Inspection on 02/05/07 for The Manor House

This inspection was carried out on 2nd May 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Manor House 20/04/09

The Manor House 29/11/05

The Manor House 08/09/05

The Manor House 15/03/05

The Manor House 20/09/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The Manor House North Walsham Wood North Walsham Norfolk NR28 0LU Lead Inspector Hilary Shephard Key Unannounced 2nd May 2007 09:00 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 House DS0000027287.V338865.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 DS0000027287.V338865.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Manor House Address North Walsham Wood North Walsham Norfolk NR28 0LU 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) 01692 402252 P/F 01692 402252 The Manor House (North Walsham Wood) Limited Mrs Pamela Mary Davis Care Home 52 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (42) of places The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th November 2005 Brief Description of the Service: The Manor House is a care home providing personal care for up to 52 older people, 10 of whom may have a dementia type illness. The home is located close to the market town of North Walsham and is set in 18 acres of beautiful gardens and woodland, all of which are accessible to residents. The home provides accommodation in 45 single bedrooms and 3 shared bedrooms including 5 “apartment” type rooms located within a courtyard to the back of the home. Most of the bedrooms have en-suite facilities and the apartments have en-suites and small kitchen areas. Residents’ accommodation is located on the ground and first floors and outside in a small courtyard area, to which residents and staff access through the courtyard. There is extensive communal space in the home including a conservatory, dining room, lounge, lounge/diner and library. This home has won awards for its pet-friendly approach and residents are encouraged to bring their own pets into the home. Since the previous inspection, the home has been bought by Healthcare Homes Limited. The home informed CSCI of its charges in February 2007 and charges from £530 to £560 per week for care provision. Residents are expected to pay extra for hairdressing, chiropody, taxis, newspapers, pet food, vet fees, telephone and personal shopping. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers care outcomes for people using the service. The key inspection of this service has been carried out using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgments for each outcome group. A total of 3 requirements and 3 recommendations were made as a result of this inspection. What the service does well: What has improved since the last inspection? The September 06 inspection made a recommendation that care records should contain more comprehensive life histories, and activities recorded which is still ongoing and not fully implemented. The manager now keeps records of the staff supervision that takes place. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 6 Healthcare Homes identified their medication practices were potentially unsafe and made significant improvements ensuring their practice is now safe. 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 DS0000027287.V338865.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 DS0000027287.V338865.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 People who use the service experience good quality outcomes in this area. The needs of prospective residents are assessed and the manager ensures as much information as possible about the person is collected before admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The previous inspection carried out in September 2005 found that comprehensive information was gathered regarding the most recent service user, but home did not have a set format for the pre-assessment procedure. The manager had collected information from Social Services and the hospital about the newest resident. Relatives often visited to look round the home on behalf of prospective service users and frequently prospective service users would visit themselves. Comments made in the February 07 CSCI survey indicate that 80 of residents received enough information about the home before they moved in and 53 had received a contract. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 9 The homes Statement of Purpose briefly sets out the homes aims and objectives for care provision, but does not clearly set out the purpose of the 5 courtyard apartments, and needs to expand on the information so that prospective residents are made aware of their location, accessibility and facilities within them. The May 07 inspection found the manager had been unable to visit the person most recently admitted before admission but had made every effort to obtain as much information about the resident from family and GP. The current format used for assessing people needs before admission is basic and brief and only encourages a very small amount of information to be written down, there is a tick box regarding peoples emotional and social needs which is not adequate to properly assess those needs. Once the new care planning system is fully implemented, it is understood that pre admission assessments would offer more detailed information about the residents so the home can use that to plan how the residents’ needs are to be addressed. A recommendation has been made regarding the homes Statement of Purpose. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 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. 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. Residents who are physically and mentally able receive the appropriate care because they can express their needs, however, care records for those people who are unable to communicate their needs show their healthcare needs are not fully addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections carried out in March and September 05 found that care planning was good, but care records were being kept together in one file and lacked information about residents’ life history, social and emotional care needs, and end of life care. Care records were looked at during the May 07 inspection. The manager advised a new system was being introduced because Healthcare Homes had recognised the old care planning system was inadequate. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 11 15 care plans had been updated into the new style and these encouraged information about residents care needs to be recorded in a more comprehensive and person focussed way. Care plans of both styles were looked at as part of this inspection and varied in the amount of useful information they held. Previous inspections have found they lacked information about residents emotional and social care needs and the May 07 inspection found some effort has been made to include information within the new style care plans about emotional and social needs. One file showed some useful information had been recorded about the persons emotional needs and how staff should be caring for them. However, the care records seen showed that information about residents’ specific healthcare needs had not been recorded in enough detail to ensure staff would be able to use them as guidance for how they should meet the residents’ needs. For example, a relative had made the manager aware of his relatives specific health needs but the information had not been transferred into a plan of how staff should be addressing these care needs. Another care plan indicated the resident had severe communication difficulties, but the guidance for how staff should address this care need was inadequate to enable this persons needs to be met. There was no reference made to the residents’ emotional and social needs and no indication of how he communicates his needs. Another resident had recently suffered a bereavement and was clearly upset, however, the care plan had not been updated to reflect this persons changing needs and did not include guidance for how staff should be caring for his emotional needs. Staff spoken with confirmed they knew the residents care needs and were aware of the information contained in care records and thought the care records were improving and would help them provided better care for the residents. Observations showed staff knew residents well and were aware of their preferred ways of being cared for. Information gathered from relatives and residents in a recent CSCI survey indicates that 47 of relatives think the staff meet the needs of the residents and 53 said they usually do. 67 of residents indicated they felt they received the care and support they needed, 27 said they usually did and 7 said they sometimes did. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 12 Relatives comments were generally very positive about the care that staff provided: “residents are cared for to the highest standards”, they are treated with respect” “my relative has had the best possible care in the last few years in the manor House” “every effort is made to accommodate my mothers needs and wishes whatever they may be” “I think the home is excellent at setting up and maintaining all essential routines of daily life.” Some relatives expressed concerns about staff addressing the residents’ healthcare needs in a timely way. Medication was inspected during the March 05 inspection and that visit found good practice during the administration of medicines, secure and appropriate storage and staff had received training. The May 07 inspection found Healthcare homes had identified some potentially unsafe practices with the way medication was being administered and have improved this significantly. Medication was seen to be stored safely and appropriately. The manager advised that staff administering medication have received training and are assessed on two occasions before being allowed to administer medication alone. Medication records were checked and no anomalies were seen. Although care planning is not entirely adequate to meet the care needs of more physically and mentally disabled people, Healthcare Homes are aware of this and are making significant improvements, therefore no requirements are made at this time. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,14, 15 People who use the service experience good quality outcomes in this area. Residents who are able to, enjoy a full and varied lifestyle, but those residents who are not so able because of various disabilities lack adequate occupation and activity. Food remains of good quality but more thought needs to be given about providing choices to those residents less mentally able. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspection carried out in November lifestyle that matched their preferences enabled to entertain their visitors when access the local community as much as 2005 found that residents had a and expectations. Residents were they wished and were supported to they could. The November 05 inspection found lunch was a 3-course meal and was enjoyed by the residents, the residents expressed choices were respected and special diets were catered for. The food was freshly prepared using fresh produce and meals were well presented. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 14 The May 07 inspection found that residents who are physically and mentally able were able to live a very good life. Those residents spoke of how they enjoyed being able to have their pets, use the grounds of the home, keep up with their hobbies such as gardening, crochet and reading and advised they were very happy to be there. Residents spoke of how their lifestyle was how they expected it to be and were happy living in the home. One resident commented in the recent CSCI survey “I can always go for a walk in the garden and wood, on a warm day sitting in the garden is nice, we have had tea in the garden on a warm day”. Another commented: “religious meetings etc arranged for most religions if possible, other entertainment arranged, flower decorating, musical events, bus outings, sometimes speeches & slide shows, garden parties, sales & dog shows” all take place in the home. Two residents also run a weekly shop selling items to residents that they have bought or made. Residents who are more physically and mentally disabled rely on staff to help them with their social needs. One resident spoke of how she enjoyed watching her TV and did that most of the time. Care staff were seen to take some residents out into the gardens. Interaction between care staff and residents was briefly seen during the course of the day, but no detailed observations were made. The home cares for up to 10 people who have dementia and does not provide accommodation for them in a separate unit. But there is plenty of communal space and residents are able to make full use of that. The residents who have dementia tend to stay in the south wing lounge and observations made during lunch showed staff cared for them with great kindness, but their approach was not always appropriate. Some staff forgot to introduce themselves and explain what they were about to do creating unnecessary distress to two of the residents who were confused. However, staff were very good at giving reassurance to the residents and gave plenty of assistance as required. Relatives were seen to visit throughout the day and comments in the recent CSCI survey indicate they are made very welcome in the home by the staff, but do express concerns about the amount of activities provided, some saying “Physically the care is first rate, but some greater thought could be given to mental stimulation & social activities” and “I sometimes wonder if there are enough activities.” The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 15 A small kitchen area is available on the south wing, but the manager said residents are not encouraged to use this facility and there was no evidence to show that residents with dementia are supported with meaningful occupation such as cooking or household chores. Care records failed to contain much information about residents social and emotional care needs, however, this has been recognised by Healthcare Homes who are addressing it. The food continues to be of a high quality and residents in the main dining room clearly viewed lunchtimes as an opportunity to enjoy conversation with each other. Residents who have dementia tend to take their meals in the south wing dining room and care staff were observed gently assisting them in a kind and sensitive way. A choice of meal is provided and staff ask residents the day before which meal they would prefer. Choice for the residents with dementia is only offered verbally, and staff didn’t offer residents a choice of meal as it was being served. Its likely the residents would have forgotten what they ordered the day before and may not be able to express themselves verbally, so more thought needs to be given about how these residents are given choices about their meals. A recommendation has been made regarding activity provision and the offering of choice. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 16 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 People who use the service experience good quality outcomes in this area. Residents and relatives concerns are listened to and dealt with in a professional and sensitive way and staff make every effort to protect residents from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspection carried out in November 05 found the complaints procedure displayed and known by residents and visitors. Two complaints had been received by the home in the last 12-months (2004-5) and in both cases, the home had acted appropriately and in a timely manner. Staff spoken to had a good understanding of adult protection matters. The home had robust recruitment procedures in place that include obtaining Criminal Records Bureau and Protection of Vulnerable Adults (CRB/POVA) register checks. A complaint was received in April 07 and was dealt with very well by the manager and to the complainant’s satisfaction. Residents and relatives indicated in the recent CSCI survey that 93 of residents knew how to make a complaint, and 88 of relatives said they knew how to complain. 53 of relatives stated the home always responded appropriately to the complaint and 29 said usually. A relative had also commented that the manager dealt with any problems immediately and to good effect. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 17 Residents and staff when spoken with during the May 07 inspection had no hesitation about speaking with the manager about their concerns. Staff said the manager was approachable and they would always go to her if they were worried about anything. Staff confirmed they have received training in recognising the signs of abuse and gave some good examples of the signs they would look for. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 18 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, 25, 26 People who use the service experience good quality outcomes in this area. Residents enjoy a variety of comfortable indoor facilities with beautiful views over the grounds. There is a choice of bathing facilities; however, all of them need some work to make them more comfortable and welcoming. The range of choice in the building is restricted to some extent because of the needs of some of the residents and parts of the building need to be made safer and more easily accessible. Residents’ wellbeing is compromised at times because parts of the building are cold, and poorly lit. Some areas are potentially unsafe because of the use of free standing heaters and access to the courtyard apartments would be difficult for anyone with sensory, physical or cognitive impairment. This judgement has been made using available evidence including a visit to this service. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 19 EVIDENCE: Previous inspections have found the premises to be very well maintained and kept in a good state of décor and offering a good range of indoor and outdoor facilities. The May 2007 inspection found this continues to be the case. The majority of the home is well maintained and offers residents a good choice of comfortable communal areas. However, parts of the building were very cold throughout the duration of the inspection, particularly those bedrooms situated off the service corridor by the kitchen as staff kept leaving the back door open. The manager has distributed freestanding oil filled radiators to some of the residents and there were many of these seen around the home. This practice is potentially unsafe as the radiators and the flexes create possible trip hazards and were often seen to be blocking exit doors. Some parts of the home were a little dark. This practice also indicates the central heating in the home may not be sufficient. The manager also advised that the heating went off during the day. The registration of the home allows for a diverse mix of people, and accommodates some residents who have dementia. During the tour of the building it was evident that people who need to walk freely around the home because of their psychological care needs were causing a few problems for some of the other residents. One lady had chosen to have a safety gate at her door, so she could have the door open but not be subject to unwanted intrusion. Similarly the top of the stairs had safety gates fitted, so that those people who might wander and were accommodated on the first floor were safe. However, these gates were difficult for any of the other residents to operate independently. The courtyard area offers able-bodied residents the choice of five bed-sitting type accommodation arrangements. The only way in which this area can be accessed is via an unheated corridor and then by going outside. One or two of the people accommodated in this area have become heavily dependent and the Inspectors were concerned to note that one person was wheeled to her room in a wheelchair over some very uneven flooring. Night staff also have to access this area at night and the management of the home need to consider ways in which the access to the rooms can be improved and made safer and more welcoming. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 20 All of the bedrooms seen were highly personalised and the home continues to encourage residents to bring their pets, which is very good practice. The bathrooms seen were in need of some major renovation, which is accepted by the management of the home. As with all residential care homes, storage of bulky items of equipment was an issue throughout the building. The manager has some plans for how this can be improved and it might be worthwhile to consider whether the people who need hoisting should be accommodated on the first floor. Some lovely gardens and woods surround the home and there were many sheltered areas where people could sit. However, the lounge, which is used by people who have dementia has no secure garden so staff have to be vigilant to ensure that people were maintained safe when pets come and go. This communal area needs attention to make it less institutional in appearance as the chairs were arranged in a row in front of the TV. This room is also used as a dining area, which offers residents with dementia a quiet place to take their meals. The Manor House DS0000027287.V338865.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 People who use the service experience good quality outcomes in this area. Residents are provided with care appropriate to their needs by trained and competent care staff. Staffing levels during the day are good and sufficient to meet the varying care needs of all residents. The night staff levels are too low and create a potentially unsafe situation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspection carried out in September 05 found that staff were vetted properly before commencing work but their files did not contain photographs of them. That visit confirmed care staff had received appropriate training, including dementia care and although formal supervision was taking place it was not being recorded. The November 05 inspection found that numbers of staff exceeded that required. Senior care staff were trained to NVQ 3. Rosters indicated 3 waking night staff were employed. The May 07 inspection found sufficient numbers of staff on duty during the day, but staffing levels at night have remained at 3 care staff to care for a maximum of 52 residents. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 22 There are 5 apartments outside of the main building and 2 staff are required to leave the main building to attend one of the residents during the night. Although staff carry pagers, this practice is not acceptable and creates a potentially dangerous situation. The location of the home and layout of the building could create difficulties in evacuating residents in the event of a fire occurring at night. However, the levels of staff have remained the same for the past two years and there is no evidence to suggest residents care needs are not being met. The provider now needs to consider how to manage this potentially unsafe situation but as a means of resolving the situation, he should not consider moving the resident who lives in the apartment to the main building without that person making the choice to move. A requirement has been made. 6 care staff and the manager have just commenced a dementia awareness training course which will take them a few months to complete and should improve the care outcomes for those residents who are confused and have dementia. The manager advised that there have also been some in house dementia awareness training sessions. Information provided by the manager in February 07 indicates out of 35 care staff employed, 17 have NVQ 2 and 4 are working towards it. One member of care staff is currently undertaking NVQ 4 in care and one member of cleaning staff is working towards NVQ 1 in housekeeping. The regional manager has also held training sessions for staff in care planning. Staff spoken with confirmed they are working through an induction programme and were being monitored during their induction period by the manager or senior staff. Files of new staff showed the manager continues to practice safe recruitment practices by ensuring staff are properly checked before they start work. The Manor House DS0000027287.V338865.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, 33, 35, 38 People who use the service experience good quality outcomes in this area. Residents’ benefit from living in a home that is managed by a competent manager. Improvements need to be made to the parts of the building that are cold and potentially unsafe and to how the residents diverse needs are incorporated in order to minimise the impact on other residents’ wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspection carried out in November 05 found that the manager was well qualified and competent to undertake her role. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 24 A range of records regarding health and safety matters were seen during that inspection and were found to be up to date and in good order. The May 07 inspection found the home continues to be managed well by a competent manager and discussions about the home showed the manager has a good understanding of her management responsibilities. Healthcare Homes offer good support and guidance. Quality is monitored by the manager and regional manager and a formal survey is carried out on a yearly basis. This years survey has been completed but the results are yet to be made available and until they are it is difficult to evidence how the manager is making improvements to the issues already discussed throughout this report. The home accommodates a diverse mix of people and some residents and relatives have expressed concerns about how this is managed. One resident said how the behaviour of another resident (who has dementia) makes her unwell. Relatives have made comments such as: “does training & qualifications match the profile of residents with such mixed needs?” “there have been difficulties re troubled people wandering round the home, that has now been resolved, but if it reoccurs, I am not convinced positive action would be taken”. Relatives have made comments in the recent CSCI survey such as: “does training & qualifications match the profile of residents with such mixed needs?” “there have been difficulties re troubled people wandering round the home, that has now been resolved, but if it reoccurs, I am not convinced positive action would be taken”. Thus indicating the accommodation of people with such diverse needs may be having detrimental effect on the wellbeing of some of the residents. The home was cold throughout the duration of the inspection, particularly those bedrooms situated off the service corridor by the kitchen as staff kept leaving the back door open. The manager has distributed freestanding oil filled radiators to some of the residents and there were many of these seen around the home. This practice is potentially unsafe as the radiators and the flexes create possible trip hazards and were often seen to be blocking exit doors. This practice also indicates the central heating in the home may not be sufficient. A requirement has been made. The provider needs to consider how to manage these issues that are clearly affecting the wellbeing of some of the residents. The manager advised she does not hold money for any residents. The usual practice is for staff to obtain shopping for residents and send them an invoice detailing the amounts owed. The manager advised this practice is explained to residents when they are admitted. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 25 Records for fire management and accident auditing were seen and were in good order. The manager regularly checks accident reports and addresses issues relating to any patterns noted from accident records of residents who are reported to fall often. The manager advised the handyman was currently undertaking a course in health and safety. The Manor House DS0000027287.V338865.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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X X X 2 3 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 X 2 X 3 X X 2 The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP25 Regulation 23 (2, p) Requirement Heating and lighting must be sufficient to ensure residents health and wellbeing is promoted and protected. The provider must show how the health, safety and welfare of residents is protected by considering how the care, safety and well-being of residents at night can be improved. Residents who have access to portable heaters should have their safety ensured. Timescale for action 30/06/07 2 OP27 18 (1, a) 30/06/07 3 OP38 13 (4, a) 30/06/07 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 OP1 Good Practice Recommendations Prospective residents should be fully informed about the type of people able to be accommodated in the courtyard apartments. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 28 2 OP12 OP14 3 OP33 Residents who are less physically and mentally able should be enabled to pursue meaningful occupation and activity. These residents should also be enabled to make informed choices. The provider needs to consider the impact on the residents of accommodating so many people with such diverse healthcare needs. The Manor House DS0000027287.V338865.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 House DS0000027287.V338865.R01.S.doc Version 5.2 Page 30 - 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!