CARE HOMES FOR OLDER PEOPLE
Stanton Manor Piddocks Road Stanton Burton On Trent Staffordshire DE15 9TG Lead Inspector
Lesley Allison-White Unannounced Inspection 13th June 2007 10:00 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 Stanton Manor DS0000020098.V338913.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. Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Stanton Manor Address Piddocks Road Stanton Burton On Trent Staffordshire DE15 9TG (01283) 565447 01283 565447 stantonmanor@aol.com 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) Mrs Pamela Mary Mycroft Mrs Pamela Mary Mycroft Care Home 28 Category(ies) of Dementia - over 65 years of age (28) registration, with number of places Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2 places for service users under the age of 65 years as named in the notice of proposal. 6th June 2006 Date of last inspection Brief Description of the Service: Stanton Manor is a care home registered to provide personal care and accommodation for up to 28 people in the category of older persons with dementia. The home is situated in its own extensive and well-maintained grounds. The nearest town is Burton on Trent, which is about 10 minutes drive from the home. Stanton Manor has both single and shared rooms, some of which have ensuite facilities. The home consists of two separate units, the main house and The Mews, which is located across the courtyard. Bedrooms are situated on the ground and first floor. Information about the service is provided through the Statement of Purpose and Service User Guide available to all service users and their relatives. The Commission Of Social Care Inspection report is available also. The fees for Stanton Manor are between £400.00 and £440 per week. The Certificate of Registration for the Commission for Social Care Inspection (CSCI) is displayed in the hall way and the Employers Liability is also displayed there. Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is on outcomes for service users and their views of the service provided. The home provides care for up to twenty-eight service users. On the day of inspection there were twenty-seven service user, one service users was in hospital. The inspection took over seven hours to complete. Preparation included examining inspection records and the past history of the service. This aided the inspection process by identifying areas to be examined during this inspection. Discussion was held with four service users. However, other service users were observed in their daily routine. Two service users were unable to communicate very much with the inspector. Two service users’ relatives spoke with the inspector and comments from the April 2007 survey undertaken by the Registered Manager at Stanton Manor was also used in this report. The primary method of inspection used was “case tracking”. This involved speaking with the service users who use the service provided, looking at two service users’ care plans and making observations. All the required key standards were inspected during this visit. Areas of concern raised by the last inspection report were discussed not all of them had been addressed. The Registered Manager facilitated the inspection. What the service does well:
Care staff assisted service users to move safely where help was required. The inspector observed transfers including the use of a transfer belt which encourages service users who can stand to have assitance to do so. Two or three staff were seen helping services users at any one time wherever needed. In this way service users are encouraged to remain independent. Interaction between staff and service users was observed to be polite, friendly and relaxed. Staff sat at one of the tables assisting service users who needed one to one assistance with their meal. It was a pleasant unrushed affair. Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 6 Staff who spoke with the inspector demonstrated an awareness of what to do to ensure the safety and well being of service users in their care. Domestic staff were employed to ensure that standards relating to food and nutrition are met, and that the home is maintained in a clean and hygienic state, and free from unpleasant odours. Service users, relatives and staff who spoke with the inspector said they were happy with the management of the care home. Service users and relatives who spoke with the inspector felt that service users had their needs met. They felt confident that if they needed to raise a concern the Registered Manager would address the issues. Relatives’ comments included ‘I like the homely atmosphere of Stanton Manor, all the staff are very good’. ‘I feel that my mother is well cared for and she seems to like it here,’ What has improved since the last inspection? What they could do better:
Service users were transported in wheelchairs. Footplates were used although it was noticed that both brakes were not always applied when service users were being transferred. The use of both brakes is important to ensure that the wheelchair does not move during a transfer procedure to ensure that the risk of any injury to service users is minimised at all times. Controlled medications should be checked and recorded separately to ensure that the numbers received into the home matches the amount recorded on the bottle by the dispensing Pharmacist. In a shared bedroom prescribed creams were left out after use. This did not comply with the medication policy seen at Stanton Manor by the inspector and safer practices are required in view of the nature of this service user group who have dementia and other memory problems. Meals times could be improved by ensuring that service users are not brought to the table before the meal is ready to be served as for some service users
Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 7 this is too soon as they repeatedly leave the table or annoy other service users by their behaviour. The kitchen door should be closed when making up softer diets then the sound of the whisk will not disturb the service users whilst dining. Recruitment practices must be improved, as inspected staff records did not have all the relevant information in them. 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. Stanton Manor DS0000020098.V338913.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 Stanton Manor DS0000020098.V338913.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have information about the home in order to make an informed decision about whether the service is right for them. EVIDENCE: Service users living at the home were unable to explain their involvement in the admission process. However family members were able to confirm that the Registered Manager visited the service user before admission to the home, often on more than one occasion, to assess that the placement could meet the needs of the service user. Evidence of this assessment process was seen in care records Relatives also said that they were welcomed when they visited the home, before any decisions were made. Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 10 They said they were given a copy of the Service User Guide and Statement of Purpose, which contain information about the service provided at Stanton Manor. In this way they felt able to make decisions affecting the future care of their relative. Standard 6 was not inspected as intermediate care is not provided. Stanton Manor DS0000020098.V338913.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 poor. This judgement has been made using available evidence including a visit to this service. Staff at Stanton Manor delivers appropriate care to individual service users. Service users’ physical and mental health care needs are met. However, further improvements in the handling of medications are required. EVIDENCE: Both service users case tracked lived in the independent part of the home in a building called the Mews. Both were physically independent and required reminding when they needed to do things. Both were able to communicate with the inspector although short-term memory and recall was poor. Services users living in this part of the home are free to spend their time in either parts of the home and one of the service users case tracked chose to join the group of service users who lived in the main part of the home called Stanton Manor. Care plans of the two service users case tracked were satisfactory as they included all the relevant details needed for their care. Care plans identified the service users’ needs and the care that they receive is evaluated on a regular
Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 12 basis. All service users’ have access to care from the community including General Practitioners, Psychiatrists, Chiropodists, Opticians and District Nurses. Care staff assisted service users to move safely where help was required. The inspector observed transfers including the use of a transfer belt which encourages service users who can stand to have assitance to do so. Two or three staff were seen helping services users at any one time wherever needed. In this way service users are encouraged to remain independent. Where service users were transported in wheelchairs footplates were used although, it was noticed that both brakes were not always applied when service users were being transferred. The use of both brakes is important to ensure that the wheelchair does not move during a transfer procedure to ensure that the risk of any injury to service users is minimised at all times. This will be a recommendation. Interaction between staff and service users was observed to be polite, friendly and relaxed. Medications of the service users case tracked were checked. Improvements in the dispensing of tablets had taken place. However, one controlled drug was found to contain more tablets than on the label. The Registered Manger checked with the dispensing Pharmacist who did not have knowledge of this. The Registered Manager has said that she will ensure that controlled medications are now checked and recorded separately to ensure that the numbers received into the home matches the amount recorded on the bottle by the dispensing Pharmacist. In a shared bedroom prescribed creams that were in use were left out. This did not comply with the medication policy seen at Stanton Manor. Safer practices are required in view of the nature of this service user group who have dementia and other memory problems. Requirements will be made. Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 13 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. This judgement has been made using available evidence including a visit to this service. The lifestyles of the service users match their expectations. However, some service users unable to communicate should also have activities provided for them to take part in as this may enhance their limited opportunities. EVIDENCE: Service users in both parts of the home were seen having either one to one conversations with each other at lunchtime or during the day with staff, watching television, sleeping or stroking the cat. One of the service users case tracked explained that they came to the home for peace and quiet and when dancing took place they took part other wise they were happy to walk around the home. Other service users appeared comfortable although only a few took part in activities. Two relatives who spoke with the inspector said that activities took place on a regular basis however one of the relatives explained that in reality their relative would not mind if they did not get involved in formal activities. This relative also said that on a nice day services users went out in the grounds either with staff or family members.
Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 14 Meal time was observed and the food looked pleasant, hot and of good portions. Staff sat at one of the tables assisting service users who needed one to one assistance with their meal. It was a pleasant unrushed affair. However two things spoilt it. Service users were brought to the table before the meal was ready to be served and for some service users this was too soon as they repeatedly left the table or annoyed other service users by their behaviour. The cook left the door to the kitchen open when making up softer diets and the sound of the whisk was disturbing. Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. The Registered Person has procedures for dealing with complaints and protection. Sufficient numbers of staff are also trained in this area, which should further protect the safety and well being of the service users living at Staton Manor and the Mews. EVIDENCE: The Commission of Social Care Inspection (CSCI) has received a complaint about Stanton Manor. This complaint is recorded and has been dealt with appropriately by the home. One of the service users case tracked was able to say that they would go to the person in charge if they had a problem and relatives who spoke to the inspector also felt able to complain or make suggestions. They explained that they would go to the Registered Manager if they had a complaint and expected that it would be dealt with appropriately. It is expected that all complaints will be concluded within the given time scales of the policy at the home. The Complaint records were checked and satisfactory. The Complaints procedure is displayed in the hallway at the front entrance of the building.
Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 16 Staff members who spoke with the inspector were aware of the need to protect residents in their care and would report any concerns to their line manager. Both care staff members explained their awareness of outside agencies such as Social Services, the Police or CSCI if they have serious concerns regarding care issues. Training certificates shown to the inspector demonstrated that an adequate number of staff had received safeguarding adults training. Staff who spoke with the inspector also demonstrated an awareness of what to do to ensure the safety and well being of service users in their care. Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 17 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a safe, hygienic and comfortable environment. EVIDENCE: During the inspection areas seen by the inspector at Stanton Manor and the Mews were clean, tidy and homely. Access to and from both front doors was by keypad codes however the Registered Manager told the inspector that the fire officers had been out during the week and that both doors opened automatically when the fire alarms went off. In this way service users are protected from the risk of fire. Domestic staff are provided to ensure that the home is kept clean. Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 18 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 poor. This judgement has been made using available evidence including a visit to this service. Staff are well trained and supported. There is a need for the recruitment process to be reviewed. Service users will then be fully protected and not put at risk. EVIDENCE: The inspector chose two newer staff members to speak with. They were able to describe their induction process and subsequent supervisions were also seen in their staff records. The rota was seen and each shift covered adequately. Domestic staff are employed to ensure that standards relating to food and nutrition are met, and that the home is maintained in a clean and hygienic state, and free from unpleasant odours. A maintenance person is employed who ensures that breakages or repairs are carried out. A key worker system is in place. The key worker is a care worker who is allocated to a service user to ensure that tasks that may get forgotten are checked and done. They will get to know the service user better and form a friendship with them. Two staff files were checked and clear evidence of training was seen.
Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 19 (Moving and handling, National Vocational Qualification (NVQ) level 2 in care, basic first aid, emergency first aid, fire safety, infection control, handling of medications and vulnerable adults training). The Registered Manager explained that the there was a sufficient number of staff trained to meet the needs of the service users. Recruitment practices must be improved, as inspected staff records did not have all the relevant information in them. This requirement will be repeated. Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management of the home was satisfactory with the exception of part of a staff record. EVIDENCE: Service users and relatives who spoke with the inspector felt that service users had their needs met. They felt confident that if they needed to raise a concern the Registered Manager would address the issues. Relatives’ comments included ‘I like the homely atmosphere of the Stanton Manor, all the staff are very good’. ‘I feel that my mother is well cared for and she seems to like it here,’
Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 21 The Registered Manager at Stanton Manor undertakes a quality review with service users and relatives, however other people such as the district nurses could also be asked for their opinions when they visit Stanton Manor. The comments seen were positive about the home. ‘I think that my relative is well cared for at Stanton Manor. We hope that if there are any problems with our relative I have asked the staff to contact me at any time of the day or night. I hope that if my relative needs anything I will be informed. In this way we can all make our relatives life as happy and as comfortable as it can be’. Staff also completed the questionnaires with service users one comment said ‘This service user does not like to have a shower and finds the bath chair too low for her back.’ The response from the Registered Manager has been prompt. A different bath chair has now been provided for this service user to use. The Registered Manager does not hold any money for residents. Family members or other people with legal authority to do so do this. The Registered Manager explained that the fire records and the water temperatures taken within the home were up to date. The inspector verified this. This ensures the safety of residents living at the home. Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 23 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 The Registered Manager must ensure that controlled medications are checked and recorded separately to ensure that the numbers received into the home matches the amount recorded on the bottle by the dispensing Pharmacist. Prescribed creams must not be left out once used. Safer practices are required in view of the nature of this service user group who have dementia and other memory problems. All information and safeguards missing from staff files must be obtained. 31/08/06 repeated at this inspection. Timescale for action 13/09/07 2. OP9 13 (2) 13/09/07 3. OP29 19(1)(b)( 4)(b) 13/10/07 Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 24 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 OP7 Good Practice Recommendations The use of both brakes is important to ensure that the wheelchair does not move during a transfer procedure to ensure that the risk of any injury to service users is minimised at all times. As two or three staff members were seen helping on this occasion this is a recommendation. Stanton Manor DS0000020098.V338913.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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
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