Inspection on 25/07/05 for The Manor House, Frenchay

This inspection was carried out on 25th July 2005.

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

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

Other inspections for this house

The Manor House, Frenchay 18/03/08

The Manor House, Frenchay 14/11/06

The Manor House, Frenchay 04/03/06

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 Announced 25-26 July 2005 09:30 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Manor House Address Beckspool Road Frenchay South Glos BS16 1NT 0117 9566424 0117 9566050 mailbox@themanorhouse.org Mrs Marilyn Joan Clarke 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) Ms Susan Dorothy Williams Care Home for Younger Adults 32 Category(ies) of LD Learning disability for 32 registration, with number PD Physical disability for 32 of places The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 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 10th February 2005 Announced 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 home is registered to provide residential care and accommodation to 32 adults with a learning and physical disability. Presently the home has 25 residents. The Manor House is a large detached property that is divided into two units Chestnut and Arandel each with its own facilities including two lounges, a dining room and kitchenette. Accomodation is on three floors. There is a lift which is accessible to wheelchairs to the first floor only. Over the last few years the home has been down sized 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 residents to live as independently as possible. Equipment and beds to meet the needs of residents 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 the Commission for Social Care Inspection to provide respite care to children with a learning disability and there is a day centre. Four of the services share the Manor House site. The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection following the visit in February 2005. The purpose of the visit was to review the progress to the requirements and recommendations made at that inspection and to monitor the quality of the care provided to the individuals living in the Manor House. There have been no additional visits during this period. The home has been keeping the Commission for Social Care Inspection informed of incidents that affect the wellbeing of the individuals living at the Manor House and the provider has sent monthly appraisals of the service. This information was used to plan the inspection process. The inspection was conducted over two days a total of 12.5 hours. The inspector had an opportunity to meet with most of the residents, four members of staff and the manager. The methodology used during this inspection included viewing care records and other relevant documents required of a care home and a tour of the home. Residents were actively encouraged to participate in the process by the staff on duty. The inspector received four relatives and two professional questionnaires and the pre-inspection questionnaire completed by the manager. The inspector would like to take this opportunity to thank the team and the residents for their welcome and their assistance in the inspection process. What the service does well: There is a strong commitment from the provider in meeting the National Minimum Standards and developing the service based on current good practice. The provider has submitted a three-year refurbishment plan, which ensures the home will meet the National Minimum Standards and provide all single bedrooms in two distinct groups of ten individuals. Whilst the home is registered to provide accommodation to 32 persons it was clear that the home would not fill the 6 vacant places to enable individuals to have their own bedroom and not share with another. The home has three double rooms with a long-term plan for these to be singles. Residents are evidently treated as individuals with an individual package of care. The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 6 There is a strong commitment to provide a quality service to the individuals. Many of the residents have treated the Manor House as home for many years and are happy. However, there are some that are working towards more independence. This is good practice. There is a strong commitment to ensuring that staff are supported by competent and trained staff. What has improved since the last inspection? There were six requirements from the last inspection and four recommendations. The home has demonstrated a commitment to meet the requirements however, there are two that remain outstanding but evidence was provided that the home was trying to meet these requirements. One relates to the premises and the other a review of risk assessments. Since the last inspection the home has amended the statement of purpose to include information about the accommodation and the minimum staffing levels enabling residents and relatives to have further information about the home. Whilst the home has devised a review sheet for the risk assessments and many had been reviewed there are still some that have not been reviewed in the last twelve months. The provider has sent a refurbishment plan for the Manor House to the Commission for Social Care Inspection. This plan includes down sizing the Manor House to provide two units, ten people in each unit. All rooms will have single occupancy with ensuite facilities. The plan is for this to be completed within three years and will commence after the refurbishment of BeckHouse which will accommodate some of the residents from the Manor House. The home has developed a plan to ensure that all staff attend training on the protection of vulnerable adults. Whilst this is not within the timescale of August 2005 the training co-ordinator stated that only two staff are permitted to attend the training organised by South Gloucestershire Council at one time so to ensure all staff attend, the last two staff will attend in February 2006. In the interim this is discussed with staff during induction and a video is made available on what constitutes abuse and how to respond. The training coordinator stated that the operations manager has attended a course on ‘training the trainer’ and will complete training with staff. The home has demonstrated a commitment to meeting this requirement. Records relating to individual staff are now kept in the home and available for inspection. The home has demonstrated a commitment to meeting the recommendations and the manager has signed the contracts of care and reviewed how food is The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 7 prepared and served to the individuals once delivered to the dining areas from the kitchen and there was a clear record of who attended the care review meetings with minutes kept. What they could do better: The Manor House is a large home registered to provide accommodation and personal care to 32 residents. The proprietor had developed a plan to refurbish the home to provide accommodation for twenty residents into two groups of 10. There is a strong commitment from the organisation to meet the National Minimum Standards and current good practice for supporting individuals with a learning disability. There are seven requirements and three recommendations from this inspection. Residents would benefit from plans of care and their risk assessments being reviewed at least every six months and being involved in the process. The home must ensure that the process of care reviews is clearly documented in the statement of purpose. Residents with mobility issues would benefit from their wheelchairs being cleaned at regularly intervals. Residents should have clear documentation in care files that describes why restrictions are imposed on them and the affect that this could have on the other individuals living in the home. Where environmental restraints or bedsides are used a third party consent must be obtained demonstrating a multi-agency approach. This information must be kept under review clearly describing the reasons and the decision process for the chosen intervention. Residents must have an individual record of medication including any short course prescriptions. Residents must be protected by thorough recruitment practices. The home must ensure that there are two references obtained for all new employees including one from their last employment. Good practice recommendations are as follows. The manager to sign all the risk assessments demonstrating that she has overall responsibility for these. Residents would benefit from a review of the administration of medication in Chestnut to ensure that this is person led rather than custom and practice. Residents and staff would benefit from having a medication profile which details information about the medication that people are taking including the The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 8 reasons, side affects and the support that is required to assist with the safe administration. In addition residents would benefit from the statement of purpose and the service user guide being more accessible to individuals living in the home. 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 D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 9 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 Standards Statutory Requirements Identified During the Inspection The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,5 Residents have information to make an informed decision on whether to move to the Manor House. Residents assessed care needs were being met. EVIDENCE: The home has a statement of purpose, service user guide and contracts of care. These met with the requirements of the legislation. However the statement of purpose states that if a person is unhappy with the way a complaint has been dealt with they can contact the National Care Standards Commission however, this is now the Commission for Social Care Inspection and the document must be amended. In addition the statement of purpose states that care reviews would be every twelve months where the National Minimum Standard state that these should be no more than six monthly. Care reviews will be further discussed in the next section. The manager stated that the home has yet to respond to a recommendation for the service user guide to include photographs and pictures to assist individuals who may have reading difficulties and make the information more accessible. The inspector saw many examples of the staff team demonstrating the capacity to meet the residents’ specialised needs. The Manor House is registered to accommodate and provide personal care for younger adults with The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 11 a learning disability. It was evident from care records, discussions with staff and residents 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 individuals living in the home. Residents had been supplied with written terms and conditions of residency that outlined the facilities and services to be provided, personal support offered, financial arrangements, expectations and absences and terms of contract. Residents, their representatives and the manager had signed these. The contracts were user friendly and included pictures and symbols. The inspector reviewed three of the five standards and the home has demonstrated a good understanding to the legislation. The other two standards had not been assessed on this occasion these have been assessed as met on previous inspections. The home has not had a new admission since 1996. However, the manager demonstrated a good understanding of the admission process and this was clearly documented in the statement of purpose. The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9,10 Residents’ needs were being met however plans of care and risk assessments were not being reviewed in accordance with the National Minimum Standards. Individuals were being supported to make decisions about how they wanted to live and involved in all aspects of life in the home in varying degrees based on the individual’s ability. EVIDENCE: The inspector viewed six residents’ plans of care, four from Chestnut and two from Arandell the two units within the Manor House. Plans of care seen were person centred and clearly described the support needs of the individual. Four of the plans of care seen had not been reviewed in the last six months and where reviews had taken place this had only included a date on the plan with no staff signature. Plans had been written in some cases over five years ago and had not had any amendments in that five-year period whilst others had comments documented on the side of the initial plan of care. It would be advisable for these to be rewritten to ensure that information is clear and less confusing. The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 13 The statement of purpose stated that residents would be involved in an annual review with their relatives and other professionals where appropriate. There was no reference to the National Minimum Standard in respect of six monthly reviews by the care staff. Whilst some records included a formal review detailing who attended and what was discussed this had not automatically been used to update the plan of care. The National Minimum Standards clearly states that plans of care should be reviewed a minimum of six monthly or more frequent where care needs are more complex. Some of the more able residents stated that they were actively encouraged to make decisions about their care and that they were in control. Care plans included an element on how individuals make decisions including documenting 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. Residents were supported to be as independent as their limitations allowed. This was achieved through ensuring that residents daily living experiences were as normal as possible an ethos that promoted independence and skills development planning with the individuals living in the home. Communication seen between staff and residents was positive, appropriate and inclusive. Relationships were relaxed and friendly. Staff described how residents 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. Residents told the inspector that meetings are held regularly and lots of things are discussed including holidays and food. Minutes were kept of the meetings. The minutes were accessible and included pictures and diagrams. Residents spoken with described how they were involved in the décor of their bedrooms, menu planning, leisure and social activities and visiting relatives. Residents are involved in the quality audit and recently completed a questionnaire on the service that was provided. Evidence was provided that where an issue had been raised this was being addressed via the care planning process. One resident has a plan of care detailing their involvement in the recruitment of staff. However, the manager stated that residents are only involved in the informal interview when prospective employees visit the home and the formal interview is conducted with the manager and the provider. Risk assessments were on file and covered a wide range of activities both in the home and the community. Whilst many of these had been reviewed there were still two thirds that had not been formally reviewed in the last twelve The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 14 months. It is recommended that the manager and the provider sign these. Some of the risk assessments imposed restrictions on residents the information lacked the reasons for the action. These included the use of bedsides, stair gates or double handled doors. The only justification for the action was to keep the individual safe. These restrictions must be reviewed and more information included on the decision process and how this affects others living in the home. Where restraining measures or restrictions are imposed for example the double door handles and the bedsides consent must be sought from the individual, a relative or an independent professional. Information was held securely. Staff were aware of the need to maintain confidentiality and the home has a policy on confidentiality and data protection. The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,16,17 Residents are encouraged to lead full and active lifestyles. The menu was healthy and varied. However, records must be available to demonstrate that a choice of food is available. Residents are encouraged and supported to maintain contact with friends and family. EVIDENCE: Residents expressed high satisfaction levels in what they did both in the home and the community. From care plans and discussions with staff and residents 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. A resident described how they looked after they personal allowance and chose what they wanted to spend their money on and others were supported to look after their own medication, another person stated that they did they own laundry in a training kitchen. Staff described how they were The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 16 supporting an individual to move to more independent living and how other professionals were involved in the assessment process. The age range of individuals living in the home varied and many had 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 resident had recently celebrated their eighteenth birthday. Presently there are no residents under eighteen and that this condition of registration could be removed as the plan is for the home to cater for adults over the age of 18. The provider is advised to write to the Commission for Social Care Inspection. The inspector observed individuals being supported to access the local community with trips to the shops, walks on the common, a small group went out to a café and one person went ten pin bowling. 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. Residents have structured day care which was tailored to suit the individual and included day centres, college courses and a couple were supported by the staff in the home. Staff stated that activities are organised in the home including arts and crafts, games evenings and cooking, to name a few. Residents were happy to discuss their planned holidays and it was evident that where residents had attended that this had been an enjoyable experience. Photographs were seen of a recent holiday to Euro-Disney. Another individual had been supported to go to Lapland. From conversations with staff this had taken a lot of organising due to the individual’s physical disability. 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. Staff stated that contact varied and many relatives were actively involved in fund raising for the home and supported fetes, parties and other social gatherings. Residents had photographs in their bedrooms of friends and relatives. Residents described how they were supported to see family and had access to a telephone to enable them to maintain contact. Four 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 residents” and another stated that “the relative is very happy living in the Manor House”. The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 17 Residents have a varied and nutritious diet. From discussions it was evident that they enjoyed the food and that this was discussed at residents meetings and where requests have been made these had been included in the menu. The record of food lacked information supporting that a choice was provided. The home must maintain an actual record of food available to individuals. Residents stated that they are asked on a daily basis what they would like and that there are always alternatives to the planned menu. This was supported with a list that the cook was working from on the day of the inspection. The inspector was invited to participate in the lunchtime meal, which was relaxed with staff and residents eating together. Staff supported residents sensitively. There was available tuna pie with vegetables, salad and jacket potatoes and sandwiches. The meal was tasty. Residents stated that they could help themselves to drinks and snacks and there were fruit bowls strategically put in the dining rooms. Care plans included information sought from dieticians. The home has demonstrated that they have partially met all the standards in this range, however the home must maintain a record of the actual food available which would further evidence that residents are given choices on what they want to eat. The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20,21 Residents’ health and personal care needs were being met. Systems are in place for the administration of medication. However, records must be kept for each individual and the individual should determine the practice of administration of medication. EVIDENCE: Care plans clearly documented the personal and health care needs of the residents. Systems for monitoring an individual’s wellbeing were in place and concerns about health were quickly addressed. Residents had access to other health professionals including a GP, opticians, chiropody, dentist and the community learning disability team. The doctor visits the home on a weekly basis. The manager stated that good links had been built with the surgery. There were clear records for monitoring epilepsy and evidence of staff training on epilepsy and the administration of rectal diazepam. The training coordinator stated that this is updated annually and a session is being organised for new staff and a refresher for existing staff. The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 19 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. 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. Staff confirmed the home’s policy that female staff supports female residents. The manager stated that new staff spend a period of supervised practice prior to supporting residents with their intimate care, offering individuals living in the home protection. The home has robust procedures and practices on the administration of medication, including a comprehensive induction and training package for staff. However, it was noted that short-term medication for all the residents was written on one medication record collectively in addition to the individual record of regular medication. All residents must have an individual record. A profile of medication was not available detailing what the medication was for, the side effects or the contra-indications. Whilst information on how individuals prefer to take their medication was in the plan of care it would be advisable that this was kept with the medication record. A member of staff stated that all residents in Chestnuts take their medication either crushed or with yoghurt. This was documented and discussed with the doctor and the pharmacist in accordance with the guidelines. However, the inspector was concerned that all residents had their medication by this method. The home should review the practice to ensure that it is not custom and practice and to ensure that it is individually led. All staff spoken with stated that residents are told that they are taking their medication and it is never done in a covert way. The inspector advises that the administration is reviewed. The home has a policy for staff to follow in the event of a death of a resident and care plans included the wishes of the individual in the event of death. This included consulting with relatives where relevant. The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Residents are protected by robust procedures on making complaints and ensuring that they are protected from abuse. This will be further enhanced when all staff have attended training in the protection of vulnerable adults. EVIDENCE: The home has a robust complaints procedure in place. Residents and relatives were confident that a complaint would be taken seriously and responded to in an appropriate manner. Information was gained from relative questionnaires and through discussion with residents. Where concerns had been raised this had been investigated and appropriate action taken involving the complainant. Residents meetings also covered concerns or complaints. These included the actions to discuss the concerns raised. The home has procedures for the protection of individuals living in the home including an abuse, bullying, anti-racism, financial, gifts and a whistle blowing policy. Staff were aware of the procedures to safeguard residents. There was a strong awareness of the individuals’ rights. There was a requirement for the home to ensure that staff undertake training in prevention of abuse. Training was being arranged by the Organisation and a senior manager has attended a ‘training the trainer’ course on abuse. The plan is for this to be cascaded to all staff over the next six months. The timescale for this requirement has been extended to enable the home to comply. 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. The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 21 Records were maintained where residents 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. Finances were checked. These were found to be satisfactory and safeguards were in place to protect the individual’s monies including regular checks, receipts and two staff signatures. The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) all Manor house though large in appearance is homely, clean and comfortable. 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 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. 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 residents to live semiThe Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 23 independently. Equipment and beds to meet the needs of residents with physical and mobility needs has also been provided. The home has continued to provide planned respite to a small number of residents who have used this service for a number of years. The provider stated that whilst this is being offered in the short term, this would be subject to a review in the next twelve months. The home has included in the statement of purpose information about the respite care service and the two bedrooms that have been made available for this purpose. The home does not offer separate facilities and persons staying in the home for short-term care live with the other residents. The proprietors have developed a business plan to down size the Manor House further into two units of 10 and to ensure that all residents have a single room over the next three years. Planning permission for the extensive building work has been agreed. There are three double bedrooms presently in the Manor House. The home was clean and tidy and looked well maintained. There were number of taps that were dripping and this was recorded in the repair book. Evidence was provided that repairs were responded to promptly. The home addressed the requirements from the previous inspection except the cubicle style toilets, which should be made more private and domestic in style. The manager stated that this would be addressed in the building plans for the home. Two thirds of the bedrooms were seen these had been personalised by the occupier and were furnished to a satisfactory standard. Residents had sufficient communal space, which was homely and comfortable. Residents were seen relaxing both in the lounges and their bedrooms. 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 inspector noted that three of the wheelchairs were dirty and required cleaning. The home has a separate laundry facility and employs staff who complete the laundering of clothes and the domestic responsibilities in the home. This area was well organised and clothes appeared to be well laundered. The home is working towards a plan to ensure that it meets the National Minimum Standards in relation to the environment. This has included consultation with the Commission for Social Care Inspection on the standards and a plan of works to be undertaken has been submitted to address the shortfalls. The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 24 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 Competent and sufficient staff support residents, however the home failed to demonstrate that recruitment practices protect individuals. EVIDENCE: Evidence at this inspection was that the home had sufficient staff to meet the care needs of the residents living at the Manor House. There was evidence that additional staff were rostered to provide residents opportunities to go out socially. The home employs a minimum of five staff (from the rota the home was aiming for seven 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. Job descriptions were in place to guide staff. 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. The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 25 This is good practice. This forms part of a quality audit and the home’s business plan identifying key targets for the year. Staff recruitment did not include all the checks required under legislation to ensure residents are protected. One member of staff has worked in the home for the last eight months with only one reference having been received and another member of staff had two references but one was from employment over six years ago. 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. The staff have attended training relevant to the care needs of the residents including supporting residents with autism, person centred planning and epilepsy to name a few. Records and conversations with staff confirmed this. 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. From discussions it was evident that a large number of staff have worked in the home for many years and they described how the home has changed, progressed and moved with the times to provide a quality service to the individuals living in the home. Staff were seen during the inspection supporting residents in a positive manner. Staff were knowledgeable about their roles as carer and the care needs of the individuals living in the home. A member of staff was aware of the General Social Care Council Code of Conduct and stated that this is given as part of the induction process. Copies were seen in staff training files. The staff are issued with handbooks covering many of the key policies and the philosophy of the home. This is commendable. The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 26 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,41,42,43 Residents live in a safe environment and benefit from a well-managed service. 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 inspector observed an open, relaxed atmosphere in the home with an emphasis upon providing residents with a good standard of care and support and promoting an individual’s self worth and independence. It was evident that the aims and objectives of the home were known by staff and formed part of their day-to-day roles within the home. Staff spoke The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 27 positively about the management of the home both from the manager and the proprietor. The home is commended on the quality assurance systems in place ensuring that the Manor House provides a quality service. Audits were completed on aspects of the home including seeking the views of the residents and their relatives. In addition the provider completes a monthly audit on the home in respect of the Care Homes Regulations. The Commission for Social Care Inspection is receiving copies. 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 residents are protected and supported by competent staff. Fire records were viewed and found to be satisfactory including the fire risk assessment. A fire officer has inspected the home and records indicated that the visit was satisfactory. The home has had a recent environmental health officer visit. Areas identified included providing fly screens to the window and the inspector would recommend the door, as this was open on the day of the inspection and for the worktops and dry storage to be painted. Evidence was provided that this was being addressed. There were a number of generic risk assessments on the environment, household and care activities and accessing the community. The home has an extensive policy file to guide staff and support the residents. It was evident that the residents were the focus of the policies. The home has recently reviewed a significant number of the policies. A recommendation would be to ensure that the information relating to the Commission for Social Care Inspection is correct. All records examined at this inspection were well ordered and up to date with the exception of care plan and risk assessment reviews, in addition references for staff must be obtained prior to offering employment. This inspection did not focus on the financial viability of the home. There was no evidence that the financial viability of the service was threatened in any way. The organisation has a business plan. The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 28 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x 3 x 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 2 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 2 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Manor House Score 3 3 2 2 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 3 3 D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 29 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 6,9 Regulation 15 (2) Requirement Care plans and risk assessments to be kept under review at least six monthly. To include who was involved in the review process. (Outstanding 1/6/05) Review the use of stair gates and double door handles including how this restricts others and to document the reasons. Restraint used in the home such as bedsides, double door handles to be kept under review. This must include the reasons and consent sought from a representative or the individual concerned where possible. A medication record must be maintained for each individual. Two references must be obtained for new employees including one from their last employment. Wheelchairs to be kept clean. For all staff to complete training in the protection of Vunerable Adults (still within the timescale 30/8/05 and extended) Timescale for action 26/12/05 2. 9,23 13 (6) 26/8/05 3. 9,23 13 (6) 26/8/05 4. 5. 6. 7. 20 34 29 23 13 17 (2) Schedule 4.6 23 (2) 13 (6) 26/7/05 26/7/05 26/7/05 26/12/05 The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 30 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. 2. Refer to Standard 9 20 Good Practice Recommendations For the manager to sign the risk assessments. The home to review the medicaton administration in Chestnuts re all residents taking medication with yoghurt to ensure that it is resident led. Individual guidelines on how each individual prefers to take their medication to be kept with the medicaton record. For each individual to have a medication profile on what the medication is for, side effects and contra-indicatons. For the statement of purpose and the service user guide to include photographs and symbols, or be made available in an audio format to make more accessible to residents who may not be able to read it. 3. 4. 20 1 The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 31 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Manor House D56 D05 S3354 The Manor House V229468 25260805 Stage 4.doc Version 1.30 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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