Inspection on 07/08/08 for The Manor Care Home

This inspection was carried out on 7th August 2008.

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

The Manor Care Home 03/12/09

The Manor Care Home 28/07/09

Extracts from inspection reports are licensed from CQC, this page was updated on 28/10/2008.

CARE HOMES FOR OLDER PEOPLE The Manor Care Home The Manor Care Home Greendale Drive Manor Park Middlewich Cheshire CW10 0PH Lead Inspector Joan Adam Key Unannounced Inspection 7th August 2008 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 The Manor Care Home DS0000071371.V366125.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. The Manor Care Home DS0000071371.V366125.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Manor Care Home Address The Manor Care Home Greendale Drive Manor Park Middlewich Cheshire CW10 0PH 01606 833 236 01606 833 324 ahussa22@googlemail.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) Manor Care Home Ltd Mrs Susan Johnson Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places The Manor Care Home DS0000071371.V366125.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP The maximum number of people who can be accommodated is: 45 Date of last inspection New Service. Brief Description of the Service: The Manor is a privately owned 45 bedded care home, providing personal care, to residents over the age of sixty five years set in four and a half acres of land close to the town of Middlewich. The current fees for the home are £375 to £401. The manager supplied this information. The Manor Care Home DS0000071371.V366125.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is one star. This means that the people who use the service experience adequate quality outcomes. This unannounced visit took place on 7th August 2008 by two inspectors and lasted six hours. The visit was just one part of the inspection. Other information received about the home was also looked at. The home was not informed of the date the visit was to take place, but a few weeks before the visit the manager was asked to complete a questionnaire to provide the inspector with some information about the service. During the visit the inspector spoke with the manager, staff, residents and visitors. They toured the premises and looked at various records held by the home. What the service does well: People who live in the home and visitors think highly of staff who work there. Comments such as “ my relative is well looked after” Good homely atmosphere” ”home from home” ”all staff are caring” were received by the inspector. A senior staff member visits people wherever possible to carry out an assessment of their care needs before they move into the home to make sure their needs can be met there. People say that the standard of catering is generally good so they have a good diet. There is a complaints procedure for the home so that people know they are being listened to and that their concerns will be taken seriously and acted upon. The Manor Care Home DS0000071371.V366125.R01.S.doc Version 5.2 Page 6 The home is pleasant, clean and has a good standard of décor. Residents finances are handled well and records of accounts are kept. What has improved since the last inspection? What they could do better: The management of medicines must be improved so that people living at the home receive medications, which they are prescribed. Staff must not commence work at the home without all appropriate safety checks being completed and two written references being obtained, one from the last employer so that the manager can be sure the people working at the home are safe to care for vulnerable adults. All people working at the home should receive regular training in fire safety and take part in fire drills so they know what to do if there is an emergency. All staff involved in moving and handling should undertake training in this subject so that they are able to move people safely. All staff working at the home should receive safeguarding adults training so that they know how to recognise and report any abusive incidents. The manager must formally supervise the staff team as a minimum six times per year so that staff are provided with consistent messages and have the opportunity to air their views. Keep the grounds maintained so that they are pleasant for residents to enjoy. The original registration certificate must be prominently displayed within the home. The Manor Care Home DS0000071371.V366125.R01.S.doc Version 5.2 Page 7 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. The Manor Care Home DS0000071371.V366125.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 The Manor Care Home DS0000071371.V366125.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): 1,3. Quality in this outcome area is good. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Up to date information is available for prospective residents to decide if the home can meet their needs. An assessment of people’s needs is carried out before they move into the home to make sure their needs can be met there. EVIDENCE: The statement of purpose has been up dated to contain all the information required regarding the new owners who purchased the home in February 2008. The manager stated that the service user guide has also been up dated but one was not available at the time of the visit. The care file for a resident who had recently been admitted to the home was looked at. This contained an admission form which was fully completed and pre-admission information from Cheshire social services. There was adequate The Manor Care Home DS0000071371.V366125.R01.S.doc Version 5.2 Page 10 information to enable the home to know that they could meet the resident’s needs. Care plans were based on information obtained at the assessment. The Manor Care Home DS0000071371.V366125.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): 7,8,9,10 Quality in this outcome area is adequate. People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Care plans are adequate but need more detail so that the people who live in the home can be sure they receive the care they need. Medication management needs to improve so that people who live in the home always receive their prescribed medication. EVIDENCE: All of the people living in the home had a care plan which was written in every day. Care plans were looked at for three people who live at the home. One resident who had been admitted with dementia and arthritis. Needs identified were: - Hygiene, Diet, mobility, and continence. A care plan review sheet is in place and care plans had been reviewed. A moving and handling assessment was in place and this had been completed. The manager said she has discussed new care plan formats with the new owners to improve the The Manor Care Home DS0000071371.V366125.R01.S.doc Version 5.2 Page 12 documents being used at present. The care plan was adequate but contains little detail of the resident’s daily life in the home. No reference is made to their mood and how dementia is affecting them, whether they are in pain with arthritis and how they spend their day. Daily entries are poor and statements such as “good day” “ checked every two hours” are made by staff and do not give any detail as to what is happening to the resident so that staff are aware of any changes to their condition. Care plan for one resident looked at did not contain enough detail to guide staff to meet their needs. Daily notes were not detailed and night staff had given times when they were checked but did not say whether they were sleeping, awake or if any interventions such as changing position was needed. One other care plan had been recently up dated by the manager and contained more information so that the needs of the resident could be met. How to communicate with them and method of transfer from chair to bed. The daily records were more fully written but some staff were still writing very little. The care plans showed that residents’ health needs are monitored and visits are made to the home by doctors and district nurses as required. Residents spoken with said the staff “ looked after them very well” “ I like living here”. Staff were observed to have a pleasant and positive attitude towards residents. Medication management was looked at. There are good storage facilities in the home and controlled drugs used were recorded correctly. The home uses blister packs and for six residents there were tablets left in the pack which had been signed for as being given. It was difficult to ascertain which days they had not been given as staff had not administered the tablets in a sequential order. Medication management training has not been undertaken by staff since 2006. The manager had a training pack from Boots and was to arrange staff training in the near future. The Manor Care Home DS0000071371.V366125.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): Quality in this outcome area is good. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The activities for people living in the home need to be improved so that residents can keep active and stimulated. The range of food on offer is nutritious and wholesome. EVIDENCE: Care staff at the home are responsible for the activity programme. Some activities do take place but not on a daily basis. Entertainers are booked to visit the home and any activities are recorded in a diary. Card making, clothes show, nail care and afternoon tea in the garden have been recorded as taking place over the last few months. The activity programme should be increased to ensure the residents have enough to do. Residents are given choice as some like to stay in their own rooms or sit quietly reading. Ministers of different faiths visit the home on a regular basis. The Manor Care Home DS0000071371.V366125.R01.S.doc Version 5.2 Page 14 Visiting is open and visitors are welcome at any time. One resident said her grand-daughter took her out and then had stayed for an evening meal at the home on their return. Menus are available on a four week cycle and are displayed on a notice board in the dining room. All residents spoken with felt that the food was of a high standard. Home made cakes and scones are baked daily. Resident said “ the food is lovely” “ we have a marvellous cook” “always plenty to eat” The Manor Care Home DS0000071371.V366125.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): 16,18 Quality in this outcome area is adequate. People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. There are procedures in place at the home to ensure that complaints are handled well. Staff training needs to be given in safeguarding adults to protect people from abuse. EVIDENCE: The complaints procedure for The Manor is displayed in the entrance to the home. The complaints book showed that the two complaints that had been received by the home had been dealt with within the appropriate timescales and that actions had been taken to put matters right. The home has a policy in place regarding safeguarding adults. The home has had one issue regarding safeguarding of adults and the manager has dealt with this appropriately. The staff have not received safeguarding adults training since 2006 and this needs to be addressed so that residents living in the home have their safety maintained. Fifty per cent of staff have achieved NVQ level 2 and safeguarding adults is addressed within the course, however more detailed training needs to take place at the home. The Manor Care Home DS0000071371.V366125.R01.S.doc Version 5.2 Page 16 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): 19,26 Quality in this outcome area is good. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home is a comfortable place for people to live. The garden and driveway need to be improved to ensure the safety of residents and visitors. EVIDENCE: The home is clean, pleasant and in good condition. The bedrooms are well personalised with residents own furniture. The top floor of the main building is at present being refurbished to accommodate residents who have a dementing illness. One bedroom has an odour problem and the manager stated that a meeting with the resident and their family is to take place to address the problem. The Manor Care Home DS0000071371.V366125.R01.S.doc Version 5.2 Page 17 The grounds and gardens have not been maintained and the grass is long and in need of cutting so that the residents have a good outlook and can use the gardens safely. The driveway to the home is in poor condition and there have been some complaints by relatives regarding this. The Manor Care Home DS0000071371.V366125.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): 27,28,29,30 Quality in this outcome area is adequate. People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Staff training needs to be improved so they can maintain and develop their skills when providing care. Recruitment procedures are not thorough to make sure that new staff are suitable to work with the people who live at the home EVIDENCE: Care staff are well regarded by people living in the home and relatives. Comments were made such as, “very good, everyone is very kind.” Duty rotas were looked at and the home has adequate numbers of staff on duty to meet the needs of the residents. The training records for staff was looked at and there were over fifty per cent of care staff who had achieved NVQ level 2 in care. Some staff at the home had not received mandatory training regarding fire safety, health and safety, moving and handling and food hygiene. Training records indicated that eleven members out of twenty four staff had attended a fire safety training course in May 2007. No fire safety training has taken place since that date. This means that staff may be unaware of what to do in the event of a fire. The Manor Care Home DS0000071371.V366125.R01.S.doc Version 5.2 Page 19 The records also indicated that only five of the twenty four have completed moving and handling training since February 2007. This means that some people living in the home could be at risk of harm or injury through poor lifting practice. The recruitment records of four staff were checked. One of the files looked at contained all relevant information required to enable the management to be aware that the person could work with vulnerable adults. Three members of staff had been commenced work in the home before POVA 1st checks had been received or current CRB checks were completed. Two written references had not been received for these employees prior to them commencing work at the home. The application forms did not have an area to write dates of employment so that a detailed employment history could be recorded. There is no record of these staff members receiving moving and handling training since commencing work at the home. The Manor Care Home DS0000071371.V366125.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): 31,33,35,36,38 Quality in this outcome area is adequate. People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. Some areas of management need to improve to ensure the safety of the residents living at the home is maintained. EVIDENCE: The manager is experienced and has been managing the home for some time. She is registered with CSCI. She has attained NVQ level 4 and 5 in management. The deputy manager has attained NVQ level 4. The home has recently been purchased and the new owners visit the home daily. They were on holiday at the time of the inspection. The Manor Care Home DS0000071371.V366125.R01.S.doc Version 5.2 Page 21 Medication management was not satisfactory with medications being signed for but not being given. Mandatory staff training is not up to date so residents health and safety is not being addressed. Recruitment files looked at showed that not all relevant safety checks had been carried out prior to someone starting work to the home to enable the management to be aware that the person could work with vulnerable adults. Formal staff supervision is not taking place, however the staff are supervised on a daily basis and said that they felt supported by the manager and deputy. The manager must formally supervise the staff team as a minimum six times per year so that staff are provided with consistent messages and have the opportunity to air their views. The home records all financial transactions well. Four examples of residents’ money and written balances were checked and were accurate, with receipts kept as appropriate. Records indicated that the maintenance man tested and checked fire safety equipment. Accident forms checked and audited on a monthly basis. All health and safety risk assessments have not as yet been up dated. The owners have made an appointment with a consultancy firm on return from their holiday next week to address these issues. The original registration certificate was not displayed in the home. A photocopy of the certificate was in the entrance hall. Original certificates must be prominently displayed in the care home as stated in Care Standards Act 2000 section 28. The Manor Care Home DS0000071371.V366125.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 The Manor Care Home DS0000071371.V366125.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A 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 Requirement Medicines must be administered as prescribed and in accordance with the home’s policy and procedures. This means that people living in the home can be confident they will receive their medicines as prescribed. All staff who administer medications must receive up to date medication training. This means that people living in the home can be confident they will receive their from a competent person. All staff must receive up to date moving and handling training so people living in the home are not placed at risk of possible injury. All staff in the home must undertake an annual refresher course in fire safety training so that people in the home are protected. The registered person must ensure that all staff employed DS0000071371.V366125.R01.S.doc Timescale for action 31/08/08 4 OP38 18(1)(c) 30/09/08 4 OP38 18(1)(c) 30/09/08 5 OP38 23 (4)(d) 30/09/08 6 OP18 13(6) 30/09/08 The Manor Care Home Version 5.2 Page 24 receive suitable and sufficient training in the protection of vulnerable adults, including the prevention of abuse. 7 OP29 19(1)(4) The registered person must ensure that no one commences employment at the home before a POVA 1st check, CRB check and two written references have been obtained, one from the previous employer. 31/08/08 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 OP19 Good Practice Recommendations Ensure that the grounds of the home are maintained to provide a pleasant environment for the people who live there. The Manor Care Home DS0000071371.V366125.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.northwest@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 The Manor Care Home DS0000071371.V366125.R01.S.doc Version 5.2 Page 26 - 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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