Inspection on 19/11/07 for The Manor House Lynmouth

This inspection was carried out on 19th November 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Manor House Lynmouth 05/10/09

The Manor House Lynmouth 28/10/08

The Manor House Lynmouth 24/04/08

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Manor House Lynmouth The Manor House Lynmouth Devon EX35 6EN Lead Inspector Andy Towse Key Unannounced Inspection 08:00 19 and 21st November 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Manor House Lynmouth DS0000070220.V352798.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Manor House Lynmouth Address The Manor House Lynmouth Devon EX35 6EN 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) 01598 752269 Mr Gordon Wilfred Watson Mrs Waltraut Charlotte Watson John James Smith Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 17. New ownership (6/6/07) Date of last inspection Brief Description of the Service: The Manor is a detached Georgian property situated in a secluded position, in its own grounds, overlooking the sea at Lynmouth. It is within easy access of the facilities of Lynmouth. It is registered to accommodate up to 17 elderly people. Accommodation is provided in 13 single occupancy and two double occupancy rooms. The fees for accommodation at this home range from £281.00 to £372.00 per week. Additional fees are levied for items such as chiropody, newspapers, hair dressing and toiletries. Copies of previous inspection reports are available at the home. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. It was conducted over two days. Prior to the inspection information about the running of the home was obtained by surveys which were forwarded to staff (including agency workers), and professionals involved with the home and latterly to people who reside there. This information was complemented by an Annual Quality Assurance (AQAA) form which was completed by the registered manager. This is the first inspection that the home has undergone since it was purchased by the present owners, although the registered manager had commenced managing the home under its previous ownership. The inspection comprised a site visit, when the premises were inspected. Time was spent talking to those who live at the home, staff, the registered manager and the owners. In addition, there was observation of staff interaction with the people who live at the home and examination of records, including care plans, policies and procedures, rotas and daily records. The following report contains the findings of this inspection. What the service does well: What has improved since the last inspection? Since the last inspection the new proprietors have commenced a programme of redecoration and refurbishment. This has included painting part of the exterior of the premises, recarpetting and redecorating bedrooms and replacing bedroom furniture. The new proprietors are also purchasing more items, such as bingo and quiz games which they hope to introduce in order to provide a more stimulating environment at the home. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 6 What they could do better: When pre-admission visits are made to prospective new residents a record should be kept of these including any assessment made. The registered manager needs to introduce an admissions procedure which can demonstrate that the needs of those who want to live there are properly assessed before decisions are made about admitting them. Care Plans need to be updated and thereafter reviewed at least each month or more frequently depending upon the changing needs of the person. Wherever possible the person living at the home should be involved in the compilation of their care plans and also involved at any reviews of these. The files of people living at the home should contain up to date risk assessments which are reviewed regularly and amended when appropriate. Inspection of the home’s medication procedure showed that medication was not always recorded appropriately, that instructions regarding changes in medication were not always recorded and staff had not received accredited training relating to the administration of medicines. Whilst staffing levels at the time of the inspection during the day were appropriate as there were only eight residents there is concern that night support has potentially left people at risk when there have been people with complex needs being supported by staff who were unfamiliar with the home and the needs of those who live there. Not all staff have participated on mandatory training courses. This has meant that staff without basic food hygiene qualifications have been preparing food and staff without moving and handling qualifications have been assisting people around the home. Communication systems are poor. The registered manager has not instigated regular formal supervision or staff meetings and there is no provision for hand overs between shifts in the rota. The management structure is unclear. The registered manager has not proceeded with his qualifying courses as he has been expected to undertake care duties rather than managerial ones. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is poor Records available at the home were unable to show that the home operates a consistent and thorough admissions procedure which ensures that only those whose needs can be met will be admitted to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection we were informed that there was only one person still resident at the home, who had been admitted to the home for long term care. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 10 This admission took place before the new owners were in charge of the home. The registered manager was responsible for managing the home at that time. He said that the previous owner had visited the prospective resident at their place of residence. The registered manager was unable to show any record of this visit having taken place, neither was there a pre admission assessment on the person’s file or other information to demonstrate how decisions had been taken regarding the suitability of this person to live at The Manor. In the previous inspection which took place on 6th. June 2007 it had been recommended that ‘the admissions process would be improved if records were kept of pre-admission assessments carried out by the home.’ The files of another person no longer resident at the home were examined. These did contain an assessment form which had been completed before the person was admitted to the home. The file also contained a care plan compiled by social services personnel which gave details of the person’s needs. This home does not offer intermediate care. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. Care Plans are not up to date and are not reviewed regularly. When advice is given by healthcare professionals, this may be included on files but there is rarely evidence that such advice is being carried out. Medication records were not maintained appropriately in the interests of the safety of those who live in the home. Medication procedures should be updated as some of those do not reflect changes in the procedures used at the home. Those living at the home considered that their privacy and dignity was respected. This judgement has been made using available evidence including a visit to this service. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 12 EVIDENCE: The files of five people who either were still living at The Manor or who had recently lived there were examined. One of the files belonging to a more recently admitted person did contain reference to the person’s needs in as much as it said the person needed to be ‘handled carefully’ due to their physical condition, but did not give any further instruction to qualify this in respect of moving and handling. The care plan record also referred to the person needing ‘one carer to assist with getting up, washing and dressing’ and ‘cream to be applied to legs morning and evening’. There was nothing written in the notes of this person to confirm that what was written in the care plan had been carried out. The file of a person admitted about six months previously was examined. Sections of the care plan headed ‘Weekly Routine’, ‘Resident Care Management Assessment’ and a section entitled ’Self-care skills’ had not been completed. Another person’s file, contained, in the care plan, instruction about support stockings which should be worn and instruction about cream being applied to this person’s legs at specified times. There was no record in the daily notes to confirm that these instructions relating to the person’s welfare had been carried out. We however spoke to the person, who confirmed that the instructions on the care plan had been complied with. A further file referred to the need for a person to do daily leg exercises designed by a physiotherapist and which needed the help of one carer. This entry was written on the person’s file approximately five months ago. We looked at this person’s file taking a sample time between 3rd. November and 14th. November. There were no entries on that person’s file to confirm that the person either had staff support in carrying out the exercises or whether they were carried out at all. Responses from staff to the pre inspection survey contained the comment, ‘lack of information is a big issue here. Care Plans and daily records are rarely kept up to date. We usually have to ask the district nurses about the care of the client so we are kept up to date.’ All care plans of those who had been resident at the home in January 2007 were reviewed then when the previous management ran the home. These reviews had not involved the person to whom they referred. Risk assessments had not been updated. One file contained a risk assessment which had been completed in July 2006; another had a client handling assessment which had been completed in May 2000, October 2000 and most recently November 2004. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 13 Records contained on care plans showed that there is considerable involvement in the home from healthcare professionals. Discussion with healthcare professionals suggests that those working at the home are not always clear about when it is appropriate to call on doctors or nurses and vice versa. The home still uses policies and procedures compiled by the previous owners. These have often not been updated for a considerable time. The medication procedures come from this category. There is a section which refers to homely remedies. We were informed that the home no longer uses any of these but the policies have not been updated to reflect this. Information contained in pre-inspection surveys and also obtained from discussion with staff gave instances when secondary dispensing was said to have occurred. The registered manager said that he had instructed staff not to engage in the secondary dispensing of medication and that he unaware that it was occurring. The administration of medication is recorded on Medication Administration Record (MAR) sheets. These are checked each week by the registered manager. They had yet to be checked on the week of the inspection, and when examined it was seen that some medication had not been signed for. In another instance a dosage of medication had been given which was double that of previous and later doses and did not correspond to what was written in the records. In discussion the registered manager said that this had been done under the verbal instruction of the doctor, although no evidence could be found to confirm this and the medication records had not been amended to show this change in instruction. In discussion staff said that they had received training which was ‘basically inhouse’ and had been carried out by the registered manager. The registered manager said that he had been shown how to administer medication at the previous home where he worked, by the pharmacist who supplied that home’s medication. A signed record is kept of medicines which are returned to the pharmacy. People who live at the home spoke positively about the care they received and the staff. One commented that they were ‘very nice people.’ Staff were observed knocking on bedroom doors before entering. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. Those who live in the home are satisfied with the level of care they receive. Those who live at The Manor can receive visitors whenever they wish. The new owners are introducing more activities for those who live in the home. Those who live at the home are satisfied with the choice and variety of food available This judgement has been made using available evidence including a visit to this service. EVIDENCE: We sat amongst the residents and spoke with and observed them. One period of time lasted approximately 45 minutes and another about half an hour. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 15 During these periods of time there was limited interaction between staff and residents and that which was observed was task oriented, such as a staff member accompanying a person to his/her seat and then leaving them there. We had later discussion with the owner regarding interaction with those who live at the home. During the time that we observed minimal interaction between staff and the people who live in the home, the two staff were in the staff room where one was writing up reports and the other was doing some clothes repairs. It was discussed that the latter’s work could be done sat in the lounge talking with those who live there and the importance of 1:1 interaction in offering care and support. Of the three residents observed, two were reading and a third was making a rug, later a video was put on in the lounge and four people were watching this whilst another was busy with a jigsaw puzzle. We spoke to people about activities within the home. One described themselves as ‘a loner’ who ‘enjoyed going out alone’. This person had their own telephone line and was independent enough to make their own dental appointments and see to their own affairs. Another, when asked about activities said that the new owners were, ‘just beginning to get there. We had a singer last week and someone is booked for Christmas.’ This person also said that the new owners were going to get in a bingo game. A further person said that they thought the new owner was ‘arranging things’ with regard to increasing entertainment and activities within the home. In discussion the new owners confirmed that they were trying to make the home a more stimulating place for those who live there and that they had already purchased a bingo game, a quiz game and a game called Connect 4 as well as a collection of 148 DVDs. The proprietors were also considering hiring transport to take people to a Christmas Market, there was also a visiting library and a singer had entertained those who live at the home the previous week. People said that they were able to get up when they wished. Bedrooms were seen to have been personalised, with people being able to bring with them pictures, items of a sentimental value and pieces of furniture. They also confirmed that they could have visitors whenever they wished, with one telling us of a relative visiting later that week to take them out for a meal, and another referred to a son visiting. We spoke with several residents regarding the food available at the home. We received a variety of responses. These included, ‘the food is`fabulous’, the meals are, ‘very nice, there is a choice, but l’m not a fussy person,’ to the ‘food is pretty good.’ Fresh fruit was seen in bowls around the home on both days of the inspection. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 16 The home operates a three-week rotating menu. This was seen to be varied. Whilst the menu did not show a choice, both staff and those who live at the home confirmed that alternative meals would be made available if requested. There was seen to be a choice of what to eat at tea time with staff asking people what they wanted to eat then. Likewise, there was seen to be a choice of food available at breakfast time. One meal time was observed. It was seen to be relaxed. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate The Manor has a complaints procedure which is displayed where those who live at the home, staff and any visitors can see it. It however needs amending to show timescales for responding to any complaints which are made. Whilst some of those who live at the home are aware of whom to complain to, others are not. It would be in the interests of those who live in the home to receive further information about who to complain to and how to make a complaint. Following recommendations in two previous reports the manager has now arranged for staff to receive training relating to the protection of vulnerable adults. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a written complaints procedure. This has been written by the new owners. A copy of this procedure has been placed in the entrance of the The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 18 home. This ensures that those who live at or visit the home are aware of their right to complain. The procedure needs amending so that it contains timescales relating to how complaint investigations will be carried out. Also in the entrance hallway is a small hard backed book in which complaints can be recorded. At the time of the inspection there were no entries in this book. Three of the people who live at the home were spoken to regarding who they would go to if they wanted to make a complaint. One said they would ‘go to Val [owner] or John [registered manager] if he was here’ another said they would ‘see the main lady if unhappy’ and the third said they ‘wouldn’t know who to go to to complain.’ We spoke with some members of staff. They were aware of what constituted abuse and what action they should take if they considered that it was occurring. It was recommended at both the inspection which took place on 6th.June 2007 and the inspection prior to that, that staff have ‘further training to ensure they are aware of what constitutes abuse and how it should be dealt with. During the course of this inspection the registered manager arranged training for the staff relating to the protection of vulnerable adults. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. The new owners have commenced a programme of refurbishment and redecoration which, when completed will improve the environment for those who live there. The home has a good standard of hygiene and cleanliness. This judgement has been made using available evidence including a visit to this service EVIDENCE: The Manor is a detached Georgian property situated within its own grounds overlooking the sea. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 20 Currently eight people reside there although it is registered to accommodate up to seventeen older people. Those who live there can access both floors by the use of a chair lift. This home does not have a passenger lift. All those who were living there at the time of the inspection were accommodated in single occupancy bedrooms. These were seen to be appropriately furnished. They had also been personalised by those who lived there by the addition of furnishings and pictures and ornaments of sentimental value. They were all satisfied with the physical environment at The Manor. Responses from staff to the pre inspection survey also made favourable comments when asked what the home did well. Such comments included, ‘comfy rooms with good views’ and ‘rooms are comfortable.’ In discussion, those who live at the home expressed satisfaction with their rooms and the physical environment in general. Whilst the home has not produced a programme of maintenance and renewal of the fabric and redecoration of the premises as recommended in the previous inspection, since taking over the home the new owners have carried out refurbishment and redecoration. This work has included the redecoration of the external entrance to the home. Internally they have recarpetted all of the unoccupied bedrooms and have commenced ordering new bedroom furnishings, including wardrobes, dressing tables and duvets some of which had arrived on the second day of the inspection. One of the bathrooms has been recarpetted and we were told, new carpets had been ordered for both the lounge and sun room. The owners are also considering upgrading two existing bathrooms and making them into wet rooms. This was discussed by the previous owners but never commenced. If this goes ahead the home will have bathing facilities which will benefit those who live in the home. Externally the home has a level garden area with gravel pathways. This is a pleasant recreational area overlooking the sea. One of the owners told us that it was their intention to make the garden more accessible to people by installing ramps and also by replacing the gravel pathways to make them more accessible to people in wheelchairs and walking frames. They also intend to build a patio and put up a canopy to make the area more pleasant and fitting for those who live in the home. A tour of the premises found no areas of malodour and an appropriate laundry area. Staff were asked about hygiene procedures and gave responses which showed these to be adequate. A response from a healthcare professional contained the comment that the home ‘appeared cleaner than it was’ and that The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 21 ‘the laundry appears to be done well’, another commented that the home was ‘cleaner than it was and seems warmer.’ The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. To ensure the safety and wellbeing of those who live at the home the registered manager must ensure that at all times there are staff on duty who have the experience and skills to meet the needs of those who live in the home. Since the last inspection the home has recruited staff using a procedure which safeguards the people who live at the home, however, not all the files of existing staff contain the necessary evidence to confirm their identity. To ensure staff deliver an appropriate standard of care and are familiar with how the home operates it is essential that the registered manager introduces an induction programme. To ensure the safety and well being of those who live at the home the registered manager must ensure that all staff receive mandatory training for the work they perform. This judgement has been made using available evidence including a visit to this service. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 23 EVIDENCE: Examination of rotas showed that this home has been reliant upon workers from three agencies. There are currently four permanent care staff working at the home and one of the proprietors also does care and other duties within the home as well as being on call every night. The use of agency workers means that there is a lack of continuity of care as this results in a coming and going of different staff, who may have limited or no knowledge of the people who live in the home, compared with a home which has a stable staff group who are familiar with the home and the needs of those who reside there. At the time of the inspection most of the eight who currently live at the home were physically able and several were very independent. This meant that the staffing levels seen during the inspection were appropriate to meet their needs. Records did however show that on evenings the home only has one wakeful carer. This person has frequently been an agency worker, most likely unfamiliar with the home or those who reside there. This person is supported by one of the owners who although having no previous experience of residential care and who has yet to undertake the mandatory training expected of carers, is on call. As this home had until recently, three residents with complex needs, these staffing levels could have potentially put those who resided at the home at risk. Of the four permanent staff, two have attained NVQ 2, which is the recognised qualification for care workers. At the last inspection on 6th. June 2007 the registered manager was reported as ‘being aware that staff had not received the level of training they should’ with future training including ‘in-house manual handling’ planned. On the day of that inspection fire safety training was taking place, however, in the five months since that training staff have not received further training. However a course in Moving and Handling is scheduled for the end of November and during the inspection the registered manager made arrangements for staff to receive training relating to the protection of vulnerable adults. Discussion with staff doing care duties combined with inspection of files showed that at the time of the inspection not all staff involved with the preparation of food had completed basic food hygiene courses and another did not have evidence on file to show that they had completed a Moving and Handling course. Night support is provided by one wakeful night care assistant who can obtain support from one of the owners who is on call every night. Records and responses from surveys showed that agency staff, who had no previous knowledge of the home, were regularly doing night duty. On occasion, when The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 24 this occurred, there were several people with complex needs. The proprietor who was on call has no previous experience of working in residential care. Responses from staff showed that they did not consider they had appropriate support especially considering the lack of formal induction and the rotas showing that agency staff often worked alone at night, being in a home of which they were not familiar and residents whom they did not know. There has only been one permanent member of staff recruited since the last inspection. This person’s file was inspected in order to assess the home’s recruitment policy. It was found that this person’s file contained the appropriate police checks and that checks had been made to confirm that this person’s name had not been placed on the Protection of Vulnerable Adults (POVA) register. Appropriate written references were on file as were items to confirm the identity of the person. Examination of other staff records showed that one staff member did not have the items on file to confirm their identity as required, however this person had been recruited prior to the current registered manager being in post. We discussed the issue of staff induction with the registered manager. There was conflicting responses to the surveys regarding this with one respondent saying it was the best induction they had ever had through to staff saying they had had no induction and had just been left to get on with the job. One staff member said,’ I was not given a very good induction on starting day l was given a quick introduction to clients and look around the building then left to get on by myself,’ another wrote, ‘no real induction’. A member of staff spoke about being introduced to those who lived at the home and being shadowed by more experienced staff after commencing work. The registered manager confirmed that, as was stated in the inspection report of the inspection of 6th. June 2007, there is still no formal induction available. He had however got information regarding induction from the Mulberry group, which was entitled, ‘Developing Competent Carers’. He intends to use this to produce a formal induction programme. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is poor. The registered manager should complete the training required of someone managing a care home. The home lacks a clear management structure. The home would benefit from the registered manager updating the Quality Assurance System to include open-ended questions which would obtain more relevant information from which to develop the service offered by the home. The registered manager could run a more effective home if he introduced better support and communication systems such as regular formal supervision, regular staff meetings and formal hand over sessions between shifts. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 26 Records examined show that the home is maintained in a way which protects the safety of those who live there in respect of their physical environment, however, the absence of appropriate induction programmes and some staff not having received mandatory training in subjects such as Moving and Handling and Basic Food Hygiene could compromise the safety of those who live and work in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has yet to complete his NVQ 4 qualification or commence his Registered Manager’s Award. In discussion he explained that due to staff shortages he had been doing care work. This had meant that he hadn’t had time to do managerial work. He had been doing work for his NVQ 4 however his assessor had been unable to continue assessing him as he his pre occupation with care work had meant there was no or limited managerial work for the assessor to evaluate. Records showed that the manager had been in discussion with the owners since September 2007 regarding him not being a ‘hands on’ carer all the time and the need for him to commence management duties so that he could pursue his NVQ 4 assessment. The registered manager said that he had now agreed with the proprietors that he would have time to do managerial work within the home. He intended to resume his NVQ 4 training which he anticipated he would complete by Christmas 2007 or January 2008 and he intended commencing his Registered Manager’s Award in April 2007. The registered manager does not have access to IT facilities within the home. This means that he cannot access information about the running of a care home unless he uses his home computer. He informed us that he has used his home computer for receiving information such as POVA First responses for staff and for downloading and printing information required by the home. This has necessitated him working from home in addition to the hours he works on rota at the home. Discussion with the providers and the registered manager did not provide us with evidence of clear lines of accountability within the home. There appears to be an expectation that the manager will also continue to offer hands on care, with the owners not being clear about the responsibilities the registered manager has legally. The registered manager also has duties as a retained fire officer. This means that he can at times be called out which may conflict with his duty to manage The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 27 the home. In discussion he said that he had only been called out ‘about four times’ since becoming registered manager. He maintains that the call outs have only been for brief periods of time and have not conflicted with his duty of care. Responses from staff surveys suggest that this is not the perception of staff, some of whom have reported being left alone on duty when the registered manager has responded to a call out by the fire service. There was limited evidence at this inspection that the registered manager had taken action to address issues raised during the previous inspection. Recommendations at that inspection included the creation of a management approach which creates an open, positive and inclusive atmosphere, which referred to the lack of meetings and poor communication between the management and staff, that the registered manager ensured that all new staff receive an appropriate and recorded induction, that care staff receive regular, formal and recorded supervision and that he sets out a schedule to enable him to achieve the changes he wants to put into place to ensure the effective running of the home. We discussed the home’s Quality Assurance system with the registered manager. He was able to show us that he had distributed surveys to people who live at the home on 22nd October 2007. These were the surveys written by the previous owners and related to a choice of meals and to other issues such as entertainment, diet and standard of care. These surveys comprised questions which were not open ended. This had been discussed at previous inspections as such questioning does not encourage broad ranging responses which would be of benefit in a service which wants to incorporate the views of its users in it’s development. The home only holds money on behalf of one person who resides there. Wherever possible receipts are retained to confirm expenditure. The registered manager said that at the time of the inspection the home was not holding any valuables on behalf of people who live in the home. We discussed the issue of supervision with the registered manager. He said that currently staff did not receive formal supervision. He said that he had talked to staff about their ‘futures’ but had not logged anything down about it. He said that he had downloaded information from the Mulberry group about supervision and that he intended to start supervision, ‘sometime this week.’ When asked about staff meetings which would improve communication within the home, the registered manager said that no meetings had been held since he took over responsibility for the home. Responses from staff to the pre inspection survey reflected poor communications within the home with comments such as,’ never had meetings with manager—get information from other sources, have to make decisions for ourselves when manager is off duty’, and, ‘this is the main problem, no training or support. Expected to be a mind reader, No communications’ or ‘one staff meeting in two years’ to ‘he is an auxiliary fireman so can get called out at any time so on my own.’ The issue of The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 28 poor communication within the home was mentioned in the previous report, including reference to no formal hand over meetings between shifts, an absence of formal supervision and staff meetings. There has been no improvement in this situation since the last inspection. Responses from Healthcare professionals refer to poor communication with the home, and concern that ‘no-one is suitably qualified and informed to know when to seek help’ with other comments such as the home being ‘less organised’, ‘inexperienced staff’ and a manager regarded as not being supportive. From surveys received from people who work at the home comments were made about poor handover sessions between shifts. At the time of the inspection there was no time allocated on the rotas for hand over meetings between shifts, when information could be discussed relating to peoples’ needs which would benefit the delivery of care. This was discussed with both the registered manager and the owners. There is a hand over form which is completed at the end of each shift however this does not contain anything to confirm that staff have taken the time to read it. The registered manager said that the home has a fire risk assessment. He also produced a Fire Safety Audit which had been carried out by Devon and Somerset Fire and Rescue Service in June 2007. Documentation was produced to show that the electrical installations within the home had been safety tested during 2007 as had portable electrical appliances within the home. The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 1 X 2 The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 18(1)(c) Requirement As required from previous inspection: The registered person shall ensure that persons employed to work at the care home receive training appropriate to the work they perform. (This refers to staff feeling uncertain about the training they received regarding medication administration and also errors in the recording of administered medication) As required from previous 2 inspections: The registered person shall maintain in the care home the records specified in Schedule 4 (this refers to the forms of identity required when recruiting staff.) The registered person should keep care plans under review, revise the care plan and notify the person of any changes in their care plan. Timescale for action 31/01/08 2 OP29 17(2) 31/12/07 3 OP7 15(2) 31/12/07 The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 31 4 OP27 18(1)(a) 5 OP30 18 (c) 6 OP31 10 7 OP36 18(2) The registered manager must ensure that the home is staffed by suitably qualified, competent and experienced persons at all time, relevant to the numbers and needs of those who are residing in the home. The registered manager must ensure that those working at the home receive training appropriate to the work they perform. This refers to staff assisting people when they do not have Moving and Handling training or assisting in the preparation of food when they do not have the Basic Food Hygiene qualification. The registered manager shall undertake such training as is appropriate to ensure that he has the skills and experience for carrying on the care home. The registered person shall ensure that persons working at the care home are appropriately supervised. 31/12/07 31/01/08 31/01/08 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations When the registered manager visits a potential resident, this visit should be recorded together with any information which can be used to assess the person’s suitability to be admitted to the home Those living at the home would benefit from being involved in the compilation of their care plans. That the home’s Complaints Procedure is amended to include timescales for the investigation of complaints 2 3 OP7 OP16 The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 32 4 OP16 5 OP33 It would be beneficial if the registered manager could ensure that all those who reside at The Manor were made aware of how to make a complaint and whom they could complain to. The registered manager could develop the Quality Assurance System by using open ended questions in order to obtain more relevant information for those who use the service and other stakeholders The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. Extracts may not be used or reproduced without the express permission of CSCI The Manor House Lynmouth DS0000070220.V352798.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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