Inspection on 18/03/08 for The Manor House, Frenchay

This inspection was carried out on 18th March 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Manor House, Frenchay 14/11/06

The Manor House, Frenchay 04/03/06

The Manor House, Frenchay 25/07/05

The Manor House, Frenchay 10/02/05

The Manor House, Frenchay 29/09/04

The Manor House, Frenchay 24/03/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 The Manor House Beckspool Road Frenchay South Glos BS16 1NT Lead Inspector Paula Cordell Key Unannounced Inspection 18th March 2008 09:30 The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 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 DS0000003354.V359047.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 Adults 18-65. 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 DS0000003354.V359047.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Manor House Address Beckspool Road Frenchay South Glos BS16 1NT 0117 9566424 0117 9566050 mclarke@themanorhouse.org 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) Mrs Marilyn Joan Clarke Ms Susan Dorothy Williams Care Home 32 Category(ies) of Learning disability (32), Physical disability (32) registration, with number of places The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 32 persons aged 18 - 64 years May accommodate up to four persons under 18 years of age Date of last inspection 14th November 2006 Brief Description of the Service: The Manor House is situated in a semi-rural location in Frenchay Village within close proximity to the M4 and Avon Ring Road. There are shops and facilities within a mile of the home. The Manor House is a large detached property that is divided into two units, Chestnut and Arandell, each with its own facilities including two lounges, a dining room and kitchenette. The home is registered to provide residential care and accommodation to 32 adults with a learning and physical disability. Presently the home has 23 people living there. Accommodation is on three floors. There is a lift, which is accessible for people with wheelchairs to access the first floor only. Over the last few years the home has been downsized to provide more single rooms with some having ensuite facilities. Several of the rooms have been modernised. The home provides some ground floor accommodation and a facility to enable four people to live as independently as possible. Equipment and beds to meet the needs of people with physical/mobility needs have also been provided. Manor House is one of three homes within the Manor House Organisation that provides for adults with learning disabilities and a further home is registered with OFSTED to provide respite care to children with a learning disability. There is also a day centre. Four of the services share the Manor House site. The registered manager is Mrs Sue Williams. The weekly fees at the time of publishing this report were in the region of £594 to £1,075. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced visit as part of a key inspection process. The purpose of the visit was to review the progress to the requirements from the visit conducted in November 2006. In addition to monitoring the quality of the care provided to the individuals living at The Manor House. There have been no additional visits between this visit and the visit conducted in November 2006. There has been one safeguarding referral made to the local authority and it was evident that the provider has worked closely with all concerned ensuring the continuing safety of the person. A further referral was made by the home in respect of an external service provided to one of the individuals further evidencing that home works closely with the appropriate professionals ensuring an open and transparent service is provided where the individual’s safety is paramount. Ensuring that safeguarding adult procedures are followed. During the site visit, the records were examined, a tour of the premises conducted and feedback sought from individuals living in The Manor House, the staff and the registered manager. Prior to the visit some time was spent examining documentation accumulated since the previous inspection, including correspondence and notified incidences in the home (Regulation 37’s). Feedback from relatives (11), staff (10) and individuals (23) and professionals (5) was received prior to the visit by comment cards that were sent to the home. The visit was conducted over six hours. What the service does well: There is a strong commitment from the provider to meet the National Minimum Standards and to develop the service based on current good practice. The provider has developed a three-year refurbishment plan, which ensures the home will meet the National Minimum Standards and provide all single bedrooms in two groups of ten individuals. Whilst the home is registered to provide accommodation to 32 persons, it was made clear that the home would not fill the 6 vacant places to enable individuals to have a single bedroom. The home has one double room. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 6 People receiving a service are evidently treated as individuals with an individual package of care. There is a strong commitment to provide a good quality service to the individuals. Many of the people have treated the Manor House as home for many years and are happy to continue in this view. However, there are some people that are working towards more independence. This is good practice. There is a strong commitment to ensuring that competent and trained staff support individuals. There are good systems for monitoring the quality of the service provision, appraising the service and developing their own action plans. It is evident that staff are informed of changing practices in the care field. What has improved since the last inspection? 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 DS0000003354.V359047.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals have sufficient information available to them make a decision on whether to move to the Manor House. Individuals can be confident in the assessment process ensuring their care needs are being met. Contracts would be enhanced if the cost of the service and who is responsible for paying this was documented which would ensure an open and transparent service. EVIDENCE: A statement of purpose and a service user guide was in place. These met with the requirements of the legislation. The manager was able to demonstrate that the statement of purpose had been kept under review. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 9 Twenty-three Comment cards were received from people living in the Manor House. All but four stated that they chose to move to the home and had sufficient information to enable them to make a decision on whether the Manor House was suitable. Four people could not remember or were unable to understand the question. One person stated that they like living at the Manor House. The age range of individuals living in the home varies. Many have lived in the home since it was a children’s home. The condition of registration of the home includes four persons under the age of eighteen. The manager stated that the youngest person accommodated is twenty-one. Presently there are no younger adults under eighteen. Individuals’ need assessments and care plans are written from a “person centred perspective” involving the individual and where relevant, relatives. Assessment information had been regularly reviewed and updated. The home has recently reviewed the assessment process and developed a tool that ensures that this is completed to a high standard. As part of the assessment process prospective persons coming into the service are allocated a link person to ensure consistency. This is good practice. This was evidenced in conversations with the manager, looking at the new documentation and described clearly in the annual quality assessment completed by the provider. Since the last visit the home has admitted one person to the home. Good evidence was provided that a comprehensive assessment had been completed that had informed the home’s plan of care. From talking with staff, the manager and the assistant manager it was evident that this was being kept under review. Many examples of the staff team demonstrating the capacity to meet the people’s specialised needs was seen through the home’s care planning processes and in conversations with staff. The Manor House is registered to accommodate and provide personal care for younger adults with a learning disability. It was evident from care records, discussions with staff and the individuals that several individuals also have complex physical, psychological and communication needs. There was evidence that the Community Learning Disability Team including the consultant psychiatrist and a behaviour team was supporting the home, staff and the individuals. This is seen as good practice and demonstrated a multi-disciplinary approach to the care of the individuals. Training will be discussed later. However, it was evident that the training was planned around the care needs of the people living in the home. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 10 Individuals have been supplied with written terms and conditions of residency that outlined the facilities and services to be provided, personal support offered, expectations and absences, and terms of contract. However, since the last visit the legislation has changed and more information is required in respect of the fees and who is responsible for paying them. The individuals, their representatives and the manager had signed these. The contracts were user friendly and included pictures and symbols. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be confident that their assessed care needs are being met and this determines the plan of care. Good systems are in place to monitor the effectiveness of the planning processes, which had been developed in response to this visit. Individuals are involved in the running of the care home and the planning of their care. EVIDENCE: Four care plans were looked at as a means of determining the processes the home goes through to support the individuals living at the Manor House. Care plans detailed the support needs of the individuals focusing on life skills and personal care. It was evident that these had been devised based on the assessment and care plan drawn up by the placing social worker and the home’s assessment processes. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 12 The care staff on a six monthly basis and an annual basis were reviewing care plans with the individual, their relatives and where relevant the professionals involved in the planning of the care. This met with the National Minimum Standards and the Care Homes Regulations. However, concerns were raised about an individual’s plan of care whose needs had changed due to the ageing process. The care plan seen was originally written in 2005 and did not fully capture the person’s changing care needs. It was evident from talking with staff that some different more complex behaviour was being exhibited and again these were not captured in the home’s care planning processes including risk assessments. Professional advice appeared not to be included in the plan of care, which could indicate that there was not a consistent approach. One member of staff was not aware of the individual’s plan in respect of their diet. The care plan did not offer the staff clear guidance and could be open to interpretation differently by members of the team. Monitoring of this care plan was not in place and the person had gained weight during the last six months, which could be an indication that this was not being followed. A meeting was conducted with the provider shortly after the visit to the service and it was evident that the above had been rectified. The new format for care planning was seen during the meeting and it was evident that this was more logical and had been amended to reflect the changing needs of the person. In addition staff had signed the new care plan and risk assessments that had been drawn up. The provider stated during the meeting that a new system of monitoring has been developed so that the manager, the provider and senior carers can be assured that the care plans for individuals are current. This is good practice and demonstrated that the home organisation was committed to ensuring a good standard of care was delivered to the individuals. The home records activities and general information about individuals in a daily handover report. Two individuals have a daily dairy and staff said that this was because one person was new, and this would assist with the care planning process and the other was due to changing needs of the individual. Information for both people was clear and written in a positive manner. However, concerns are raised in relation to all the information for the other people being recorded on the handover record in that this does not lend itself to person centred planning. In addition if one person wants to see what has been written about them this could breach the confidentiality of information for the other people living in the home. If each person had an individual diary this would assist with the reviews of the care plan and make retrieval of information more accessible. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 13 Care files have been expanded to include a history of each person, and information pertinent to the individual, which is person-centred, in a separate booklet. These documents identified the individual’s aspirations and listed goals that they wanted to achieve and how the staff would support this. The plan included photographs and it was evident that the person and where relevant their relative had been involved in the process. The work that has been undertaken is commended. Some of the more able people stated that they were actively encouraged to make decisions about their care and that they were in control. Care plans included an element of how individuals make decisions, including how an individual communicates their needs. Advice on issues of consent had been sought from professionals and recorded in the plan of care. This is good practice. Individuals were supported to be as independent as their abilities allowed. This was achieved through ensuring that daily living experiences were as normal as possible. An ethos that promoted independence and skills development planning was evident with the individuals living in the home. The Manor House has a self-contained flat for four people, to enable individuals more independence. From talking with the manager it was evident that where an individual expressed an interest to move to more independent living, this would be supported involving the person and their social worker. Communication seen between staff and people living at the Manor House was positive, appropriate and inclusive. Relationships were relaxed and friendly. Staff described how individuals with non-verbal communication were supported to make choices using gestures and staff observing facial expressions. Plans of care described the communication needs of individuals and the home has sought advice from speech therapists. Care plans included how staff should support with individuals “psychological” needs and how to respond if the person is distressed or angry. The home continues to work closely with professionals in supporting individuals who are challenging the service. It was evident that the staff had a good awareness of the individuals and were supporting in a positive way, to alleviate anxieties and stresses. Evidence was provided that individuals are regularly consulted on the running of the home. Meeting minutes provided evidence that these were taking place every two months. A variety of topics are discussed including likes and dislikes, important news about the home, holidays, food and activities. From talking with staff where an individual has expressed a choice either in respect of food or an activity this is supported. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 14 Individuals are involved in the quality audit and periodically complete questionnaires on the service that is provided. Two individuals expressed a need for a shower room and this was recently supported. Risk assessments were on file and covered a wide range of activities both in the home and the community. It was noted that some of these had not been reviewed and updated to meet the changing needs of one individual. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals have available to them a wide range of activities both in the home and the local community. It was evident that individuals are not discriminated against due to their disability and opportunities for every day activities and leisure pursuits are open to them. Individuals are encouraged to be as independent as possible. Individuals are supported to maintain contact with relatives and friends. Individuals have access to a healthy and varied diet, which takes into account the individuals preference. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 16 EVIDENCE: Individuals expressed high satisfaction levels in what they did both in the home and the community, both in person and via the comment cards sent to individuals prior to the site visit. Comments included “I can do what I want” and a number detailed their particular interests including shopping, going for walks and going to football matches. From care plans and discussions with staff and people living in the Manor House it was evident that individuals made choices on how to spend their time and with whom. In addition there was a commitment for individuals to be as independent as their abilities would allow. Some of the individuals look after their own finances and medication, whilst others may be encouraged to go out independently or make snacks and drinks for themselves. During the visit, individuals were being supported to access the local community with trips to the shops, support to attend their day centres and one individual was visited by a relative. Others were involved in arts and crafts. Staff stated that all individuals are supported to go out with their key worker on a one to one basis at least once a month as well as for group activities. The staff have access to a mini bus, a car and a people carrier to enable individuals living in the home to make full use of the community. Individuals contribute to the cost of the vehicles based on usage. This was not clearly documented in the contract of care. Individuals have structured day care, which is tailored to suit the individual, and included day centres, college courses and activities organised by the care staff. The home has recently negotiated additional funding to provide day care for five individuals throughout the week due to closure of one of the day centres. One individual stated that it was better than before although they did miss the day centre. A group of people in the home during lunch described the activities that were available which included going to the library, arts and crafts, and cooking and visiting places of interest. From talking with staff it was evident that the activities were tailored to the individual. The home has employed staff solely responsible for supporting the individuals with their day care. Staff said records are maintained of the activities and the support that each person has. These were not seen on this occasion. Staff stated that activities are organised in the home including arts and crafts, games evenings and cooking, to name a few. Evidence was provided that the individuals have theme nights for example Christmas Parties, birthday parties, discos and cinema evenings. Clear records were in place detailing the activity that had been undertaken through the month but what was lacking was records of how the individual had or not enjoyed the activity. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 17 In addition, individuals have access to Indian massage, an aromatherapist and a manicurist. Individuals are supported to attend church if they wish. One person said that they are supported to watch home matches at the Bristol City football ground and other people are supported to watch Bristol Rovers. Individuals are supported to have an annual holiday with the home or if individuals prefer day trips to places of interest. Holidays have included trips to Devon, Butlins and Blackpool and from talking with individuals it is evident that they have enjoyed their holidays. Holidays were evidently planned around the preferences and support needs of the people living at the Manor House. It was evident that the staff strived to give individuals normal life experiences and their disability did not deter and hinder opportunities being given. Care records included information about contacts with friends and relatives Individuals had photographs in their bedrooms of friends and relatives. Individuals described how they were supported to see family and had access to a telephone to enable them to maintain contact. One person stated that they go to see a parent on a weekly basis and the home provides the transport. Ten completed relative questionnaires confirmed that they were made welcome in the home and that they could see their relative in private and were kept informed of important matters. Comments included “excellent standards of hygiene in the home and the care of the people living in the home” and another stated, “I could think of nowhere else I would want my relative to live”. There was one area of concern raised by a relative, which was “the attention to the small details that make a person comfortable for example not having tight fitting trousers or shoes and staff should have more an awareness in these matters in respect of their relative”. However, the person went on to say that they were very satisfied with the care provided at the Manor House. Individuals have a varied and nutritious diet. From discussions it was evident that they enjoyed the food offered. This was discussed at house meetings and where requests have been made, these had been included in the menu. Individuals stated that they are asked on a daily basis what they would like and that there are always alternatives to the planned menu. On the day of the visit individuals were observed eating alternatives to the planned cooked meal including omelette, sandwiches, jacket potatoes and salad. Individuals stated that they could help themselves to drinks and snacks and there were fruit bowls strategically put in the dining rooms. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 18 Care plans included information sought from dieticians. However, a professional advised one individual to lose some weight there was no clear plan in place describing how this was to be achieved or how it should be monitored. The home completes a quality assurance audit on service provision, which includes seeking the views of individuals on the food that is available to them. This is good practice. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals’ health and personal care needs were being met. Individuals are protected by the home’s medication practices. EVIDENCE: Care plans clearly documented the personal and health care needs of the people living in the Manor House. The home was continuing to build on the health action plans for individuals. Systems for monitoring an individual’s wellbeing were in place and concerns about health were quickly addressed. Individuals had access to other health professionals including a GP, opticians, chiropody, dentist and the community learning disability team. It was difficult to navigate one person’s health care information due to letters and general information not being in date order. The manager was aware and was working with the key worker to address this. Staff have attended training in first aid and manual handling. The home has developed a comprehensive planner for training to ensure that periodic updates are undertaken. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 20 Plans of care included individual assessments for manual handling. Training for staff was in place. There were clear records detailing the personal care support needs of the individual and a daily record of care given. The home has an intimate care policy. The manager stated that new staff spend a period of supervised practice prior to supporting people with their intimate care, offering individuals living in the home protection and continuity of care. Staff assisted people in a good humoured and courteous manner, and the individuals had evidently built good relationships with staff. Staff on duty communicated among each other and worked well as a team. Daily activities were planned at a meeting in the morning and staff were allocated specific responsibilities during the shift. In addition staff have a comprehensive daily planner that ensures that staff complete key tasks on a daily basis. The home has robust procedures and practices on the administration of medication, including a comprehensive induction and training package for staff as seen at the last visit to the home. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals can be confident that their concerns would be responded to appropriately and taken seriously. One person’s behaviour is potentially putting individuals at harm however, it is evident that the home is working closely with professionals to ensure the person can continue to live at the Manor House, whilst ensuring the safety of others. EVIDENCE: The home has a robust complaints procedure in place. Individuals and relatives were confident that a complaint would be taken seriously and responded to in an appropriate manner. Information was gained from comment cards received prior to the visit from relatives and people who use the service. Where concerns had been raised they had been investigated and appropriate action taken involving the complainant. House meetings also covered concerns or complaints. The home has had three complaints since the last visit. Two have related to safeguarding issues, one in respect of a member of staff working in the home and the other a day care provider external to the home. The home has followed the local authority’s safeguarding procedures and worked with other professionals to resolve the issues. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 22 The third complaint related to concerns about personal care from a relative in respect of one individual. It was evident that a full investigation took place and an action plan drawn up to address the issues. It was evident that the home would take seriously any concerns and would take the appropriate action to address these. The home has procedures for the protection of individuals living in the home including safeguarding, bullying, anti-racism, financial, gifts and a whistle blowing policy. Staff were aware of the procedures to safeguard individuals. Training records provided evidence that staff have attended training on safeguarding. A person working within the organisation who has attended “train the trainer” completes this. Training records provided evidence that staff attend yearly updates on ‘Nonviolent Crisis Intervention’ and this was compulsory training for all staff. Staff stated that restraint is never used. Care plans where relevant, included information on what to do if an individual becomes angry or aggressive. However, for one person this requires updating where there have been significant changes to the individual. In addition it was noted from looking at the incident forms and the daily records maintained by the home that there has been a significant increase in one persons aggression towards other individuals living in the home and staff. The home has not reported this to the Commission for Social Care Inspection in respect of regulation 37. If this situation continues a safeguarding referral should be made. This was discussed with the provider shortly after the visit and it was evident that the home had addressed these shortfalls. The new care plan was seen and detailed the behaviours, the triggers and how staff should support them. In addition the home has been forwarding notifications of any aggression towards others. This will continue to be monitored by the Commission for Social Care Inspection. However, what was clear from the provider was that the organisation had a zero tolerance to bullying but this had to be balanced with the changing needs of the person with additional support being put in place to support the individual when they were known to become anxious. A visiting professional had clearly stated that “the Manor House should continue to be the person’s home and the individuals assessed and changing care needs were being met”. Records were maintained where individuals have become angry and these are discussed with the appropriate professionals including the consultant psychiatrist and psychology. It was evident that the staff supported individuals in a positive manner and not in a punitive way. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals live in a homely, comfortable and clean environment. The provider is planning to refurbish the home ensuring that the home meets the National Minimum Standards. EVIDENCE: The Manor House is situated in a semi-rural location in Frenchay Village within close proximity of the M4 and Avon Ring Road. There are shops and facilities within a mile of the home. The home is a large detached property that does not lend itself to providing an ordinary domestic style living environment, however the proprietors have addressed this by dividing the home into two sections. Chestnut and Arandell each with its own facilities shared communal space and staff teams although staff do also work across both sections to ensure continuity. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 24 Over time the home has “down sized” to provide more single room accommodation and some en-suite facilities have been added. Several rooms have been modernised and comfortably furnished to provide a homely feel. Accommodation is on three floors. There is a lift to the first floor, which is accessible to wheelchairs. The home provides some ground floor accommodation and a facility to enable four people to live semi-independently. Equipment and beds to meet the needs of individuals with physical and mobility needs has also been provided. The proprietors have developed a business plan to “down size” the Manor House further into two units of 10 and to ensure that all individuals have a single room over the next three years. There is only one double bedroom presently in the Manor House. No requirement has been made because the provider is planning to address this. From talking with staff the two people who continue to share have done so for a long time and are happy to continue to share until the refurbishment takes place. The home was clean and tidy and looked well maintained. This was confirmed in comment cards received from people who use the service who stated that the home is always clean. One comment card returned from a relative stated, “the home provides a relaxed and homely atmosphere”. Approximately half of the bedrooms were seen: these had been personalised by the occupier and were furnished to a good standard. Individuals had sufficient communal space, which was homely and comfortable. Individuals were seen relaxing both in the lounges and their bedrooms. There has been some refurbishment to the home since the last visit, which has included installing a shower room (a request made by people living in the home), the small kitchens in the dining areas and a bathroom. Since the last visit the main kitchen has been completely refurbished. The kitchen is fitted with industrial type equipment. This area was clean and well organised. The home has had an environmental health visit in October 2007 and has been given a five star rating. This is commendable. The home has appropriate aids and adaptations to support the individuals and the staff team ensuring and promoting independence according to the assessed needs of the individual. The home has a separate laundry facility and employs staff who complete the laundering of clothes and the domestic responsibilities in the home. The laundry area was not seen on this occasion. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient and competent staff support the people living at the Manor House. The home is not following safe recruitment practices with staff starting work without references. This could be putting individuals at risk. EVIDENCE: Evidence at this inspection was that the home had sufficient staff to meet the care needs of the people living at the Manor House. There was evidence that additional staff were rostered to provide individuals with opportunities to go out socially. The home employs a minimum of five staff during the day and one waking and two sleep in members of staff cover the nights on a daily basis. There was a senior carer on duty at all times. Senior carers were responsible for managing the shifts on a daily basis and administering the medication. It was evident from conversations with staff that individuals were clear about their roles and the expectations of the service. The roles have been developed further since the last visit, with clear guidelines and standards for the roles being developed. This is good practice. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 26 Staff spoken with during this inspection described a high level of job satisfaction. Staff described good support mechanisms in place from the manager and the provider enabling them to fulfil their role as carers. Training was in place including an action plan to address shortfalls and future need. This is good practice. This forms part of a quality audit and the home’s business plan identifying key targets for the year. All staff comment cards returned prior to the inspection confirmed good training and support networks in place. The home conducts an annual questionnaire seeking the views of the staff. It was evident that this again was used to improve the service. The manager stated that where concerns had been highlighted, for example paperwork, this was discussed in depth. It was evident that ideas were generated from the team as well as the individuals living in the home. Four staff were case tracked in respect of the recruitment processes adopted by the home. Three out of the four did not have the required references that must be in place. Two staff had no references. However, all other documentation was in place including a transcript of the interview, an application form and evidence that a check had been completed in respect of a criminal record bureau. The manager stated that it has been a busy time in relation to recruitment and this has been an oversight on her part. In the last twelve months nine staff have left, one member of staff was dismissed for poor communication with the people living in the home. However, this oversight could potentially put people living in the Manor House at risk. Again the provider gave reassurances that this would be addressed and action was being taking to address the lack of references. Once a member of staff is employed in the home, they complete a comprehensive induction after which they will proceed onto completing an NVQ 2 or 3 in care. Presently the home has achieved 45 of the workforce obtaining an NVQ in care with a further five staff in the process of completing this. It was evident that the home was planning to exceed the 50 target. There was a good rolling programme of mandatory training, which was being closely monitored, by the registered manager and the individual within the organisation responsible for organising the training. In addition the staff have attended training relevant to the care needs of the people living in the Manor House, including supporting individuals with autism, person centred planning and epilepsy to name a few. Records and conversations with staff confirmed this. Staff comment cards returned prior to the visit commended the commitment of the provider and the manager on the training that was available. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 27 The home has good communication systems in place including daily handover records, monthly one to one meetings with staff and the manager and monthly team meetings. Staff spoken with described good support networks and a commitment to working for the organisation and the home. Staff were seen during the visit supporting individuals in a positive manner. Staff were knowledgeable about their roles as carer and the care needs of the individuals living in the home. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good management arrangements are in place and individuals benefit from a well-managed service. The service is commended on the quality assurance initiatives that are in place that improve the service for the people that live in the Manor House. Individuals are assured their safety. EVIDENCE: Mrs Sue Williams is the registered manager and has been in post since April 2004. Mrs Williams is an experienced manager and has worked for the organisation for a number of years. Mrs Williams has completed the NVQ 4 Registered Manager’s Award. There was evidence that Mrs Williams attends regular training both in care and management. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 29 As noted at the last visit an open, relaxed atmosphere in the home with an emphasis upon providing individuals with a good standard of care and support and promoting an individual’s self worth and independence was in place. The home is commended on the quality assurance systems in place. Audits are completed on aspects of the home including seeking the views of the individuals that live in the home and the staff team. Relative feedback is sought through the care review process. In addition the provider completes a monthly audit on the home in respect of Regulation 26 of the Care Homes Regulations. Copies of these are held in the home and these are sent to the Commission for Social Care Inspection monthly. Health and safety in the home was monitored both by the manager and an Operational Health and Safety manager. Health and safety training for staff was in place to ensure that individuals are protected and supported by competent staff. A new training co-ordinator has recently been appointed and is completing an audit on training that is in place. Fire records were viewed and found to be satisfactory including the fire risk assessment. There were gaps in the fire training but the newly appointed training co-ordinator was devising a plan to address the shortfall. Three bolts bolt the front door. There could be a cause for concern that this could hinder staff in the case of a fire. Advice was given to the home to contact the fire brigade and to complete a fire risk assessment in relation to the use of the bolts. Good systems were in place for monitoring the health and safety of the people living in the home including checks on window restrictors and the home in general. In addition radiators were covered and the water had safety temperature valves fitted. The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 4 X X 3 X The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 31 No 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 YA5 Regulation 5A Requirement For the contracts to include the fees and who is responsible for paying them, including any additional costs. Ensure that care plans and risk assessments are current and based on the changing needs of individuals. New staff must only be employed subject to two references. To keep the Commission for Social Care Inspection informed of any incident that affects the wellbeing of people living in the home including all incidents of aggression. For the home to ensure that individual daily records are maintained ensuring that information is confidential. Timescale for action 18/06/08 2. YA6 15 (1) (2) 18/04/08 3. 4. YA34 YA23 17 (2) Sch 4 (6) (c) 37 (1) 18/03/08 18/03/08 5. YA6 12 (4) (a) 18/04/08 The Manor House DS0000003354.V359047.R01.S.doc Version 5.2 Page 32 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 DS0000003354.V359047.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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