CARE HOMES FOR OLDER PEOPLE
The Manor House 61 Manor Road Medomsley Consett DH8 6QW Lead Inspector
Gavin Purdon Announced 25 April 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 DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service The Manor House Address 61 Manor Road Medomsley Consett Co Durham DH8 6QW 01207 560099 01207 560099 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) Aimgo Limited Mrs M Mukherjee ( Acting Manager ) CRH 36 Category(ies) of OP Old age (21) registration, with number DE(E) Dementia - over 65 (15) of places The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: No additional conditions of registration. Date of last inspection 23 November 2004 Brief Description of the Service: The Manor House is a care home registered to provide care and accommodation for a total of 36 older people. This home includes a separate unit, The Margaret Suite, which provides care and accommodation for 15 older people with dementia. There is an emphasis on integrating the service users with dementia into the main part of the home. The Manor House is owned by a private company, Aimgo Limited, which has its address in Consett, County Durham. This is the only care home operated by this company. The home is located in Manor Road which is the main road through Medomsley in North West County Durham and is convenient for the limited local amenities of the village. The home was opened in 1990 and consists of a large and extended and adapted two storey building. All bedrooms are in single use. There is a passenger lift to the first floor. The home has extensive and pleasant gardens with fine views over the local countryside. The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on 25/4/05 and lasted exactly 6 hours. That time was mostly spent talking at length with 3 service users, the home’s acting manager, and 4 care staff. On this occasion, some of the building was seen by the inspector and some records were examined, but the bulk of this inspection went into 8 individual interviews covering service user, management, and care staff views of 14 standard areas where improvements had previously been required or recommended. The topics covered included admissions of service users to the home, planning for the care of service users, how satisfying the daily life of service users is, how much notice is taken of service users’ opinions, what service users think about the food, the staff, and how well they are cared for, what management and staff think about all of these matters and how well staff training, staff supervision and health and safety checks are going. The outcome of these interviews, which also took into account the written comments of 6 relatives, the content of 3 care plans, and the good state of repair and cleanliness of the home, was that considerable satisfaction was expressed about many of the areas discussed, as well as the recognition that other things need to improve. The direction and pace of improvement has been hampered by changes of manager and ongoing temporary management arrangements. Not all previous requirements and recommendations have been acted on but many have. The 2 outstanding requirements are long overdue and attending to them will help the home move on. The home is developing its own sense of purpose and its own plan for change. Not everyone is happy with how things are in the home at present, but there is a general expression of feeling that the home has its good points and that it is improving. What the service does well:
Admissions are well conducted. The home does try to ensure that it is the right choice for people who might be coming to live there. Admissions are based on
The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 Page 6 verbal and written information being shared by those concerned. Service users are very satisfied with their own personal experience of coming to live at the home. The staff are clear that admission is an important activity that has to be conducted in a competent and caring manner. The staff of the home are very highly thought of by service users and staff for their part have a close working relationship with the people they care for. The home is very welcoming to service users’ friends and relatives who come to visit. Service users feel safe and free to make their views and feelings known. Staff are committed to ensuring the well being and protection of service users. What has improved since the last inspection?
The design, content, and use of service user’s individual plans of care are much improved. The home’s management and staff agree on this and see them as the basis for further improvements to the delivery of good care. The home is showing some progress in building on its provision of good basic physical care in safe and pleasant surroundings, and is working towards providing more activities and stimulation for individual service users. There is a strong commitment to take this development further. Revised recruitment practices now ensure that staff who have been employed in care homes elsewhere have a new criminal record check and clearance before being employed at The Manor House, which helps give better protection to service users. Supervision arrangements for staff have improved and the new discussion style meetings are is seen as a success by management and staff. These allow for a useful exchange of ideas about how best to care for service users. The management team of the home has been strengthened with the important addition of a new senior member of staff. Temporary management arrangements are satisfactory the home would benefit more from a suitable permanent registered manager who can ensure that the improvements needed for the benefit of service users are carried through on a day to day basis. The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 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 DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 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) 1, 2, and 3. Prospective service users and their representatives are given the written and verbal information they need to make a decision about whether The Manor House will suit their needs. Service users have a written contract or terms and conditions document setting out the basic arrangements for providing their care and accommodation. Prospective service users have their needs assessed, and admission to the home will only be made if their needs can be met. EVIDENCE: The conduct of admissions, and the documents used to support that process were discussed in detail with 3 service users and with 2 senior members of the home’s care staff. The 3 service users spoken with were satisfied with the conduct of their admissions. Service user comments included, “A social worker found me the place. I came to have a look at the home and liked it.” “The home was recommended to my
The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 Page 10 daughter. It looked all right and the people were friendly. I was asked what I liked and the rules were explained.” “The son found me a place here and it’s a lot better than the way I was living.” The 2 senior members of care staff spoken with considered that admissions were well managed, and recently completed admission documentation was produced which confirmed this. The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 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 All service users have an individual plan of care based on a detailed assessment of health, personal, and social care needs. The home needs to do more work, where possible, to involve service users and their representatives with the care planning and review process. EVIDENCE: 3 care plans were examined. These were more readable, more detailed, and more comprehensive than at the time of the last inspection. The 4 care staff interviewed confirmed that care plans were used to direct the everyday care of service users. The 2 most senior care staff, and the acting manager, confirmed further improvements were intended in the drawing up and use of care plans. None of the 3 service users spoken to could confirm that they had a care plan, even when it was explained in a jargon free way what a care plan was. Comments included, “I don’t have a care plan.” “A care plan? No.” The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 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 standard(s) 12, 14, and 15. Some service users and relatives told the inspector they are satisfied with daily life in the home, others that they are less satisfied. In the interests of demonstrating that it does promote service user satisfaction, it is important that the home evaluates and records levels of service user satisfaction and actions taken to improve this. Not all service users spoken to by the inspector thought outside contacts are well maintained. Not all service users spoken with were satisfied with meals. Given the range of view points being expressed it is important that the home improve its methods of gathering, recording, and responding to service user views. This will defend the home from unfair criticism, put criticism into context and demonstrate that it does take action to promote satisfaction and identify and deal with the personal dissatisfaction of service users. EVIDENCE: 3 service users offered their views on daily life and social activities. These varied significantly.
The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 Page 13 “I like it, I am quite comfortable. I like to get up early. I see my daughter and granddaughter. We go shopping. The meals are very nice, but if you don’t like it you can have something else.” “Family can come in. The food is very good but you can get chicken two days running.” “There’s nothing much in the way of activities. There’s no choice of food. If there was a choice nobody told me about it. They are potato mad. I don’t call chicken soup and ice cream a meal.” Staff are very well thought of by the service users spoken with. Those staff spoken to thought that they worked hard to provide for the daily life and social activities of all service users. However, staff are not complacent, and expressed a commitment to plans for further developing the management delivery and evaluation of care. The 6 relatives who provided written comments expressed general satisfaction with the care provided, although some thought stimulation and recreational activities for service users could improve. The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 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 standard(s) 16,17, and 18. Service users, their visitors, and the staff of the home, are all confident that the home would deal properly with serious complaints, would protect service users from abuse, and uphold their rights. The home has a number of vulnerable service users without independent advisors to protect their interests. The home’s intention to improve its service by providing advocates for those service users without supporters who lack capacity to manage their own affairs will provide an important safeguard to vulnerable service users. EVIDENCE: The 3 service users spoken with confirmed their trust and confidence in the staff of the home. Comments included, “ I would be happy to speak to any member of staff. They are all pretty fair. Nobody ever need to be afraid in here.” 1 service user spoken with, who was interested in politics confirmed that they had been assisted to vote at the last election. Staff spoken with showed a strong commitment to protecting and ensuring the rights of service users. Since last inspection written guidance has been provided on the protection of service users from abuse. This was seen to be available in the home. The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 Page 15 None of the 6 relatives who provided written comments had felt it necessary to make a complaint. The home is interested in providing advocates for service users without supporters who are unable to attend to their own affairs. The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 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) None of these standards were looked at during this inspection. EVIDENCE: The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 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 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) 28 & 29 The management and staff of the home do work hard to ensure service users are in safe hands at all times. The home’s recruitment policies procedures and practices have improved and offer better protection to service users. EVIDENCE: Service users spoken with feel that they are in safe hands and that their carers can be trusted. The management team of the home are trying to ensure that the target of 50 trained members of staff with NVQ level 2 and that the home’s staff training programme is improved. Care staff spoken to confirmed that they were actively involved with NVQ 2 studies. A more recently recruited senior member of staff gave a positive account of their own experience of the recruitment process. Confirmation was provided by the acting manager that CRB checks are now completed before staff are employed. The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 Page 18 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) 33, 36 and 38. Arrangements for consulting with service users and relatives regarding how satisfied they are with the standards of care at the home need to be developed. Since the last inspection a better standard of supervision has been put into place. The discussion and evaluation of care practices will be of benefit to service users . Further strengthening of the management team, since last inspection, offers a better basis from which to promote and protect the health safety and welfare of service users. The temporary management arrangements of the home are acceptable as such but the appointment of a suitable permanent manager would put arrangements on a better footing. EVIDENCE: The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 Page 19 Discussion with service users, management and senior care staff of the home confirmed that improvement was necessary in how service user views were gathered and acted on. Management and care staff spoken with thought the “job chat” format devised and used for conducting and recording supervision in the home a good and worthwhile development. Staff and management valued this opportunity to exchange praise and criticism, discuss performance and plans for development. Each of the 2 care suites within the home now have their own senior staff to direct the day to day care within those suites, giving the home’s acting manager a better opportunity to concentrate on overall responsibilities of general health safety and welfare. Care staff spoken with confirmed that they had received health and Safety training, and the acting manager confirmed environmental risk assessments and arrangements for maintenance were in place. A microwave oven in the home had recently been identified as potentially dangerous and removed from service. The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 2
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 2 3 x x 2 x x 3 x 3 The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 Page 21 Are there any outstanding requirements from the last inspection? yes, but some have been actioned. 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 17 Regulation Requirement Timescale for action 1/10/05 2. 33 12, 14, 35 The registered person must consult with service users and their representatives to ensure that routines are not unecessarily rigid and restrictive. The home must act upon the wishes of service users. The use of advocates must be promoted where service users cannot voice their own views sufficiently well. (previous timescales of 1/8/04 and 1/4/05 unmet) 4, 5, 6, Effective quality assurance 14, 15, systems must be put in place, 17, 21, based on the views of service 22, 24 users and the stated aims and objectives of the home. (previous timescale of 1/8/04 and 1/4/05 unmet) 1/10/05 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 OP1, 2 Good Practice Recommendations The registered person should continue with the plan to make further good practice improvements to the
DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 Page 22 The Manor House 2. OP 28 Statement of Purpose, Terms and Conditions of admission as well as staff and service user records. The registered person should continue with the proposal to make further good practice recommendation to the training plan The Manor House DB54 S7513 The Manor House V 215726 250405 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection No 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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