CARE HOMES FOR OLDER PEOPLE
The Manor House Care Home The Manor House Brook Street Sutton In Ashfield Mansfield Nottinghamshire NG17 1ES Lead Inspector
Stephen Benson Unannounced Inspection 4th April 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 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 Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Manor House Care Home Address The Manor House Brook Street Sutton In Ashfield Mansfield Nottinghamshire NG17 1ES 01623 554552 01623 554552 starryeyed1@ntlworld.com 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) Dr Sudaram Rai Dr Thambithurai Raj Chandran Janice Elaine Bather Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places The Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users shall be within category OP Date of last inspection 17/10/05 Brief Description of the Service: The Manor House is a care home providing personal care and accommodation for 25 older people. The home provides short term, long term and respite care and can accommodate emergency admissions. The home is owned by Dr Chandran and Dr Rai and is run as part of a small business. The home is located near the centre of Sutton in Ashfield close to shops, pubs, the post office and other amenities. The home was opened in 1997 and consists of an extended house. All of the homes bedrooms are single, and the majority of the bedrooms have en-suite facilities. Bedrooms are located on 2 floors and there is a passenger lift. There are gardens to the front of the property and a small car park to the rear. There is a ramped access to the front door and most areas of the home are accessible to wheelchair users. The home does not provide a structured programme of activities. The manager said on 21/04/06 that the fees for the service range from £277 £319 per week depending on dependency needs. There are additional charges for hairdressing and chiropody. The Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first visit to the home since 1st April 2006 by The Commission for Social Care Inspection. The inspection lasted for 4 ½ hours and the main method of inspection used was called case tracking which involved selecting 3 residents and tracking the care they receive through the checking of their records and discussing this with them. Additional records were seen and other residents were spoken with, however limited views were expressed by residents so some areas of this report do not reflect residents views. A discussion was had with staff on duty and care practices were observed. No relatives or other professionals were available to be spoken with. The premises were not inspected in detail but various areas of the home were visited as part of the inspection What the service does well: What has improved since the last inspection?
There were ten requirements set at the last inspection, three of which have been complied with. A second chair has been provided in a resident’s bedroom, staff have received training on safe working practices and the records showed that the hot water is being stored at a temperature above 60 degrees centigrade. The system for administering medication has been reviewed and there is now a second member of staff who witnesses each administration of medicine. Staff morale within the home has improved and they felt that the temporary manager has started to improve things within the home.
The Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 6 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 Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 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 Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New residents are assessed prior to admission to ensure their needs can be met within the home. The home does not provide an intermediate care service. EVIDENCE: There has been one resident admitted since the interim management team took over the running of the home in January 2006. The resident was assessed prior to admission and it was established that her needs could be met within the home. This placement has now been reviewed by Social Services and made permanent. The resident has said that she is very happy in the home. . The Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not all of the residents needs are set out in an individual plan of care. Poor record keeping prevents establishing whether healthcare needs are being fully met. The system for administering medication has been improved. Care practices promote residents’ privacy and dignity. EVIDENCE: A requirement was set at the last inspection to include ways of increasing choice in care plans, which has not been complied with and must be complied with to avoid enforcement action. Staff said that there has been work going on with care plans and a keyworker system had been introduced to provide oversight to plans and a system for them to be updated. A sample of three care plans were seen and these did not fully describe residents’ needs and how these are to be met. There were some entries seen that were inaccurate, for example referring to one resident walking with a frame who now requires a wheelchair. Care plans seen did not show signs of being reviewed and updated. There were requirements set at
The Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 10 the last inspection to include residents’ social arrangements in care plans and their comments on these. This has not been done in the care plans seen. Residents said that they had not been involved in discussions about their care plans. There are sheets within the care plan to record any medical appointments or visits. Those seen were not up to date and did not include details of recent chiropody or opticians appointments. Residents said that they had been visited by the chiropodist a few weeks ago and there was an entry confirming this in the diary, although no record of who received treatment. Residents said that the optician had recently visited the home and they had their eyes tested. One resident said that she was waiting for some new glasses to arrive. One resident was seen being pushed in a wheelchair without the use of footplates. This was bought to the attention of staff and footplates were seen being used after this. Appropriate lifting techniques were seen being used. A new system has been introduced for administering medication, which requires a second member of staff to witness every administration. Medication was observed being given out at lunchtime and residents were observed to take their medication. One resident requested a painkiller, however when she said that she would take it later she was asked to return the tablet and told she would be given one when she required it in line with recommended practice. Residents said that staff give them their medicine at mealtimes. Appropriate practices were observed in maintaining residents privacy and dignity whilst attending to their daily needs. Residents said they are happy with the support they receive and that they can have a bath when they want one. One resident raised concerns at being left for a long time when wanting to go to bed and the senior care on duty assured the resident she would pursue this to find out what happened. The Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are not sufficient opportunities provided for residents to take part in activities. Friends and relatives are welcome to visit. Residents are not well supported to exercise choice and control over their lives. An appealing diet has been provided despite disruption to the food ordering system. EVIDENCE: There were no activities taking place during the inspection and residents said they do sometimes have games organised and would like these to be more frequent. One resident proudly showed a blanket she had made but said this had been a long time ago. Staff said they sometimes play cards and bingo. Staff said that visitors are welcome at anytime and one visitor was seen coming into the home and spending time with a relative. . Some residents choose to spend their time in the upstairs lounge or in their rooms. Others make use of the main lounge and dining area. Residents are offered a choice of food at each mealtime and residents confirmed they had been offered a choice for today’s lunch of either roast lamb or sausage and onions.
The Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 12 A cooked breakfast is provided if wanted but the cook said that most prefer to have porridge. There is a four-week menu, which has not been used recently as the providers have tried to change the food ordering arrangements, however these were not successful resulting in a shortage of food within the home leaving the cooks having to prepare what they can. No record has been made of food provided during this period. The home has now returned to their previous suppliers and is building up food stocks again. The kitchen was clean and well organised and a new cooker has been provided as the previous one was condemned by Transco after a gas leak was detected. Residents said they were happy with the food and were seen to enjoy a well-presented lunch. The Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure is not being implemented properly which may leave residents at risk. Staff are aware of the procedures to protect residents from abuse. EVIDENCE: There is an outstanding requirement to make a record of all complaints received. There were no recent complaints recorded in the complaints book, despite several complaints being made during the changes in management at the end of 2005. Residents said they did not have any complaints. There was an allegation investigated by Social Services after the last inspection under the Adult Protection procedures, however this was not pursued after the initial interview as there was no evidence to substantiate the allegation. Staff spoken with were aware of the Adult protection Procedures and the home’s whistleblowing policy. The Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not maintained in line with the needs of residents. The home is kept clean and the laundry works efficiently. EVIDENCE: The building was clean and tidy and residents said they found it comfortable and nicely decorated. Requirements were set at the last two inspections to replace sagging and low chairs in the lounge, provide a new carpet in a bedroom and to provide a second chair in a resident’s bedroom, that have still not been complied with and the requirements are now immediate to ensure that residents live in a safe well maintained environment suitable to their needs. The management of the home do not have access to budgets for expenditures of this type. The laundry was well organised and there are systems for managing residents laundry. Residents said they thought the laundry system worked well and
The Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 15 their clothes were returned to them cleaned in good time. training on infection control. Staff have received The Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The absence of a full time registered manager means there are insufficient staff on duty. Information was not available to assess whether staff are suitably trained and competent to do their jobs. EVIDENCE: There were 2 care staff on duty to see to the needs of the residents. There was also 2 domestic and 2 catering staff on duty, however there was not a manager on duty, which meant that care staff were continually being interrupted from attending to residents to undertake office based activities which means that residents needs are not being sufficiently met. Staff on duty did not have access to the filing cabinet so were unable to show the staff training records and access to files is required. A check on staff files carried out on 21/11/05 established that there were some staff working within the home without a CRB check being undertaken. These were carried out following the issuing of a notice of immediate requirement. The Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The temporary manager is not able to discharge her responsibilities fully. Morale has improved with the home. There is no evidence of residents contributing to the running of the home. Financial arrangements are not suitable. Not all staff are being appropriately supervised. Residents’ interests are not being safeguarded through record keeping. EVIDENCE: Following the sudden departure of the registered manager in November 2005 the home has been managed through a series of interim management arrangements. Whilst this bought some stability to the home during a period of considerable disruption this has not provided the level of management cover required. The current arrangement is for a worker from another home to cover 30 hours a week with additional support from a consultant care manager and a consultant for administration, business and systems whilst a permanent
The Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 18 manager is recruited. The registered person must appoint a manager and provide details to The Commission for Social Care Inspection what steps have been made to recruit a manager. Although the home has not got the required management arrangements in place staff spoke positively at the improvements made during the period of the current temporary arrangements in particular regarding the morale within the home There was not any information available regarding any quality assurance or quality monitoring systems in use preventing this standard from being assessed. There is a system for the home to assist residents to look after their personal allowances, however this does not allow residents to have access to their money at any time and they were not available to be seen during this visit. There is an outstanding requirement to develop an induction for new staff, however this has not been done. There is also a requirement to provide staff with formal supervision. One record was seen showing that this had taken place, however these were not available for other staff. There were a number of standards that could not be inspected in part or in full as a result of records required to kept within the home not being available. There was a file available showing that the temperature of the hot water tank is being checked. The accident book is the correct type, however the pages are not being numbered as required. The fire records were not available to be inspected. The Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 1 X X X X 1 X 3 STAFFING Standard No Score 27 1 28 x 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 X X 2 1 2 2 The Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP7 OP7 Regulation 15 15 Requirement Care plans must be kept up to date and be regularly reviewed Include residents social needs in care plans and their comments on the plans REPEATED REQUIREMENT Consult with residents about activities and choice and provide more frequent opportunities for residents to take part in organised activities Ensure the health and welfare of residents by attaching footplates to wheelchairs when moving residents. Include ways of increasing opportunities for residents to exercise choice in care plans REPEATED REQUIREMENT Ensure that there are adequate food supplies available at all times and keep a record of all food provided The registered person must maintain records of all complaints received and the outcomes REPEATED REQUIREMENT Replace sagging and low chairs
DS0000008716.V288092.R01.S.doc Timescale for action 01/05/06 21/04/06 3 OP12 16 01/06/06 4 OP8 12 06/04/06 5 OP14 12 21/04/06 6 OP15 12 06/04/06 7 OP16 22 21/04/06 8 OP19 23 01/05/06
Page 21 The Manor House Care Home Version 5.1 9 OP24 16 10 11 12 13 14 15 16 17 OP27 OP31 OP31 OP35 OP36 OP36 OP37 OP38 18 8 S31 CSA 12 18 18 17 13 in the lounge REPEATED REQUIREMENT Provide a new carpet in room 21 and required furnishings unless there is good reason not to in which case record this in the care plan REPEATED REQUIREMENT Ensure there are sufficient staff on duty Recruit a manager for the home Staff must be employed in sufficient numbers to meet residents needs Residents must be able to access their personal allowances at any time they wish Develop a detailed induction for new staff REPEATED REQUIREMENT Provide staff with formal supervision REPEATED REQUIREMENT All required records must be kept within the home that are up to date and accessible at any time. Ensure the accident book is correctly completed 01/05/06 21/04/06 01/07/06 21/04/06 21/04/06 01/05/06 01/05/06 21/04/06 21/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Manor House Care Home DS0000008716.V288092.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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