Inspection on 24/05/05 for The Manor House

This inspection was carried out on 24th May 2005.

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

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

Other inspections for this house

The Manor House 18/09/06

The Manor House 02/11/05

The Manor House 02/12/04

The Manor House 18/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Manor House Thurloxton Taunton Somerset TA2 8RH Lead Inspector Jane Poole Announced 24 May, 2005 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 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 D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Manor House Address The Manor House, Thurloxton, Taunton, Somerset, TA2 8RH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01823 413777 thurloxmanor@hotmail.com Mrs Charis Ann Cavaghan-Pack Mrs Charis Ann Cavaghan-Pack Personal Care Home Only 4 Category(ies) of Old Age (4) registration, with number of places The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd December, 2004 Brief Description of the Service: The Manor House is registered to provide personal care to up to four people over the age of 65. The home is very much run in a family style. Mrs Charis Cavaghan-Pack is the owner and registered manager but the home is run in partnership with her husband. Both Mr and Mrs Cavaghan-Pack live on site and both are involved in the day-to-day business of the home. The home has limited care staff hours and is therefore only suitable for service users who are reasonably independent and physically mobile. The house itself is a large Grade 2 listed building set in extensive grounds, all rooms are for single occupancy and all have en suite facilities.All areas of the home are comfortably furnished and well maintained. The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. At the time of this inspection there were three service users living at the home. The inspector was accompanied for part of this inspection by a fire officer from Somerset Fire Brigade. His recommendations for good practice have been incorporated into this report. The inspection was carried out over a period of three and a half hours. The inspector was able to view records held by the home, discuss issues with the home owners, tour the building, meet with all service users in private and speak with the member of staff on duty. Prior to this inspection two feedback cards were received from local healthcare professionals and some of their comments have been mentioned in this report. What the service does well: The Manor House provides very individualised care to its’ service users. They are very aware of the level of need that they are able to meet and ensure that all service users are aware of this before moving in. The service users were all extremely complimentary about the home and it’s staff. One person described the home as like living in an extended family and stated that nothing was ever too much trouble for staff. People continue to be in control of their own lives and this is demonstrated in many ways. The routines in the home are designed around the needs and wishes of the service users. Transport is provided to enable people to access local amenities and everyone is encouraged to maintain their independence by continuing to shop for their own personal items. All service users are able to invite friends and family to visit them and often join them for meals. Two of the three service users who live at the home take responsibility for their own medication but stated that staff assisted them to visit the GP and order repeat prescriptions. All service users have single rooms with facilities to make drinks and snacks. Privacy is respected at all times and assistance is offered where appropriate, people said that they are free to determine how they spend their time and whom they socialise with. The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 6 The ethos of the home is very much about enabling people to retain their independence and individual routines whilst living in a supportive environment. All service users stated they felt comfortable to discuss any issues or raise any concerns with staff or the home-owners. The food is all home cooked by the carers/housekeepers. Fresh local produce is used when available and records show that a wide range of meals is served. All service users stated that the quality of the food was excellent and that the main meal of the day was always a pleasant social occasion served with drinks, including wine, of their choosing What has improved since the last inspection? What they could do better: The recruitment procedure in the home is poor and requirements in respect of this have been made at previous inspections but have not been acted upon. The inspector saw evidence that staff have at times begun work without two authenticated written references or with no Criminal Records Bureau or Protection of Vulnerable Adults check. A robust recruitment procedure must be followed in order to minimise the risk to service users. The fire officer toured the building and has made recommendations to improve fire safety. These include upgrading the smoke alarms to mains electricity with battery back up and providing a fire extinguisher suitable for electrical fires close to the stair lift. There is no evidence in the home that the portable electrical appliances have been tested within the last 12 months and a requirement has been made in respect of this. The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 4 & 5 The home is clear about the level of need that they are able to meet. Prospective service users and their representatives are able to visit The Manor House before making a decision to make it their home. EVIDENCE: The fees at the home range from £425.00 to £525.00 per week. The inspector saw contracts for each service user, which clearly set out the individual’s fees and state that the first month of any stay is a trial period for both the home and the service user. The home is very clear about the level of need that they are able to meet and not only assesses people prior to admission, but also within the first few weeks of a stay. There is limited staffing at the home and therefore service users need to be reasonably independent and physically able. Since the last inspection one new service user has moved to the home. The inspector was able to speak at length with this service user and examined personal information held by the home. The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 10 The service user and their representative had been able to visit the home prior to making a decision about moving in on a permanent basis. The personal file contained a pre admission assessment which not only gave details of care required but also outlined likes and dislikes and gave a brief personal history, including significant life events. The newest service user spoke extremely positively about the move and stated that they had received all the attention required in order to settle in and make it their home. The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 & 11. Service users are able to dictate how their care needs are met. Access to healthcare professionals is on an individual needs basis. The home assist service users to attend medical appointments. EVIDENCE: The inspector viewed the care records of all three service users currently living at the home. Each person has an assessment of need and an ongoing assessment, which is regularly up dated. Because of the nature and size of the home any changes in need are quickly noticed by the small staff team and responded to. Service users at the home are all able to voice their opinions about the way they wish their care to be carried out and all stated that they were comfortable to share their views with the staff and home owners. There is a policy on what to do in the event of a death and personal wishes are recorded in care plans. The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 12 Service users are registered with local GP’s and other appropriate healthcare professionals. Two comment cards were received from local professionals prior to this inspection. Both stated that they were always able to see their patient in private, that staff demonstrated a clear understanding of the needs of service users and that any specialist advice is incorporated into care plans. Service users stated that staff in the home assist them to attend medical appointments by providing transport and support. Two of the service users living in the home administer their own medication and appropriate documentation is in place in respect of this. The staff administer medication to the third service user. The service user stated that this had been at their request. Medication kept for this person is securely stored and records are kept of administrations. These records are basic but are adequate for the size of the home. Both comment cards received from health care professionals answered YES to the question “Is the service users medication appropriately managed in the home?” All rooms at the home are for single occupancy and all have full en suite facilities where personal care is carried out in private. Service users stated that their privacy is respected at all times. The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15. Service users are able to determine their own routines and retain control over their lives. The quality of food in the home is excellent and much enjoyed by all service users. EVIDENCE: The Manor House offers an opportunity for people to continue to be in control of their lives and make decisions about their daily routines. Any routines in the home are based on the wishes and preferences of service users. There are no set times to get up or go to bed and service users stated that they choose how they spend their day. There are no organised activities in the home and service users stated that they were fully aware of this before moving in. The home encourages people to continue to pursue their individual hobbies and interests. Transport is arranged to access local facilities such as shops, libraries and theatres. Two service users stated that the home owners provide transport for them to attend church on a regular basis. There are extensive grounds at the home which service users are able to access and one service user enjoys taking part in some gardening activity. The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 14 Service users are able to bring their own furniture and possessions with them. One service user stated that this was very important to them as it made their room their home. All rooms seen were very personal to the occupants, all have private phone lines. Service users spoken to stated that they are free to have visitors at any time. Refreshments are always provided and friends and families are often invited to have meals with the service users. As with every previous inspection of this home the service users were extremely complimentary about the food describing it as beautiful and excellent. All food is cooked on the premises by the care staff/housekeepers. There are no set menus in the home but all meals taken are recorded. Meals are prepared in line with service users requests and known likes and dislikes. The inspector viewed the record of meals and noted that there is a wide variety of meals. Fresh fruit and vegetables are available daily and the home uses local produce where available. The main meal of the day is at lunchtime and service users stated that this was an extremely sociable occasion. Drinks, including wine, are served with meals. One service user commented that the staff always made an effort to ensure that meals were to everyone’s taste and that a particular wine had been provided for them in line with their preference. There is a homely kitchen/diner, which is large enough to seat all service users and their guests. On the day of inspection the main meal was cottage pie and fresh vegetables followed by home-made chocolate roulade. Service users stated that they usually choose to eat breakfast and supper in their personal rooms. One person said that their daily paper was delivered to them with their breakfast. The two ground floor rooms have small kitchen areas and there is a kitchen on the first floor where service users can make drinks and snacks at any time. The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18. The staff recruitment procedure in the home is not robust and does not protect service users. EVIDENCE: The home has policies and procedures on recognising and reporting abuse. There is also a complaints procedure. Service users spoken to stated they would be comfortable to approach the owners or a member of staff if they had any concerns or worries. People felt that all concerns raised would be listened to and action taken. The inspector viewed the recruitment files and noted that Criminal Records Bureau checks had not been applied for before the person had commenced work. Neither had their name been checked against the Protection of Vulnerable Adults List. This has been a requirement of the previous two inspections. The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 23, 24, 25 & 26. The Manor House provides a pleasant homely environment. The facilities in the home are appropriate to the needs of the current service users. EVIDENCE: The Manor House is set in a rural location with extensive grounds. Service user accommodation is part of a larger dwelling, which is the residence of the owners. The inspector was able to tour the premises and spoke to each service user in their personal rooms. Service user accommodation is set over two floors with a stair lift between. Communal areas are located on the ground floor; there is a large kitchen/diner and a small sitting area. Two of the rooms have private lounges and all have The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 17 seating areas. The two ground floor rooms have direct access into the garden. All rooms have full en suite facilities that have been fitted with call bells. Service users currently living at the home have bought their own possessions and some items of furniture with them, this gives all rooms a very personal feel. There is a domestic style washer and drier in the kitchen, which is appropriate to the needs of the service users. All areas seen were clean and well maintained. Individual risk assessments have been completed for each service user in respect of hot water and hot surface temperatures. These risk assessments are contained within personal files. The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 The recruitment procedures in the home are poor and do not provide adequate protection for service users. The staffing levels in the home are reflective of the needs of the service user group. EVIDENCE: The home is very clear about the level of need that they are able to care for and the staffing levels in the home are reflective of this. Three staff are employed, one person lives on the premises. The owners Mr and Mrs Cavaghan-Pack, also work with the service users and provide on call back up. There are periods during the afternoon and evening when there are no staff based in the home but service users are able to summon assistance by using their call bell. One service user stated that there had been an occasion when they had needed to use their call bell and assistance arrived within seconds. Service users are made aware of the staffing levels before they move to the home. New staff work along existing staff when they commence work at the home. There is evidence in staff files of a basic induction that covers areas such as health and safety, policies, fire safety, current residents, complaints, medication and gifts. The staff contract clearly sets out the expectations on the The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 19 staff and issues of confidentiality. Staff spoken to stated that there is excellent communication between all staff and the owners. No new staff have been employed since the last inspection, however the inspector noted that a full enhanced Criminal Records Bureau check had still not been received in respect of one member of the staff team. The service users spoke very highly of all the staff who worked in the home and stated that they were happy to approach anyone as nothing ever seemed to be too much trouble for them. The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35 & 38. The management in the home is open and approachable. There are no formal quality assurance systems in place but service users views are sought on a regular basis. Improvements could be made to further minimise the risk of fire and enhance the safety of staff and service users. EVIDENCE: The registered manager of the home is Charis Cavaghan-Pack, but the home is very much run as a partnership between her and her husband. Both take on management and day to day care duties in the home. Neither have a formal qualification in care or management but they have owned the home for approximately tens years and therefore have considerable experience of working with older people. The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 21 Service users stated that both were extremely approachable and happy to assist at all times. Service users said that the home is run on family type ethos with all service users and staff encouraged to take part in any decision making. Both Mr and Mrs Cavagnhan-Pack were available throughout this inspection, both were welcoming and co-operative. There are no formal quality assurance systems in place in the home but all service users felt that this was unnecessary as they are frequently asked their opinions and views by staff and the home owners. The home does not take responsibility for any service user’s personal finances. All areas of the home are well maintained and Mr Cavaghan- Pack carries out monthly checks on the building including smoke detectors and hot water temperatures. The fire safety equipment was serviced by outside contractors on the 5th May 2005. The fire officer has made some recommendations to improve fire safety and the owners agreed to consider these. (These recommendations are outlined in the recommendations section of this report.) Staff record all accidents or untoward events in the home. Staff have received training in first aid and food hygiene. There is no evidence that electrical portable appliance testing has been carried out within the last 12 months. The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 4 COMPLAINTS AND PROTECTION 3 3 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 3 3 3 x 3 x x 2 The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 23 Are there any outstanding requirements from the last inspection? 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 18 & 29 Regulation 19(1)[b] Requirement A robust recruitment procedure must be followed in order to minimise the risks to service users. All staff must have two written references before commencing work and must have a Protection of Vulnerable Adults check and an enhanced Criminal Records Bureau check. Electrical portable appliances must be tested annually and records maintained. Timescale for action For all new staff. 2. 38 13(4) 30/06/05 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 38 Good Practice Recommendations A suitable number of mains operated self-contained smoke alarms with battery back up should be installed in line with specifications from the fire safety officer. A fire extinguisher suitable for electrical fires should be located close to the stair lift. The construction of the boiler room should be upgraded to provide a minimum of 30 minutes fire resistence. D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 24 The Manor House The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL 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 The Manor House D53 - D02 S16162 The Manor House V221552 240505 Stage 4.doc Version 1.30 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!