Inspection on 23/06/05 for Stanton Manor

This inspection was carried out on 23rd June 2005.

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

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

Other inspections for this house

Stanton Manor 21/11/08

Stanton Manor 03/12/07

Stanton Manor 13/06/07

Stanton Manor 06/06/06

Stanton Manor 10/10/05

Stanton Manor 28/09/04

Stanton Manor 13/05/04

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

CARE HOMES FOR OLDER PEOPLE Stanton Manor Piddocks Road Stanton Burton on Trent DE15 9TG Lead Inspector Jo Wright Unannounced 23 and 28 June 2005 9.00am rd th 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. Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 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 Mrs Pamela Mary Mycroft 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) Mrs Pamela Mary Mycroft Care Home 28 Category(ies) of 28 places - DE(E) Dementia - over 65 registration, with number of places Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 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. Date of last inspection 28th September 2004 Brief Description of the Service: Stanton Manor is a care home registered to provide personal care and accomodation for up to 28 people in the category of older persons with dementia. The home is siuated 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 court yard. Bedrooms are situated on the ground and first floor. Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over two days. The focus of this inspection was to look in depth at a number of issues that had been raised in a recent referral through the Protection of Vulnerable Adults procedures. During this visit, the files of three service users were looked at, as well as any related documentation such as accident records. Staffing levels and the files of three recently recruited members of staff were looked at. Four members of staff and the Registered Manager were spoken with. Time was also spent observing staff interaction with service users. What the service does well: What has improved since the last inspection? What they could do better: Staff need to plan for and review service users care better, to ensure that they know what to do for each service user. This must include risk assessments and detailed plans of how to manage individual service users behaviour. Staff need to improve the recording of incidents and accidents. Staff need to review their practice to ensure that the home is run in the best interest of the people who live there. Staff need to be better trained to care for older people with dementia, who may have challenging behaviour. Staff need to understand and work to the policies and procedures in the home, and fully understand the Protection of Vulnerable Adults procedure. Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 Page 6 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. Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 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 Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 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) 3 and 4 This home admits service users whose needs in principle it should be able to meet. However, the staff have not received the appropriate training and guidance to enable them to fully meet the specific needs of this service user group. EVIDENCE: Individual files were maintained for service users. The three files examined were well organised. Assessments of service users were carried out prior to admission, and based on the information available at that time, supported that the care needs could be met. Information about the service users needs prior to admission was obtained from relatives and any other professionals involved in the service users care. The Registered Manager carries out her own assessment of the person prior to admission. Written confirmation was provided that the home was able to meet the service users needs, based on the information provided. Recent incidents and information recorded in the service users daily logs did not support that all staff had sufficient skills, knowledge and experience to meet the assessed needs of all service users, for example, when service users Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 Page 9 presented with challenging behaviour. Entries in the files indicated that some members of staff were not always working within the home’s policies and procedures, for example, crushing tablets and putting them in food, using restraint. Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 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 and 10 The inconsistent use of some systems could potentially put service users and staff at risk. Personal care was not offered in such a way as to promote and protect service user’s privacy, dignity and independence. EVIDENCE: The inconsistent use of the care planning system did not adequately provide staff with the information they need to satisfactorily meet service users care. Individual plans of care were available, but were basic and not fully up to date. The information contained in the plans did not contain sufficient detail to ensure that all aspects of health, personal and social care needs were planned for and met. Some effort had been made to review care plans but the information recorded gave little indication of the actual care required. Changes to the care planning documentation were planned, in order to provide more detailed care plans. Potential risks were not adequately identified, assessed and planned for. Although staff completed trigger tool assessments for skin care, these had not been reviewed in accordance with the instructions on the assessment, for example weekly. Moving and handling risk assessments were completed but inconsistently reviewed and updated by staff. Consequently the risk Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 Page 11 assessment for one service user did not demonstrate the current level of dependency and assistance required. Significant events in the home were not always fully recorded. This was demonstrated in the logs of two of the service users who were experiencing frequent falls. Accidents forms were not always completed, and risk assessments and the associated plan detailing any preventative measures were not in place. The daily logs did not demonstrate that all staff were receptive to and acted up service users health care needs. Staff recorded for several days that a service user complained of being in pain, but did not contact the GP to review this person. Despite a senior management team being in place, it was often left to the Registered Manager to request GP visits and referrals to other health care professionals. One entry in the logs stated that the most senior member of staff on the early shift had been notified that one person’s arm was very bruised. The response recorded was that a GP visit would be requested the next day. There was no evidence in the logs to support that a visit had been requested. Staff frequently recorded that service users had unexplained bruises on their hands, wrists or arms. There was no obvious system for reporting these observations to the senior member of care staff on duty, or when they were reported, that action was taken immediately. The Registered Manager had taken action to address this issue, and developed an injury/bruising chart. The type of language used in the daily logs did not support that all staff respected service users and treated them as individuals. Frequent use was made of ‘aggressive’ and ‘agitated’ without any description of what this meant. All three service users presented with challenging behaviour toward staff who were trying to deliver care, but staff continued despite the service users actions and words clearly indicating that they did not wish to receive care at that time. Comments included ‘at 6.30am the service user told staff it was too early to get up, and was told by the member of staff could they could have another 15 minutes, ‘refused to get out of bed so pulled bedclothes off’, good as gold’, ‘out of it’ and ‘got himself in a right mess’. Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 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) 14 The practice of some members of staff means that not all service users were able to make choices and exercise control over their lives. EVIDENCE: The evidence available did not support that service users were assisted to exercise choice and control over their lives. Although the routine in the home appeared relaxed, discussion with staff and entries in the logs suggested otherwise. There were numerous entries in the logs about staff assisting service users to get ready for bed or get up in the morning when the person clearly did not want to. Some staff spoken with indicated they felt under pressure to complete the work by a certain time, but were unable to explain why they felt this and who had instructed them. Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 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 standard(s) 16 and 18 Staff knowledge and practice around the protection of vulnerable adults and related policies and procedures was insufficient, and potentially put service users at risk of not being protected from abuse. EVIDENCE: The complaints procedure was on display, and the Registered Manager reported that she had not received any internal complaints recently. The Registered Manager indicated that following the recent allegations being brought to her attention, she had spoken with as many relatives as possible, which has highlighted a number of issues that she was dealing with. Discussion took place with staff to establish their knowledge around abuse and the Protection of Vulnerable Adults Procedure and the Whistle blowing policy. Staff’s knowledge of the policies and procedures around abuse varied, and none of the staff spoken with were fully aware of the external procedures and contacts. Not all staff had received training. Staff were not fully aware of the Whistle blowing policy. Staff spoken with were aware of the home’s restraint policy, but the evidence available indicated that staff did not always follow the procedure. Some staff were unaware that their actions when dealing with service users with challenging behaviour could be interpreted as restraint. Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 Page 14 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) These standards were not assessed during this inspection. EVIDENCE: Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 Page 15 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 and 30 The staff team as a whole does not have the necessary skills and knowledge to assist them to do their jobs. The inconsistent use of staff recruitment procedures did not provide the safeguards to offer protection to people living in the home. EVIDENCE: There has been some turnover of staff in the last six months. The staff files of three staff members employed in that time indicated that the recruitment and selection policy was not always being followed, as one member of staff had commenced work without written references, and another who had left to work at another home for several weeks, had not completed a new application form. Appropriate action was been taken by the Registered Manager to address these issues. The Registered Manager was actively recruiting for additional staff at the time of this inspection, and the necessary checks were being obtained prior to employment. Care staff hours provided were satisfactory. Deployment of staff could be improved by allocating senior staff to work in each unit, when two senior members of staff were on the same shift. New staff completed an induction programme. The Registered Manager was advised to check whether the induction met the required specifications. Staff confirmed that they had completed or were undertaking training towards NVQ qualifications. Some staff had received service user specific training. However, further training was required, because the staff team as a whole lacked the required skills and knowledge to care for people currently living in the home. Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 Page 16 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) 36 and 38 Staff practice in some areas did not promote and safeguard the people using the service, and therefore did not ensure that their health, safety and welfare. EVIDENCE: Discussion with staff and the Registered Manager supported that staff received training in moving and handling, fire safety and basic food hygiene. First aid and infection control training was not provided for all staff. Despite having had this training, senior staff were observed using unsafe practices, which placed service users at risk. Staff were observed transferring a service user in a wheelchair without footrests on, that was tipped back. Discussion with staff also indicated that they did not use equipment to assist service users in and out of the bath, when they were unable to do this independently, but ‘slid’ the person in and out over the end of the bath. Appropriate equipment was available in the home, but the need to have this equipment installed for use had not been passed on to the Registered Manager. The mobile hoist required repairing at the time of this inspection, and appropriate action had been taken. Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 Page 17 One service user whose condition had deteriorated and required the hoist for transfers, was assisted out of bed by three members of staff, rather than cared for in bed. Staff receive regular supervision. However, the evidence suggests that this is not effective, as the members of staff who carry out the supervision were not addressing the issues around staff practice. The Registered Manager had organised the accident forms in separate sections for each service user, so that it was easier to monitor the frequency of falls. However, recording of accidents and incidents was poor. When the accident forms were crossed referenced against the daily logs, it was noted there were more accidents recorded in the logs than on accident forms. Incidents were poorly recorded, and the Registered Manager was implementing an injury/bruising chart, to be completed in conjunction with the accident forms. Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 Page 18 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 x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x 3 x 2 Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 Page 19 Yes 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 4 Regulation 18(1)(a) Requirement The Registered Person must provide staff with training that is service user specific and meets the assessed needs of current service user group. The Registered Person must ensure that all service users have care plans that set out in detail the action which needs to be taken by care staff to ensure that all aspects of health, personal and social care needs are met The Registered Person must ensure that all care plans are kept under review, in consultation with the service user and/or representative and ongoing changes to care recorded in the day-to-day logs must be incorporated into evaulation statements, and care plans must be amended to accurately reflect the current needs of the service user. (Previous timescale of 28 February 2005 not met). The Registered Person must ensure that the relevant general and individual risk assessments are completed for all service Timescale for action 31 October 2005 2. 7 15(1) 31 October 2005 3. 7 15(1) 31 August 2005 4. 8 12(1)(a) & (b), 13(4)(c), 14(1)(a) 31 October 2005 Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 Page 20 5. 8 12(1) 6. 10 12(4) 7. 14 12(2) 8. 18 13(6) 9. 18 13(6) & 18(1)(a) & (c) 19(4) 10. 29 11. 12. 13. 29 38 38 19(4) & (5) 13(5) & 18(1)(a) & (c) 13(2) & (4) users and appropriate action taken recorded, depending on the outcome of assessment. (Previous timescale of 28 February 2005 not met) The Registered Person must ensure that the home is conducted so as to promote make proper provision for the health and welfare of service users. The Registered Person must ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. The Registered Person must ensure that the home is run in a manner that enables service users to make decisions with respect to the care that they receive and their health and welfare. The Registered Person must ensure that staff are fully aware policies and procedures relating to the protection of vulnerable adults, whistleblowing and restraint, and work within these procedures. All staff must attend training on recognising abuse and the protection of vulnerable adults (including the local authority procedure). Two written references must be obtained for new staff employed to work at the home before they start work. Application forms must be completed for each period of employment at the home. All staff must receive refresher training for moving and handling. All staff must receive training on first aid and infection control. 31 October 2005 31 October 2005 31 October 2005 31 October 2005 31 October 2005 31 August 2005 31 August 2005 31 August 2005 31 December 2005 Page 21 Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 14. 15. 38 38 13(4) & (5) 17(1)(a) Schedule 3 Staff must use safe moving and handling techniques at all times. All accidents msut be recorded in detail in the daily logs and on the accident forms. 31 August 2005 31 August 2005 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. 3. Refer to Standard 7 27 36 Good Practice Recommendations Care plans should be kept under review, at least once a month. Consideration should be given to allocating senior staff to work in each unit, rather than in the same unit when on shift together. The policy and procedure for supervision should be reviewed to ensure that any issues around poor staff practice are highlighted and discussed. Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection South Point Cardinal Square Nottingham Road Derby DE1 3QT 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 Stanton Manor C52-C02 S20098 Stanton Manor V235223 230605 Stage 4.doc Version 1.40 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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