Inspection on 14/12/05 for The Manor House

This inspection was carried out on 14th December 2005.

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

Other inspections for this house

The Manor House 31/03/09

The Manor House 10/09/07

The Manor House 02/02/07

The Manor House 25/11/05

The Manor House 13/09/04

The Manor House 06/04/04

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

CARE HOMES FOR OLDER PEOPLE Manor House, The The Manor House 6 Bawnmore Road Bilton Rugby Warwickshire CV22 7QH Lead Inspector Christy Wannop Unannounced Inspection 14th December 2005 06:00 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 Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 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. Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Manor House, The Address The Manor House 6 Bawnmore Road Bilton Rugby Warwickshire CV22 7QH 01788 814734 01788 814734 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) Pinnacle Care Ltd Mrs Monika Relton Care Home 26 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (20) of places Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Manager achieves the Registered Manager`s Award (Adults) by April 2006. 14th October 2005 Date of last inspection Brief Description of the Service: The Manor House is a 26-bedded care home for older people. The home is registered to take up to six older people with dementia. The home is a mature building with parts dating back to the 16th Century, and is set in its own grounds, adjacent to the village green, in Bilton, Rugby. The Manor House has twenty-two single bedrooms, twenty-one of which have en-suite facilities. One of the two double rooms also has en-suite facilities. There are two communal bathrooms and four communal toilets. The home offers a range of adaptations and specialist equipment appropriate for the needs of frail older people. The local shops and amenities are a 2-minute walk away. The Manor House was converted from a private dwelling into a care home in 1985. The home has three large communal lounges with south facing gardens. The accommodation is over two floors reached via two passenger lifts. Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two different inspectors made two inspection visits in close succession; Lesley Beadsworth on 25th November and Christy Wannop on 14th December. Both of these visits were unannounced. An administrative oversight led to these two visits happening within a short period. This report covers the second visit, which took place from 6pm till 9.30pm There were 21 residents in the home at the time of the inspection. The inspector spoke with staff and several residents, observed care practice and read care plan documentation. Following the inspection, questionnaires were sent to families. Three people replied. Their comments are incorporated into this report. The manager was called in by staff and arrived to speak with the inspector and gave a tour of the building. The home is registered for six people with dementia. The Manager identified at least twelve service users with dementia and four with challenging dementia. She must not admit any more service users with dementia. She must be able to clearly identify the six service users that are resident in the home with a diagnosis of dementia. She should consider identifying the six beds in a separate area of the home and being clear about the staffing levels to meet the needs of these six service users who have a higher level of need and to whom the home should provide its specialist service. There were no matters of urgent concern identified at this inspection. Following the inspection the manager responded promptly to give information and rectify some of the matters raised. What the service does well: What has improved since the last inspection? Risk assessments have been put in place. Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 6 Recruitment procedures are clear and satisfactory information is in place about staff working in the home. The manager has acted promptly to make changes required or recommended by the inspectors at previous inspections. 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. Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 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 Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5 There is satisfactory information and opportunity to visit given to prospective service users so that they and relatives can make an informed choice about whether the home is suitable and can meet their needs. EVIDENCE: The home has information posted clearly. The Statement of Purpose is kept along with the last inspection report in the entrance used by staff and visitors at the rear of the building. CSCI has now been supplied with an updated April 2005 copy of the Statement of Purpose. The manager should ensure that any updates are sent to the Commission for Social Care Inspection in future. The Manager should consider how the home organises to meet the needs of the six people it can care for with dementia. The manager should consider staffing, care planning and the physical layout that would most assist these six people in their life at then home and the other residents who share the day-today life in the home. Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 9 The most recently admitted service user described how his relatives had visited the home and agreed his admission. He was very satisfied with the standards in the home. He described how he had been consulted about his care needs and confirmed that he had a contract and had seen full information about the home. Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 Individual plans for care; life stories and accompanying risk assessments provide a sound basis for a staff knowledge of people’s care needs. Where specific health needs are identified, lead staff must be knowledgeable about consequences and implications these have so that safer care can be ensured. This will improve and maintain residents’ mental and physical well being and a good quality of life. Resident’s individual records are accurate and securely stored when not in use. Procedures, training and systems for safe storage and administration of medication are in place. EVIDENCE: Care Plans were in place for all service users. They detail strengths and abilities and all people have a “life story”. These were informative and had the detail necessary to enable carers to deliver the care needed. Nutritional screening, fluid intake, mobility and pressure care plans were in place. Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 11 The need to ensure that food and drinks are finished was a matter of serious concern identified by the inspector in January 2005 and has been raised with the manager and CSCI as a recent concern by the family of a previous resident. People were offered drinks throughout the inspection in large plastic beakers. When asked, not all care staff knew how much an adequate fluid intake should be. Fluid intake was recorded in terms of ½ a cup or ¼ of a cup. This could put service users at risk of dehydration. Minimum quantities should be established in the risk assessment and care plan along with what staff should do next if intake is not maintained. Nutritional screening takes place at the time of admission. Care plans are supported by risk assessments. Greater detail in risk assessments for specific health care needs would address the concern raised above. All residents now have risk assessments for pressure sores. Care plans and monthly reviews showed that people’s families had been asked to sign them. One newly admitted person described how the manager and deputy had sat and gone through each area of his care with him. The registered manager reported that no service users held and administered their own medication. This makes redundant a requirement made in Sept 04. Medication recording and administration was observed. Satisfactory systems are in place to store and record controlled drugs. Only trained staff administer drugs. One service user uses oxygen therapy. Storage is satisfactory. There is a medication fridge. The manager has put in place guidance for medication for which there is a discretionary dose. (PRN) The Manager seeks the views of service users about whether male and female staff can help them with intimate personal care and their preference is recorded with their care plan. Relatives are consulted where service users cannot communicate their consent. Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Daily routines respect service user individuality, dignity, privacy and promote their well-being and independence. The home assists residents to access a variety of planned and spontaneous activities that they find enjoyable. EVIDENCE: The inspector saw a group of residents talking with a carer about the programme of activities and noting dates for past and upcoming events in his dairy. One person talked about a recent “reminiscent afternoon” he had enjoyed about Christmas past. A relative was visiting and spoke to the inspector positively about the home. The family had organised an internet connection for this service user. One service user did say that there was no phone and that “you’d never get a call.” Staff reported that residents could use the phone in the office. There is a pay phone. The manager has a portable phone that can be taken by residents to the privacy of their rooms or wherever they happen to be. The manager consults with residents through regular meetings and an annual formal written consultation. Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 13 Dementia specific care plans do detail how people like to spend their time, though dementia specific leisure activity materials could not be seen. The registered manager should consider a range of activities that people with dementia may usefully access throughout the day. This area of their leisure time should be detailed in the care plan. Staff offered drinks throughout the inspection in plastic picnic beakers. These are not appropriate and do not give dignity to the residents. Adult cups should be used. The inspector arrived after the evening meal at 6pm. All had been cleared away and washed up. Staff said that food would be prepared if needed, but no food was seen to be offered during the evening. Staff later reported that sandwiches were offered that evening. One service user praised the quality and presentation of the minced/soft food he needed. Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Service users are supported by policies and staff in having concerns raised and in being protected from harm. EVIDENCE: The home clearly displays information about complaints. The commission has received a copy of a letter of concern sent to the proprietor and manager detailing issues with laundry, fluid intake and about the manager’s approach. This was managed as a complaint by the home and was not upheld. This complainant confirmed that day-to-day concerns were usually addressed promptly by the home. One of the three families who responded said that they were not aware of the complaints procedure, but also confirmed that they ahd no cause for complaint. There have been no concerns about protection of vulnerable adults. Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24, 25, 26 The standard of the environment within this home is good providing service users with an attractive and homely place in which to live. The home is generally clean and hygienic, however some areas do smell, thus detracting from the overall impression of cleanliness. Bedrooms are attractively furnished and decorated. The home has sufficient rooms to allow for privacy or getting together with others. The small size and poor use of the laundry and airing cupboard could be a risk risks to safety. There is obviously a need for better airing and drying facilities. EVIDENCE: A number of bedrooms were seen. These were all well presented and comfortable and of good size. Three bedrooms have been redecorated. There is a downstairs “apartment” occupied very comfortably by one new resident and fitted out with internet access. There are two assisted baths in the home. Some rooms have en suite toilet facilities, four have baths and six have showers. There is one ordinary bath. There is no shortage of bathing facilities. Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 16 The laundry is very small and was overcrowded, with clothes drying over the boiler, cushions stacked against the boiler, no obvious arrangement for dirty and clean laundry. The linen cupboard is large and would better accommodate some of the drying function if better fitted with shelves and rails. A requirement is made. On entry the home had an odour of urine, as did one bathroom and the rear ground floor corridor. Bathrooms and communal areas appeared clean. The home does not meet the standard for ensuring 1 assisted bath for every 8 service users, however 10 rooms have either an en suite bath or shower and there are two assisted baths. The call bell system was seen to be working and one service user confirmed that his was in full working order. Carers responded promptly to bells. The manager has had discussions with residents and assessed people’s ability to manage keys to their own room. This is recorded in their care plan. There had been an issue recently in the home where a service user had locked her room from the inside. Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28,29,30 The home has a suitably trained and competent staff team who are committed to meeting the needs of the residents. The home now has robust recruitment procedures in place that work towards protecting the safety and welfare of the residents. The home cares for six people with dementia and this requires higher staffing levels. EVIDENCE: The inspector looked at two staff files. These had evidence of a range of induction issues discussed on the same day. Staff files were seen of two newly employed staff, satisfactory information was in place for both, including CRB checks. The Manager has supplied details of the training planned and delivered across all homes operated by pinnacle care. This does not specify the training planned and delivered to Manor House staff and staff files did not have this detail either. The manager reported that she keeps this information separately and was able to supply it subsequently. The Manager reports that 6 of 15 care staff have an NVQ 2 and a further six are working towards this achievement. Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 18 There were three members of staff on duty, two carers and a team leader. Two waking night carers arrived at 9pm. After a handover, the day shift went home at 9.30. This number is not sufficient to meet the needs of the service users when the home is fully occupied, given that there is a specialist service for six people with dementia. There should be one staff to 6 people with dementia over and above the routine staffing complement. There should be four staff on duty at all times when residents are awake and in need of care and the home is fully occupied. Three relatives who replied expressed no concerns about staffing levels and one commented very positively on the encouraging atmosphere created by staff at the home. Care staff are responsible for the evening meal and doing the laundry. One cleaner is employed. The Manager identified around twelve service users with a diagnosis of dementia, four with particular needs in this area. There was evidence from staff files that the Manager was addressing concern about staff practice and potential disciplinary matters and the inspector saw a satisfactory schedule of planned supervision sessions for the coming year. Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36, 38 The comfort, safety and well being of the residents is promoted by a generally well organised home. Fire prevention must be improved by ensuring fire doors are safely maintained. EVIDENCE: The Manager has been in charge since late 2004 and registered since May 2005. She reported that she has just completed her Registered Managers Award. There was evidence that she has taken action about matters raised in the 25th November inspection and acted promptly to supply information needed following this inspection. The Manager has reported that the building and equipment is maintained safely. The door to the lounge from the office corridor and the office door were Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 20 both propped open, by a chair and waste paper bin. These should be fitted with self-closing devices so that people can have free access but be protected in the event of fire. A recent inspection by the Fire and Rescue service found that some fire doors did not close properly. Records of drills have not been maintained correctly and do not show which staff attended. Maintenance records showed that repairs had been requested but not that they had been completed. Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 21 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 3 X X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 2 Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12a Requirement Timescale for action 31/03/06 2 OP19 16 3 OP26 18,16,23 Full risk assessments must be in place for people with specific health needs indicating optimum health, consequences of not achieving this and strategies for staff to use to counter this. Nutritional and fluid intake plans should be based on recorded professional advice. i.e. District Nurse or GP. These should be easily accessible alongside the fluid balance or daily recording charts for staff clarity. The laundry must be maintained 31/03/06 safely, free from clutter with better drying facilities and storage rails fitted in the airing room. The registered provider is 31/03/06 required to ensure that the home is maintained in a clean and hygienic state, free from unpleasant odours. 4 OP27 18 Ensure that sufficient trained, 31/03/06 skilled staff on staff duty to meet the needs of residents and to run the domestic arrangements for DS0000032248.V273307.R01.S.doc Version 5.0 Page 23 Manor House, The food, laundry and cleaning 5 OP38 13 The registered provider is required to ensure that staffs working at the care home participate in regular fire drills/procedures. The manager must address the deficiencies identified in the Fire inspection report of 13/10/05 and must ensure that wedging of doors does not place people at risk of fire. 30/09/04 6 OP38 23 31/03/06 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 1 Good Practice Recommendations The statement of terms and conditions should include fees payable and by whom (service user, local authority, relative or another). The Manager should consider how the home organises to meet the needs of the six people it can care for with dementia. The manager should consider staffing, care planning and the physical layout that would most assist these six people in their life at then home and the other residents who share the day-to-day life in the home. Service users who have a hearing aid fitted would benefit from having a loop system installed in a communal area of the home. Cups and glasses appropriate for respected adults should be used. A portable phone should be made easily available for residents use. The registered manager should consider a range of activities that people with dementia may usefully access DS0000032248.V273307.R01.S.doc Version 5.0 Page 24 2 4 3 4 4 5 6 10 10 12 Manor House, The throughout the day. This area of their leisure time should be detailed in the care plan. 7 21 It is recommended that toilet doors be widened to enable wheelchair access. The Manager should maintain a staff training record specific to the Manor House. Std 30 The registered provider should respond to recommendations made by the fire prevention officer and introduce a fire log. Care staff supervision should include all the areas listed in the standard. 8 9 30 38 10 36 Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Manor House, The DS0000032248.V273307.R01.S.doc Version 5.0 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. 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!