Inspection on 07/02/06 for Nettleton Manor

This inspection was carried out on 7th February 2006.

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

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

Other inspections for this house

Nettleton Manor 16/04/07

Nettleton Manor 08/06/06

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 Vanessa Gent Unannounced Inspection 8th February 2006 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 Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 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.V282262.R01.S.doc Version 5.1 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 enrol 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 06/05/05 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 home’s philosophy is “to provide a high staff of individual care and support and a pleasing environment for all the residents to enjoy a good quality of life.” Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over five and a half hours with one inspector. The manager was available for the first part of the inspection. The main method of inspection used is called case-tracking which involves selecting a proportion of residents and tracking the care they receive through the checking of records, discussion with them, the care staff and observation of care practices. Three of the residents’ assessments and care plans were examined. A partial tour of the home took place to see the improvements already made and the proposed future changes and improvements planned. Three of the four staff on duty, the business administrator, three of the twenty-eight current residents and one relative were spoken with. What the service does well: What has improved since the last inspection? Some areas of the home have undergone renovation, re-decoration and repair. The laundry has a new roof, and other roofing areas and guttering have been cleared and cleaned. The manager’s office has been moved to a larger room which is light and airy and pleasantly decorated. The manager has been registered with the Commission since the last inspection. The manager has been undertaking an eight week course in the care of people with dementia and is due to start her Registered Managers Award course shortly after the completion of this course. Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The document statements about the home inform any prospective resident adequately enough to make an informed decision about living at the home. EVIDENCE: The statement of purpose and service user guide are comprehensive documents that inform prospective residents on what the home has to offer and what they can expect should they choose to live at the home. Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9, 11 Care plans contain enough information and are reviewed regularly enough to enable staff to care adequately and appropriately for the residents’ needs. Staff show consideration at the end of peoples’ lives to give comfort and strength to their families. EVIDENCE: The care plans contain the information required to give staff an insight into the care the residents need, although some of the information is adequate rather than comprehensive such as the ‘life histories’. The care plans issues are reviewed monthly. Weights, blood pressures, blood sugar levels and fluid intakes are monitored as assessed as necessary. GP visits are welldocumented. An activities participation sheet and a form to say how much involvement the resident or representative wishes to have in the reviews of the care plans is included in the care plans. Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 Page 10 The care plans would benefit from dividers between each section for easier reading and understanding. The pharmaceutical practices of the home are in order. All staff who administer medications are nurse-trained. One nurse said all the nurses could do with updating their medication administration training to confirm good practice and eliminate any bad habits. Staff say they are well-trained to respect the residents, especially at the end of their lives. Relatives have complimented the manager and staff on their sympathetic manners and say how the lovely attitudes of the staff have helped them through the difficult time experienced in each instance. Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 Contact with their families and local residents in the community is encouraged but activities are not always provided in the home in sufficient quantity and variety to keep the residents occupied in between the weekly sessions. The choice of menus and the quality of the food provided satisfies the tastes and wishes of the residents. EVIDENCE: Although an activities organiser has been employed, she only works for three hours in one afternoon per week, with another person providing a painting session every Thursday. This means that residents are not provided with a range of activities that is sufficient to keep them occupied and stop them from being bored. One visitor said her relative is not interested in activities but some other residents would benefit by being given interesting activities during the day. Some residents said there aren’t enough activities provided. Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 Page 12 Two vehicles, one a saloon care and the other a ‘people-carrier’ which is adapted to take up to three wheelchairs for resident outings, have been purchased for use by the home. Contact with families is reported to be good. A lunch club is held regularly to which local community residents come and enjoy the meal and companionship with some of the home’s residents. Local residents and relatives are always invited to functions held for the residents’ benevolent fund. The food is said to be excellent; the meal served during the inspection was hot and looked appetising. A choice of menu was given. One resident, who didn’t want either choice was given a further option and was happy with this. Fresh fruit and vegetables are available and provided daily. Records are kept of the meals given to each resident. When taking meals to residents’ rooms, plate covers are used to keep the food hot and fresh. Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The complaints policy and positive attitude of the staff and manager ensure that residents are safe and comfortable in the home. EVIDENCE: The complaints policy is displayed publicly and contains all the details necessary should anyone wish to make a complaint. A letter was received from a person visiting the home who wished to complain about the physical state of the home. The complaints were contrary to any views held by the residents, and relatives have written in a complimentary manner of the conditions at the home and the care given by staff and the manager. (See also the following section on the environment). Residents and relatives say they know how to make a complaint and would go to the manager without hesitation. However, no-one spoken with was dissatisfied with the home or staff. Compliment cards have been received which state “we have appreciated all your care over the years, particularly in the last 2-3 weeks which were difficult for us all”; “for the kindness and care shown. We know she was in very good hands”; “for the excellent care [the manager and staff] gave – the attention [the resident] received was at all times professional, considerate, dignified and good-natured – we are so pleased we chose you!”; “during the time [the Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 Page 14 resident] was with you, the care and attention devoted was of the highest order … we are grateful for the kindness and consideration shown to the family and other visitors during her stay”. Authority for the use of bedrails and other forms of restraint are in the care plans and signed for by the resident or his representative. Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 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 the following standard(s): 19, 20, 25, 26 Many areas of the home are being upgraded and all areas of the home, except for the fault in the heating system in the extension, are well managed and provide the residents with a comfortable, homely and hygienic environment. EVIDENCE: A complaint was received from a visitor to the home. A tour of the building was undertaken on arrival at the unannounced inspection. No evidence was found of dirt, dust or stained carpets. The dining room was clean and tidy and although the hallway is in need of re-decoration, it was not dirty, dusty or dingy. Everywhere was clean, tidy and smelt pleasant. The smaller sitting room has been redecorated and has a new carpet. All the residents and relatives spoken with appreciate the effort that the provider is putting into improving the home’s outside state, the inside décor and the furnishings. An ongoing programme of improvements is in progress. Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 Page 16 The laundry has a new roof and other roofing areas have been cleared of moss and cleaned, with plans to re-roof other areas in the better weather. The boiler for the hot water and heating system in the extension corridor has become faulty, leaving some residents’ rooms without heat and with low water temperatures in their wash basins. This needs frequent monitoring by staff, day and night, until it is repaired, to ensure that the boiler is working and the rooms are adequately heated to prevent residents becoming hypothermic. One residents’ wash basin is too small for personal washing needs and needs replacing. The premises were found to be hygienic in all areas seen, a new dishwasher has been installed in the kitchen and systems are in place for the control of the spread of infection. Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 Staff work in sufficient numbers and are happy in their work and are adequately qualified to provide a good standard of care for all residents. EVIDENCE: The staff rotas indicate that a sufficient number and skill mix of staff are on duty at all times. One resident says they “have a bit of a laugh with staff, which is nice. I am really happy here. If I use the call-bell, the staff come pretty quickly.” Relatives have praised the staff for their positive, loving, sensitive and caring attitudes. NVQ courses are encouraged for all staff and rewards are given for achievement at all levels. Two staff have recently passed level 2, which brings the number of staff with level 2 up to ten and a further five are completing the training. The manager is an NVQ assessor. Staff interviewed say they work in a good team, enjoy coming to work and feel very well-supported by the manager and provider. “Working here is fine. There is good communication with all the other staff and I find the nurses helpful and approachable and give good advice.” Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35, 38 The residents are comfortable and safe in the care of the manager and her staff team. A risk assessment of certain areas of the home would make it a safer environment for all who live and work there. EVIDENCE: The manager, who has been registered with the Commission since the last inspection, is a first level nurse with many years’ experience, both in the NHS and in the care industry and has taken many courses over the years to maintain and improve her nursing knowledge. She is also a qualified NVQ assessor. The manager and her deputy are undertaking an eight-week course in dementia care, the learning from which they will pass on to the rest of the staff Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 Page 19 team. The manager will start her Registered Managers Award course on completion of the dementia course, having obtained funding assistance to do it. One staff stated that “since [the manager] has been in post, there has been good direction and good progress. She is very supportive, knowledgeable and understanding.” All residents, relatives and staff spoke very highly of the manager and how well the home is run under her guidance. A few residents’ finances are held by the business administrator who ensures that two signatures are obtained for each transaction and receipts are kept and numbered. As at the previous inspection, 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, such as a keypad. The manager should discuss the matter with the Fire Officer. The room in which chemicals are stored needs to be kept locked, for example with a keypad, to prevent access to the vulnerable people in the home. Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 3 X X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 X X 3 X X 3 Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 Page 21 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 OP12 Regulation 16.2.n Requirement Activities must reflect the wishes and social needs of the residents and must be adequately documented. (Timescale of 31/08/05 not fully met.) The hot water and heating system must be maintained in a good state of repair. Residents’ personal washing facilities in their rooms must be useable for the purpose for which they are required. Timescale for action 30/04/06 2. OP25 Reg 23.2 10/03/06 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 2 Refer to Standard OP38 OP38 Good Practice Recommendations It is recommended that the security at the front door is risk assessed and a safer and more efficient system such as a keypad is considered. Chemicals should be stored in a locked room or facility for the safety of residents. Nettleton Manor DS0000064035.V282262.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby 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 DS0000064035.V282262.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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