CARE HOMES FOR OLDER PEOPLE
The Manor House The Manor House 61 Manor Road Medomsley Consett Durham DH8 6QW Lead Inspector
Bridgit Stockton Unannounced Inspection 13 November 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Manor House DS0000007513.V346949.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 House DS0000007513.V346949.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Manor House Address The Manor House 61 Manor Road Medomsley Consett Durham DH8 6QW 01207 560099 01207 560099 No e-mail 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) Aimgo Limited Position Vacant Care Home 36 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (21) of places The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st November 2006 Brief Description of the Service: The Manor House is a care home registered to provide care and accommodation for a total of 36 older people. This home includes a separate unit, The Margaret Suite, which provides care and accommodation for 15 older people with dementia. There is an emphasis on integrating the service users with dementia into the main part of the home. The Manor House is owned by a private company, Aimgo Limited, which has its address in Consett, County Durham. This is the only care home operated by this company. The home is located in Manor Road, which is the main road through Medomsley in North West County Durham and is convenient for the limited local amenities of the village. The home was opened in 1990 and consists of a large extended and adapted two storey building. All bedrooms are in single use. There is a passenger lift to the first floor. The home has extensive and pleasant gardens with fine views over the local countryside. Fees range from £382.00 to £402.00 per week. Extra charges are made for toiletries, newspapers, hairdressing and chiropody. The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The purpose of this inspection was to assess the quality of the care and support received by the people who live at The Manor House Care Home. The methods I used to gather information included a visit to the home, conversations with the people who live there, their relatives, healthcare professionals and the staff. I looked in detail at the care and records of three people, examined other records and looked around the home. I spent five hours at the home. I sent questionnaires to people who live at The Manor House, their relatives and healthcare professionals. Feedback from these surveys is included in this report. The manager also completed the home’s pre-inspection questionnaire. These questionnaires provide valuable information to help me form a judgement about the quality of service offered at the home What the service does well:
The people I spoke to said they are happy with the care and support they receive. One person said ‘I am very happy living here, the staff are friendly, we all get along together’. Another said that the staff are ‘lovely and very hard working’. Relatives of the people who live at The Manor House said ‘staff are good and very kind to the people who live here. We have no complaints’. The people who live at the home and their relatives confirmed that they know how to raise a concern or make a complaint, if they needed to. One person said ‘I would tell the staff or the manager if I have a problem’. The staff are aware of their responsibilities if they believe that neglect or poor care practice is taking place and were confidant that if they raised any issues the manager would investigate. There are thorough recruitment and selection procedures in place, to make sure that staff are suitable and safe to work with the people who live at the home. The Manor House staff receive a range of training to equip them with the skills and knowledge they need to do their work properly. People looked well cared for, and there was a nice open friendly relationship between staff and people living at The Manor House. Independence is promoted, one person said, ‘ I go out each day for a walk, in the grounds and then down the road to meet my friends, I normally get back just in time for dinner’. The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 Page 6 People said they enjoyed the food they were given and said that there was a good choice. One person said ‘the meals are great; there is plenty for us to eat. I am better fed here than I was at home’. Staff treat people with care and respect. During the inspection a doctor visited the home. The staff on duty were organised and professional, ensuring that the doctor’s instructions were followed properly. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. People’s needs are properly assessed prior to admission to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans I looked at showed that assessments had been carried out before offering someone a place. This is to make sure that the home can meet the person’s needs. Social Services assessments are also used to determine this as well; these were also available to look at in peoples care plans. People are welcome to visit the home before reaching a decision. I also looked at contracts people have with the home. These were detailed and included a breakdown of the fees and who was responsible for paying for the care provided. The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 People who use the service experience good quality outcomes in this area. Good systems are in place to ensure that health care needs of the people are met. People can be confident that their privacy and dignity is protected and that they are treated with respect. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: I looked at three care plans in detail, to make sure that people’s health and personal care needs are being met in the way the person prefers. Since the last inspection all the care plans have been reviewed and amended where necessary. Risk assessments are now included in peoples care plans and are updated regularly to make sure people are safe and that risks are managed properly and any staff intervention recorded. Equipment is available such as moving and handling aids and special hoists so staff can transfer people from on place to another safely. The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 Page 10 Careful and thoughtful strategies to address particular needs or problems were well documented and sensitively written. The plans demonstrated that people are in receipt of individual planned care and support. There was evidence of involvement of specialist healthcare people such as the community psychiatric nurse, the dietician and continence nurse. During my visit I looked at how peoples medication was looked after by the staff at the home. Some areas needed improvement, mainly in the recording of when people had received their medication. The senior member of staff took action immediately to rectify this shortfall. All staff who administer peoples medication were re issued with the home’s safe handling of medication policy and procedure and all staff were to be observed by the deputy manager when administering medication to make sure staff were following these procedures and that people were safe. Staff were seen to be treating people with respect and dignity and this was also reflected within the care plans. One person said that the ‘staff are smashing’ another said ‘ staff are always kind to me, they are friendly, they never mind doing anything for any of us’ The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,&15 Quality in this outcome area is good. The recreational and social needs of people are well catered for which enables them to make daily choices and promotes independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During my visit the atmosphere in the home was friendly and welcoming, with visitors coming and going throughout the day. Some people were enjoying chatting with each other; some were listening to music, some people were away from the home attending a local day centre. Good links are maintained with the local primary school and pictures were on the notice board of a recent writing competition that the school children entered that was run by the home. Church services are held and people could attend if they wanted to. I spoke to a relative who said ‘we are always made welcome here, if I had any grumbles about the place I would speak to any member of staff, I am sure they would sort things out’. Everyone said the food was good, and a choice of meals was offered. The cook was knowledgeable about peoples diet requirements and knew what people liked to eat and what portion sizes they preferred. If anyone needed extra supplements during the day, milkshakes and fruit smoothies were some of the
The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 Page 12 things offered. One person said ‘the puddings are really nice, crumble, icecream, cakes, we get a good choice’. People could either have their meals in the communal dining area or else in the privacy of their bedrooms. The majority of people chose the communal facilities. The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16&18 Quality in this outcome area is good. People can be confidant that their concerns and complaints are dealt with appropriately and that safeguards are in place to protect them from abuse This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are adequate written policies and procedures in place to deal with complaints and the care staff spoken to confirm they were aware of these. Staff knowledge of these help ensure that they were able to address any issues or anxieties of the residents, relatives and visitors to the home. People who live at the home told me they would speak to the manager or any of the staff if they had any concerns or complaints. Staff told me that training has taken place in the protection of vulnerable adults in abuse. I looked at four personnel files and found that staff recruitment procedures were adequate and staff were employed and deployed following appropriate checks. The manager and staff team were clear and confident in the protection of vulnerable adult procedures. The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. People live in a safe, comfortable, well-maintained and homely environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the bedrooms that I saw reflect the person’s individual preferences and taste. There is a programme of re-decoration for the bedrooms, as well as for the rest of the home. Several bedrooms and corridors have been redecorated and look fresh and clean. One person’s bedroom smelt of urine. Staff and management were aware of this, the carpet was shampooed most days and advice on managing this person’s continence had been sought and was well documented in the persons care plan. The person spent most of their time in the bedroom. Alternative, suitable flooring should be looked at being laid in this person’s bedroom, this would reduce the smell of urine and make the bedroom more pleasant.
The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 Page 15 Some commodes have been replaced or refurbished. Soap and paper towel dispensers are now in all communal bathrooms, and better disposable gloves have been provided for staff when they are carrying out personal care. Staff have had training in controlling infections. The laundry was organised and people’s clothes looked clean and well pressed. There were no outstanding requirements from the fire and rescue service inspections or from environmental health inspections. The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 Page 16 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 good. People can be confident that staff are trained and on duty in sufficient numbers to meet their assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The rotas and staff numbers suggest that there are enough staff on duty at all times to meet the needs of the people who live at the home. I looked at a selection of staff files. They all included completed application forms and two written references. The files showed that satisfactory Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) register checks have been obtained. I was assured that no new member of staff starts work until a POVA register check had been completed. Then, if the CRB check had not been received, they would work only under the supervision of an experienced staff member. The manager makes sure that staff have the necessary training to help them do their work as well as possible. There is a wide range of courses available and most staff have been trained to a level 2 or 3 in the National Vocational Qualification (NVQ) in providing care. In addition some members of staff have received specialist training in looking after people who require dementia care. The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good The home is safe and well managed and people who live and work at the home can contribute to the decision-making processes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has the qualifications and the skills to manage the home effectively. Currently Mrs Mukherjee the registered provider of the home has an application pending with the Commission to become the registered manager of the service. Residents and relatives meetings are held, although I was told they are not very well attended. The home sends out questionnaires to relatives, in order to gain information about how people view the service and what improvements they would like to see. The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 Page 18 The manager has made an application to become registered with the Commission and this application is currently being processed. I looked at the records held at the home regarding people’s personal allowance. All transactions are recorded correctly and receipts are kept. One person’s money was counted and matched the total on the record. Policies and procedures are kept up to date; to make sure they provide relevant information to guide staff on how to act in every situation. Regular health and safety checks for the home are carried out in a timely manner. Staff have basic health and safety training. All these measures make sure that the health, safety and welfare of the people who live at the home is promoted and safeguarded. The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 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 3 3 X X X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 X X 3 The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 Page 20 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 OP26 Regulation 13 Requirement To ensure that the home smells fresh and clean the carpet identified during the site visit needs to be replaced with more suitable floor covering Timescale for action 30/01/08 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 OP9 Good Practice Recommendations It is recommended that the manager continue to check that staff are following the home’s policy and procedure for the recording of when people are given their medication. Medication administration records need to be monitored so all staff are signing the sheet when medication has been administered. It is recommended that the refurbishment plan for the home continues so that people live in a comfortable, safe well maintained environment 2 OP24 The Manor House DS0000007513.V346949.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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