Inspection on 04/12/07 for The Manor, Exminster

This inspection was carried out on 4th December 2007.

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 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, Exminster 07/01/09

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

CARE HOMES FOR OLDER PEOPLE The Manor Main Road Exminster Exeter Devon EX6 8AP Lead Inspector Clare Medlock Unannounced Inspection 4th December 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 The Manor DS0000070444.V351211.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 DS0000070444.V351211.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Manor Address Main Road Exminster Exeter Devon EX6 8AP 01392 824063 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) The Manor, Exminster Ltd Mrs Heather Doris Whitehead Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability (25) of places The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability (Code PD) The maximum number of service users who can be accommodated is 25. 23rd March 2007 2. Date of last inspection Brief Description of the Service: The Manor is a Georgian house set in its own grounds in the village of Exminster, Devon. The home provides service for up to twenty-five people who are over 65 years of age. The premises have been extended to include 7 single ensuite bedrooms, all located on the ground floor with level access. Bedrooms on the first floor are accessed via stairs or a stair lift and have toilet and bathing facilities within close proximity. There are two lounges and a separate dinning area. The garden area is situated at the front of the building. It is a blockpaved area with an attractive fountain and seating. Local amenities are a short walk away and local bus services into the city of Exeter are within easy access. The homes current level of fees range from £294 to £668 per week and depend upon level of need. Fees could be as high as £950 per week for the larger rooms or special arrangements. The weekly fee does not include personal items, such as non prescribed medicines, hairdressing, chiropody, dentist fees, optician fees, newspapers and other personal items. The home has just been purchased by a family business, Stonehaven Healthcare. A new Statement of Purpose, brochure and Service User Guide are available in the hallway or upon request from the Proprietor and Manager. The Commission for Social Care Inspection reports can be found inside the brochures. The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection started with a visit to the home on Tuesday 4th December 2007. We spoke with staff, people who use the service, the new provider and visitors. We looked at care plans, medicine records, accident books, and looked around the home. We spoke with three people about life at the home. We spoke with one visitor on the day of the inspection and one relative shortly after the inspection. We looked in detail at what it was like living at the home for four people. We looked in detail at their records, care plans, bedroom and what they did during the day. This is referred to as case tracking, and helps us to understand the experience of people living in the home in more detail. Two service user questionnaires were completed at the home, and two visitor questionnaires were given out at the inspection. One was returned. Two relatives contacted us after the inspection to provide their views. We received some evidence not provided at the inspection shortly after the visit to the home and we spoke with the manager on the 10th December 2007. Prior to the inspection the manager completed a questionnaire, called an AQAA (Annual quality assurance assessment), which provides information about service users, staffing, fees and confirms that necessary policies and procedures are in place. All this information gives us a picture of what it may be like at the inspection and helps focus the inspection on what matters to the people who use the service. What the service does well: People who use the service spoke very highly of the manager and staff team. Visitors and people living in the home stated that they knew of this home prior to coming to the home and that it has a very good reputation locally and have been very pleased with their choice. People who use the service were seen to be genuinely happy, relaxed and at ease with staff in the home. Staff at the home provide a good standard of care. Access to personal and health care is maintained. Communication with the local doctors and nursing team is good to ensure all personal and medical attention is accessed when needed. The staff at the home also access other health care and NHS services The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 6 so that people living at the home have a range of support. People are generally treated with respect and kindness and are cared for by a stable staff team. The home has a relaxed atmosphere, is spacious, clean and well maintained. The new extension is well designed and offers some spacious ensuite bedrooms. The previous owner had continued to make additional improvements to the home, with the fitting of a new sluice room, two new bathrooms. The new provider plans to continue this maintenance programme. The home is managed by the previous deputy manager, who has been at the home for many years. The home is now under new ownership and people who use the service say the transition has been smooth so far. People who live at the home are happy about the care they receive. Relatives are happy with the care that their relatives receive and are generally happy with the communication at the home. The new providers are clear about what does not need to be changed and what needs to be changed and have action plans to introduce changes where appropriate. What has improved since the last inspection? What they could do better: The new providers are aware that there are shortfalls and gaps in some systems at the home and have already started a programme of change. Some gaps and shortfalls are not due to the present ownership. The new management must be aware that the new ownership has caused anxiety amongst people who use the service, their families and staff. The new providers should provide an open management approach and should ensure they are visually present on a regular basis to maintain lines of communication with staff, people and their families. If they are present to ‘make up’ staff numbers they should be present to help and support staff. The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 7 Any changes that the provider plans to make should be communicated to staff and people who use the service to provide an explanation to why changes are taking place. An example of this is explaining why changes to the menus have taken place. The manager should ensure people are empowered to ask for extra snacks if they wish and reminding people of the choices that are advertised. The safety of people in the home is of great importance and can be achieved in many ways. The new recruitment procedures should be introduced and evidence missing in existing files would show that staff have had appropriate checks performed. The provider should issue the General Social Care Council Code of Practice’s to ensure staff are aware of their roles and responsibilities. The provider must, as a matter of priority introduce the changes to the training programme to ensure that staff are well trained and have the information they need to perform their roles in a safe way. The provider must ensure first aid training is complete to ensure a qualified first aider is on duty at all times. People can also be protected by ensuring all staff have received POVA training. This will show that staff are aware of the different types of abuse and know how to correctly report any allegations of abuse. It is suggested that the manager performs an infection control audit to highlight any changes that are needed to control the spread of infection. This would show the need to provide hand washing facilities where foul linen is washed and educating staff on the importance of wearing protective clothing. Changes in work practices are also needed to protect people from unnecessary risks. It is recommended that staff record bath temperatures prior to bathing people. This will provide an extra check that bath water cannot scald people. Changes to the way some medications are administered must also be made. The manager must ensure medicines are administered straight from the original packaging. The manager must work to ensure care plans reflect the care that is actually given at the home. Care plans must be written in a way that shows how care needs can be met in a consistent way. Guidelines for staff should be clear so all staff are aware of how care should be given. Care plans should be completed, dated and reviewed. Attention should be given to the mental health needs of people in the home. This is of particular importance where there is a history of depression. Staff should be aware of the signs of low mood and be able to refer to healthcare professionals. Pre admission documentation should also be improved. The provider should ensure pre admission assessments are documented to show the home have assessed to show they are able to meet the persons needs. Contracts should also be available. The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 8 The provider should allow time now to make changes that they have identified already. The manager should then commence the programme of quality assurance checks. 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 DS0000070444.V351211.R01.S.doc Version 5.2 Page 9 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 DS0000070444.V351211.R01.S.doc Version 5.2 Page 10 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): 1,2,3. The home do not provide intermediate care Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The new admission procedure will ensure that people are able to decide whether the home is where they want to live and staff will have enough information to decide whether the home can meet their needs. EVIDENCE: The new owners have written a new Statement of Purpose and Service User Guide. Both documents contain the information needed for people to decide whether the home can meet their needs. A brochure is available for people to use. This brochure contains the Statement of Purpose, Service User Guide, latest Commission for Social Care Inspection report and response from the provider. The quality assurance manual is also present and a leaflet entitled ‘Who can I tell if I am not happy’. The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 11 People we spoke to and their relatives said they had been given a copy of the new documents. People living at the home said they couldn’t remember seeing anyone before they came to the home but that their families were able to visit the home before they arrived. Records did not show that a formal assessment had been performed on people before they came to the home. The new provider said the manager had performed assessments but had not written anything down. The provider showed copies of pre admission assessment documents, which will be used on people moving to the home. The provider also produced letters explaining whether the home could meet the persons needs or not before they moved to the home. The provider was able to produce contracts for some residents but not all people who were being funded by social services. The provider explained that Stonehaven were in the process of reviewing all contracts. The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 12 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. This judgement has been made using available evidence including a visit to this service. People who use this service are generally treated with respect, and receive the care they need to help them stay well. Improvements in written care plans are needed to ensure that people needs are met in a safe and consistent way. Some improvements are needed in the administration of medicines so that people living at the home are not put at unnecessary risks. EVIDENCE: All people we saw and spoke with appeared well cared for with the finer details of care given. For example appropriate footwear, hearing aids and glasses in place and oral hygiene needs met. The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 13 When case tracking we looked at three care plans and spoke and spent time with the people they referred to. We saw many examples of good practice, where staff interacted with people in an affectionate and unhurried way. Staff spoke to people with respect and worked at a pace that was correct for the person. One example of poor practice was noted where a member of staff ignored the concern of the person. Staff were knowledgeable about some personal and health care needs of people they cared for. When we spoke to staff, they were able to talk about information, including religious beliefs and likes/dislikes. When speaking with staff we noticed that their knowledge was not always reflected in the records kept in the home and records did not clearly explain how care needs were to be met. Care plans for specific needs did not provide clear guidance for staff on approach or how that need was to be met. One care plan detailed an instruction to staff to ‘control’ a specific matter. But no instructions were given on how staff were to provide control. A greater level of detail would help carers provide support in a consistent manner and would mean the health care needs of the person are met in a safe and measured way. Some care plans detailed that some people were prone to depression. Talking to these people it was clear that they were showing signs of low mood state but care plans did not show staff had identified this or written a care plan listing signs and what staff could do. Some records had not been completed or reviewed. One file contained five documents that had not been completed, one assessment that had not been reviewed since December 2006 and records that had not been signed, which means it is difficult to monitor changes in the condition of the person. This file did not contain a falls risk assessment despite the person being unsteady on their feet, use of walking stick and medical condition that could exacerbate falls. The provider said that nutritional assessments will be used and some sit on scales are being purchased. Records did show that people who use the service access a wide range of medical and health services. Examples include local GP (General practitioner, chiropodist, dentist, pharmacist, continence nurses and district nurses where appropriate. People told us that they always receive the care and support they needed, and always have the medical support they need. Comments included ‘I ring the bell and they come’ and ‘a doctor and nurse are called if needed’. Another person said they thought the staff worked very hard and were able to offer as much or as little help as needed. People said generally staff knock on their door before entering and call them by their chosen term of address. People who use the service said that when staff assist them in the bath, they make sure their The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 14 dignity is maintained and allow as much privacy as is appropriate. People also said they receive their medicines on time and never have to wait if pain relief is requested. Medicines are generally well managed at the home. Staff told us they are only able to administer medication when they have received training. Staff said policies on how medication is managed at the home are available and that all staff are responsible for the receipt and returns process. Records of the administration of medicines were well completed with clear explanation of medicines received, administered and refused. Staff use a pre loaded medicine pack system provided by the supplying pharmacist. In addition to this medicines that can not be supplied in this system are given separately. Staff explained the medicines are transferred to separate named bottles. This system is unsafe and means that mistakes can be made. The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 15 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. This judgement has been made using available evidence including a visit to this service. People using the service are given the opportunity to maintain contact with family and friends. They have access to a balanced diet and are encouraged to take part in activities. EVIDENCE: Staff told us there were general routines at the home but these were very flexible and really depended upon what people wanted at the home. Staff said there were no set answers as everyone at the home was very different and liked different things. Staff were able to explain the individual preferences of people. People living at the home confirmed this, with one person saying they kept changing their mind about what time they wanted to be woken up but staff did not mind at all. People who use the service told us there is plenty going on at the home and that they can chose which activities they attend. One person said there are Tuesday afternoon groups where people meet to discuss a range of subjects. Forthcoming sessions were advertised included: The BBC during World War 2, The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 16 Cowboys and Indians and the Great Western films and ‘Things you don’t see anymore’. One person said the home have an Art Group where people meet to paint, sketch and draw. One person said they did not like painting but enjoyed writing poetry during this session. A number of the people who use the service are fairly independent and are able to arrange their own entertainment and outings or like to watch TV, listen to music or read books in their own rooms. Records of activities are now recorded in an activities book. People said there had been lots of activities in the summer such as barbeques, afternoon tea and trips, although access to the minibus has stopped at present. The provider gave assurances that this had been raised and steps were being taken to access another mini bus. Visitors said they are always made welcome to the home and are often bought a cup of tea. People living at the home said they are able to go out with their family and friends when they chose and staff always do their best to help them get ready on time. One person said they were looking forward to the forthcoming Guide carol service. People told us that the food in the house is “good” and “excellent”. They confirmed that the menus for the day are displayed on the white board in the dining room each day and they were always happy with the quality and quantity of meals provided. People also told us they are able to have their meals where they wish. One person was in the quiet lounge, another was in their room and many others in the dining room. People told us they had enough to eat at the home. One person said they knew they could ask for food overnight if they were hungry. Staff said they have access to the kitchen so can get snacks for people overnight. We saw people enjoying their meal of pork and apple pie, new potatoes, medley of vegetables and pear flan for dessert. One person said they enjoy the glass of sherry they is offered at lunchtime. One relative said the food has always been superb but has noticed a slight decline with the arrival of the new owners. Another relative said the menu is misleading as people at the home do not know or do not ask for different foods or extra snacks. The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. Systems are in place so concerns and complaints could be dealt with promptly. Improvements in staff training would ensure all staff are aware of vulnerable adult issues and procedures. EVIDENCE: Since the arrival of the new owners, a leaflet titled ‘Who can I tell if I am not happy’ has been issued to all people living at the home and is available at the front entrance of the home. This document gives details of how people can make a complaint or raise and issue. Contact details for the providers and Commission for Social Care Inspection are available and contact details for people to make a referral to the protection of vulnerable adults (POVA) team. People at the home confirmed that they had been given this document. Comments included ‘I don’t know why we have this, the staff are wonderful’ and ‘I am very happy here and feel very well looked after’. One visitor said it was useful having this information but would always go to the manager with concerns. People told us they have never needed to complain as the previous owner ‘was nearly always around to sort out any problems’. One person said it was a little The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 18 unsettling as they had not been told the home was being sold until the last minute, but that the deputy manager was still there for support. The home has not received a complaint since it took over the home a few weeks ago. The Commission for Social Care Inspection have not received any complaints under the new ownership. Staff spoken to abuse and who training in the showed that not on the day of inspection knew about the different types of to report concerns to. Staff on duty said they had received protection of vulnerable adults. Training records, however, all staff had received this POVA training. Staff were aware that staff could not work until the CRB (Criminal Records bureau-police check) check had been performed. Records showed that all staff had received CRB checks but these records did not show that a POVA register check had been included in these checks. The provider gave assurances that new employees would follow the company recruitment processes that would include full enhanced CRB and POVA register checks The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 19 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): 19,20,21,24,25,26 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 are provided with a homely, clean and comfortable place to live. Further improvements to the home would improve safety for people in the home and reduce the spread of infection. EVIDENCE: The home is a large detached Georgian style home, set in a small village and close to local amenities. There is a large newly paved area with a feature fountain, several benches and plenty of parking spaces at the front of the home. The home overlooks fields and beautiful views out to the estuary. The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 20 The outside and inside of the house are very well maintained. The home employs a maintenance man who performs general repairs, ad hoc changes and routine improvements. All work carried out is to a high standard. All areas of the home were well decorated and domestic in style. Lighting and ventilation was good throughout the home. People told us the home always smelt clean and fresh. Relatives told us the only smell they found was that of home cooking. The home has many assisted specialist baths and toilet facilities in close proximity to bedrooms and communal areas. Grab rails, ramps and call bells are available to promote independence. People can use the stairs to get to the first floor or use the stair lift if chosen. Specialist equipment was present to promote independence. Call bells were prominent and used with prompt response by staff. People said they do not have to wait long for staff to respond to call bells. The home have a designated sluice room and separate laundry facilities. Washing machines have separate cycles to reach high temperatures where needed. Staff explained that they soak soiled laundry in a bucket before washing. Disposable laundry bags were discussed with the provider and had been ordered prior to the end of the inspection fieldwork. There is no separate hand washing facilities for staff using the laundry. This was discussed with the provider who gave assurances that separate hand washing facilities, gloves and aprons would be obtained in the laundry. People told us that staff do not always wear aprons when providing personal care or dishing up food. A tour of the kitchen showed that cleaning programmes are in place but freezer temperatures were not always recorded and food was unlabelled and undated in the fridge. Self closing devices were seen throughout the home to enable people to have their doors open if they chose but able to close in the event of fire. Radiators were low surface temperature. Records showed that water temperatures are controlled centrally. Staff said they check the temperature of bath water before use but no records were kept of this. People told us the home was always clean and tidy and that staff keep their rooms tidy. One person showed us her room. She said she really liked having small items of furniture with her. She explained that people at the home were able to have their own telephone in the room, where direct calls could be made or received and that a safe was available for safe storage of personal items. The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 21 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. This judgement has been made using available evidence including a visit to this service. The planned changes in staff recruitment, induction and training will mean that people will be cared for by staff who have had the necessary pre employment checks, staff induction and training. EVIDENCE: Staff told us that normally there are four carers and one cook on in the morning, three carers on duty until 8pm and two staff on duty over night. Staff and people who use the service said there had been a shortage of staff recently and that when the registered manager is on duty she is ‘hands on’. One relative said staff are very good and work very hard but recently there have just been two staff on in the afternoons. Relatives told us that staffing levels have been low recently and that on some occasions the new providers have been at the home but have been shut in the office leaving the staff to do extra work. People told us they miss the daily presence of the previous owner but that staff work very hard. People said the recent shortages have left the staff very tired. Staff explained they have tried to do their best to cover shortages themselves to provide consistency. Staff explained that they have a responsibility to perform care duties and domestic tasks when needed. The cook also works as a cleaner. The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 22 The provider explained that the shortages of staff had been identified and two overseas staff have been recruited but could not yet work until CRB (criminal records bureau-police check) and POVA (protection of vulnerable adults register) checks had been completed. Five staff files were inspected on this occasion. None of these staff had been recruited by the new owners. A file of a new member of staff was shown as an example of the recruitment process which the organisation plan to use. This one file contained details to show a robust recruitment procedure was in place. The five files inspected were of a poor standard. Three did not contain an application form, three did not contain two written references, none of the files contained evidence that a POVA check had been performed and did not show what level the CRB check was. Training records were poor at the home. Training certificates and induction records were not present or not up to date in all files. Staff on duty said they had received training but evidence was not in staff files. The provider explained and provided evidence that since October 2007 this shortfall had been identified by the organisation. The provider gave assurances that it was a priority of the providers to introduce the training and induction programme at the home. Examples of training records expected to be used by the organisation and evidence of new staff training certificates were sent shortly after the inspection. Details of future training sessions were provided for fire safety, moving and handling and medication handling. Staff confirmed that they had not been given the General Social Care Council Code of Practice. The provider produced a set of these codes that were ready for issue. The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 23 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): 31,32,33,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The change of ownership is unsettling for staff and people who use the service. Improvements to communication will ensure people know that the home is well managed and run in the best interests of the people who live there. EVIDENCE: The home has recently been purchased by Stonehaven healthcare. This is a family run organisation, which owns several care homes in the Southwest. The care manager, who has recently become registered with the Commission for Social Care Inspection manages the home on a daily basis. The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 24 The manager has many years experience in the care of older people and has completed an NVQ level 4 in care management but has not yet done the registered managers award. People told us the manager was ‘very supportive’, ‘wonderful’ and ‘fantastic’. Staff said she was approachable and worked hard. People told us the change of ownership ‘came as a surprise’ and it ‘has knocked them for six’. One person said the daily presence of the previous manager is really missed. One relative said the presence of the new ownership is lacking and when they are here they shut themselves away in the office and never come down stairs. One person living at the home said ‘the atmosphere has gone. It feels like a business now and not a home’. Another relative said ‘lots of changes have been made but it’s all for show’. Another relative said there don’t seem to have been any changes and as long as ‘they (the new owners) leave it alone’ it will be fine’. The provider told us the transition had gone smoothly and they had met on an open day with families, people who use the service, and staff. The provider explained the concerns that were raised and said the majority of feedback was ‘to leave the Manor running as it is’ Staff said there hadn’t seemed to have been too many changes and the new providers were available if they were contacted by telephone. On the day of inspection the manager was on holiday and staff telephoned the provider who came to the home within one hour. The provider had sent a detailed ‘regulation 26 visit’ report the evening before this unannounced inspection. This showed many issues had already been highlighted prior to this inspection taking place. The provider explained that in the eight weeks they had been present at the home they ‘had identified a number of, mainly back office tasks that need to be introduced and carried out. The only reason they have not been implemented as yet is time’ Records showed that the manager of the home will be expected to perform quality audit forms on a timed programme, hold service user meetings quarterly, hold staff meetings quarterly and perform annual feedback surveys. The home has a policy in place in relation to dealing with residents’ monies. The home does not hold any monies on behalf of residents. Residents are encouraged and supported in managing their own monies. Where this is not possible, family or representatives have control over the monies. In these instances the home purchases small items for the resident as required and has a system in place whereby they invoice the representative monthly to reclaim the monies owed. The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 25 A tour of the home confirmed that staff make sure COSHH (Control of Substances hazardous to health) products are stored safely. Regular maintenance checks are performed on electrical equipment and fire systems, although records for these were not closely inspected on this visit. Accident books were well completed with reference to events written in the care plan. Records and discussion with staff confirmed that not all staff had received mandatory training. The Statement of Purpose showed there are gaps in existing training. Relatives and staff confirmed that there is not always a qualified first aider on duty and that some staff are out of date with much mandatory training. The provider said they were aware of the gaps in training and were working hard to make sure staff had the skills, training and knowledge to perform their roles safely. The provider gave assurances and stated that the organisation have ‘a very strong training programme and a culture of dedication to ongoing and comprehensive team member training.’ The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 26 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 2 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 3 3 x x 3 2 2 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 3 3 3 x 3 x x 2 The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 15 Requirement Timescale for action 01/02/08 2 OP9 13(2) (4) 3 OP26 13(3) 4 OP38 13 (3,4,4c) 23(4) The manager must ensure care Plans are: • Written in a way that clearly shows the needs of people and explains how care can be given in a consistent way. • Kept under review • Completed and signed The manager must introduce 01/01/08 safe systems of administration for medicines that do not get dispensed from the ‘Nomad box’ The Provider must reduce the 01/03/08 spread of infection by: • Providing separate hand washing facilities, gloves and other protective clothing for staff handling foul laundry • Ensuring staff wear gloves and aprons when performing different roles • Promoting safe systems for washing foul laundry The provider must ensure all 01/03/08 staff receive mandatory training so they are able to perform their roles in a safe and appropriate DS0000070444.V351211.R01.S.doc Version 5.2 The Manor Page 28 5 OP38 13 (4) way, which keeps people safe. This must include: • Fire safety • Moving and handling • Protection of vulnerable adults training The provider must ensure there is a qualified 1st Aider on duty at all times 01/03/08 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 OP2 2 3 4 5 6 7 8 9 10 11 OP3 OP8 OP12 OP15 OP18 Refer to Standard Good Practice Recommendations The provider should ensure contracts are available at the home The manager should ensure she documents any pre admission assessment performed The manager should ensure the mental health needs are monitored at the home and provide care where appropriate The provider should continue with the plan to access a mini bus for resident outings The manager should ensure people know they can have food out of hours and have opportunities to chose an alternative meal The manager should record that CRB checks contain a POVA check to show the correct level of check has been performed The manager should record bath temperatures to protect people from scalds The manager should perform an infection control audit to identify where changes are needed The manager should ensure freezer temperatures are recorded and covered food in the fridge is labelled and dated The provider should ensure the staffing levels are stable and if the provider is counted in as numbers they are available to support staff The manager should introduce the planned changes to the recruitment procedure and ensure staff are not employed DS0000070444.V351211.R01.S.doc Version 5.2 Page 29 OP25 OP26 OP26 OP27 OP29 The Manor unless they provide: • An application form • Two written references • A photograph The provider should also: • Issue General Social Care Council Code of Practice to all staff • Sign to say original document has been seen The provider should introduce the planned changes in training and induction programme The manager should ensure the ethos and management of the home is open and approachable and should ensure people and their families have opportunities to informally meet with the provider on a regular basis. The manager should implement the planned quality assurance programme The manager should ensure staff have received training in infection control 11 12 OP30 OP32 13 14 OP33 OP38 The Manor DS0000070444.V351211.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 © 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 DS0000070444.V351211.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!