ are used throughout the stay of the resident as necessary. Specialist equipment is used such as airflow mattresses and pressure relieving cushions. Healthcare professionals are accessed for advice and treatment, as confirmed in the care plans seen. Chiropodist, dentist, tissue viability nurse, district nurses all visit the home. The communication diary shows contact has been obtained with these and other specialists. Residents say their privacy and dignity are respected. Several residents stay in their rooms most of the time but say that staff keep an eye on them and are available when called without any delay. Staff are said by residents and relatives to be polite and were seen by the inspector to knock at residents’ doors and wait for permission to enter. Residents were observed to be clean, well presented and relaxed and interacted with staff and other residents comfortably. Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14, 15 Activities could be better managed if staff had sufficient hours to cater for the social needs of individuals who cannot or will not join in as well as with the minority group who always participate. Better documentation is needed of activities participated in. Choice in all aspects of the home-life is evident. The food is excellent: varied, fresh, nutritious and appetising. EVIDENCE: The home has two activities organisers who both work part-time. Group activities undertaken are recorded once a week in a file but not in individual care plans and not of what takes place to occupy residents in between these weekly activities. An activities plan is displayed publicly which describes the group activities available, although participation in these is limited to a minority of the total number of residents, and entertainments which are brought to the home. Staff need to record and report when activities are undertaken to show evidence that the home is meeting the needs of the residents, including their social, cultural and emotional needs. Residents say they can choose whether to stay in their rooms, where to take their meals, what they want to eat, when to get up and go to bed. Food is said by residents to be excellent with choice and variety at every meal. The four-week menu seen indicates that a balanced diet is offered and the Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 Page 13 meal provided on the day of the inspection confirmed this. Fresh vegetables were served with the lunch meal. One resident who likes porridge made in a particular way is catered for and she said “nothing is too much trouble for the staff, including the cook.” Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17, 18 Residents are safe and relatives are happy to leave their loved ones in the care of competent staff who have been trained in the prevention of adult abuse. Each individual’s rights are respected in the voting process. Restraint is not always authorised by the residents’ representative. EVIDENCE: Residents say they feel safe with the staff and that they’ve “never had any complaints”. One relative stated that she is happy to leave her mother in the staffs’ care as she knows they look after her well, as did another relative who stayed there previously. She would know how to complain and who to complain to. She does go straight to one of the staff if little problems arise and they “always sort things out” but there have “never been any big problems”. In the recent general and local elections, postal voting was obtained for all residents as the Polling Station was not accessible for most of them. Residents stated that staff helped those who wanted it. Permission and authority has not always been obtained from the resident or his/her representative for the use of restraint in any form, including pressure mats next to the bed, bedrails, reclining chairs or belts in wheelchairs. Staff have been trained in the prevention of adult abuse and it is part of their induction as new staff. The front door is kept locked with a standard lock and key, the key being located away from the lock and high enough for staff to have to stretch to reach it and close to a very hot water pipe. A safer and more efficient system should be considered. Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 24, 25 The home provides private and communal space which is light, airy and spacious and adequately meets the needs and wishes of the residents. Specialist equipment is provided as judged or advised as necessary for the safety of the residents. EVIDENCE: Some areas of the home have been re-decorated and refurbished since the last inspection but the new owner says he needs a settling in period to determine exactly what needs doing and obtain quotes for the work. He states that he is planning to incorporate the outside resident rooms into the main body of the house for safer and more comfortable accommodation. Individual repairs which were needed in certain residents’ rooms at the previous inspection, have been carried out satisfactorily. The communal areas of the home are clean, spacious, warm, comfortable and adequate for the residents’ needs. Residents visited in their rooms are satisfied with the decorations; their rooms are personalised with their own belongings and the rooms are light and airy. Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 Page 16 One relative stated that they “couldn’t wish for a better place”; it is “immaculately organised”; “very clean”. Specialist equipment was seen in the rooms as deemed necessary. There is a call alarm system in place and grab rails are provided in communal areas for safer mobility of residents. The home has a passenger lift for access to the upper floor. The hot water temperature at the residents’ sinks was at a safe level for residents’ use. There are sufficient bathrooms and toilets for the residents. The faulty cooker/oven previously seen in the kitchen has been replaced. Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 Sufficient numbers, qualified and skill mix of staff work at the home to ensure the health, welfare and safety of the residents. Staff induction and training is undertaken and valued. Recruitment practices are robust. EVIDENCE: The staff rota shows that the numbers and skill mix of staff on duty at any time is adequate. Staff say they work without undue pressure and feel wellsupported, that they “are a very good team” and “pull together”. Communication between staff on different shifts is well-documented and staff are aware of the needs of all residents. Residents state that the staff “are lovely” and “super”. A relative stated that the care of another loved one previously in the home “was lovely; couldn’t fault it”. Mandatory and other training has been undertaken by most staff. A recent employee stated that the induction process was thorough and that she was supervised in her practice until she felt confident. Induction records confirm a thorough process. Recruitment practices, as seen in staff files examined and by speaking with staff, meet the National Minimum Standards. Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 36, 37 Although there is no manager in place, the staff ensure that the residents receive a consistent quality of care. The health, safety and welfare of residents and staff is monitored and maintained to a high standard. EVIDENCE: Staff meetings have been held but not regularly since no manager has been in post. However, staff stated that communication between them is good and they feel well-supported. Many positive comments about the staff, the care and the good organisation within the home were received from both residents and relatives. The Provider completes and submits monthly reports as required in Regulation 26. Some staff, although not all, have received regular supervision sessions by the deputy manager although there is no registered manager in post. Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 Page 19 Records examined indicated that measures such as fire tests, equipment testing and servicing, staff training are in place and take place regularly to maintain the health, safety and welfare of the residents. Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 3 15 4 COMPLAINTS AND PROTECTION 3 3 3 3 x 3 3 x STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 2 x 3 x x 3 3 x Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 Page 21 NO 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 12 Regulation 16.2.n Requirement Timescale for action 31/08/05 2. 18 3. 31 Activities must reflect the wishes and social needs of the residents and must be adequately documented. 15.1, Where restraint in any form is 17.1.a used, permission and authority must be obtained from the resident or his representative. See Schedule 3.3.p,q. 8.1,18.1.a The Provider must appoint a manager to ensure the health, safety and welfare of the residents. 06/06/05 31/08/05 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 18 Good Practice Recommendations A safer and more efficient system to gain access to and from the home should be considered. Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Unity House, The Point Weaver Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Nettleton Manor C53 C04 S64035 Nettleton Manor V225553 060505 Stage 4.doc Version 1.30 Page 23 - 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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