Inspection on 28/10/08 for The Manor House Lynmouth

This inspection was carried out on 28th October 2008.

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

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 24/04/08

The Manor House Lynmouth 19/11/07

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 30/01/2009.

CARE HOMES FOR OLDER PEOPLE The Manor House Lynmouth The Manor House Lynmouth Devon EX35 6EN Lead Inspector Jo Walsh Unannounced Inspection 10:00 28 October 2008 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.V372867.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.V372867.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 753356 Mr Gordon Wilfred Watson Mrs Waltraut Charlotte Watson Vacant 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.V372867.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. 24th April 2008 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.V372867.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This is the second key inspection to take place this year. We also carried out a random inspection on the 16th September 2008. This was to check on compliance with requirements made from the first inspection. We are satisfied that the new manager has worked with the registered providers to ensure outstanding requirements have been or are being addressed. As this was the second key inspection we did not send out surveys prior to the inspection visit. We did ask the home to complete an Annual Quality Assurance Assessment (AQAA), which give us information about how the home ensures a safe environment and safe working practices. It also tells us what training, policies and procedures the home has in place to ensure that staff are competent and supported to do their job effectively. During this inspection most of the people who live at The Manor House were spoken to about their experiences of life in the home and their views are included in this report and have helped us to make judgements about the quality of care and support provided. We also spent time looking at some of the key documents including plans of care, staff files, medication records, staff rotas and menu plans. This helps us to gain a better understanding about how well the home is run. Since this inspection was completed we have been notified that the manager has now resigned. The registered providers have given assurances that they will seek to employ an interim manager and are currently seeking help from agencies. The registered providers are aware that in order for the service to remain rated as two stars they must have a registered manager in place. What the service does well: The Manor House provides people with a very clean homely and well maintained environment to live in. There are really nice touches such as fresh flowers around the home and bowls of fruit in the communal areas. The home is situated right on the sea front of Lynmouth and enjoys excellent views from the main lounge. People who live at The Manor House said • This is my home, you couldn’t ask for better • They keep the place very clean and tidy The Manor House Lynmouth DS0000070220.V372867.R01.S.doc Version 5.2 Page 6 • • Yes this is a nice place to live I enjoy watching people go by, we have the best position here. The home provides a good range and choice of meals taking into account individuals likes and dislikes as well as any special diets. The chef is fairly new to the home and is hoping to offer a larger range of meals each day. They always use fresh ingredients and meals offered are of a high standard. The care team is fairly small at present, but they have training and support to do their job effectively. Individuals are catered for in a caring and respectful way. Individuals who live at the home said ‘’ the staff are really good to us, they treat us very well, we are really well looked after.’’ The home ensures that they have robust recruitment processes in place so that people who live at The Manor are protected. What has improved since the last inspection? The home now has a manager in place who is experienced and competent She has been in post for just over two months and has already made improvements to ensure that they are meeting requirements. This includes introducing a clear plan of care that is easy to understand and gives carers a good understanding of the assessed needs of people and how they should meet these needs. This is a big improvement that will help to ensure that care is planned in a consistent way and in a way that is person cantered. The home have a new manager in post who has worked at the home for just over two months and has been able to effect good changes to ensure that they are meeting standards and requirements set during previous inspections. The manager is qualified and has a proven track record of managing other registered care homes, although not with older people. She now needs to complete the registration process so that she becomes the registered manager for the home and will then take on the legal responsibility for how the home is run. We are impressed with her commitment to making improvements in the home and she has been able to ensure that the rating has gone from poor to good, a two star service. The registered providers would not have been able to achieve this without her support, as they did not have the experience, knowledge or qualifications to manage the home. The manager has previous experience of managing care homes and is qualified to ensure that any potential new people to the service have a full needs assessment completed before they are admitted. Addition staff have been employed to replace staff that had left. The home now has a chief and cleaner as ancillary staff and additional carers are being interviewed and employed so that the home will be able to increase the number of people they admit from their current numbers. The Manor House Lynmouth DS0000070220.V372867.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Manor House Lynmouth DS0000070220.V372867.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.V372867.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential new people will have their needs assessed prior to moving in, to ensure that The Manor House are able to provide the care and support needed EVIDENCE: This standard was not directly inspected as following the last key inspection the home were advised not to take any new people as they did not have anyone qualified and competent to complete a full needs assessment. The home has not admitted any new people for over a year now. The new manager has experience and is qualified to ensure that the assessment process is robust, so that they can gain a good picture of an individuals needs and then make an informed decision about whether they could meet those needs. The Manor House Lynmouth DS0000070220.V372867.R01.S.doc Version 5.2 Page 10 The manager discussed how she would ensure this process is completed and has already started to make links with local teams from the funding authority and the community nurse team and GP practice. The Manor House Lynmouth DS0000070220.V372867.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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals’ health personal and social care needs are well met in a way that respects their dignity and right to privacy. Some improvements are needed to ensure that the medication system is fully robust. EVIDENCE: Six of the seven people living at The Manor were spoken to during the inspection. All said their personal and health care needs were well met. Some were able to say that care was delivered in a way that was respectful, and care practices observed during this inspection backed this up. Staff were seen to talk to individuals throughout the day, not just about care tasks, but making sure they were okay and having a general chat to them. Staff were also seen to offer support discretely, for example offering to cut up someone’s food. Three plans of care were looked at and these are now much clearer and give a good picture of individuals’ needs and how these needs should be met. Plans of care had been signed as agreed by the individual or their representative. The daily records also gave a better indication of how needs were being met. One The Manor House Lynmouth DS0000070220.V372867.R01.S.doc Version 5.2 Page 12 persons daily records for example showed that their medical needs were being met i.e. their legs were being creamed daily. Previously this might have been happening but it was not recorded. Plans of care give details about physical health, mobility, support needs in daily living skills and includes risk assessments. There is a clear record of what visits individuals have had and this shows us that their health care needs are being well met. Details include GP visits, chiropody and opticians visiting individuals. One person’s daily records showed staff were recording the individuals physical well being and request for GP visits. Records relating to care are now much clearer and this helps to ensure that care and support is delivered in a consistent and person centred way. The medication records were looked at and medications administered during the lunchtime period was observed. The home store and record medications well, the system is robust, but one area of concern was the number of tablets recorded as being found on the floor of individuals rooms, usually in the morning. The records of administration do not show any blanks or refusals of medication from individuals, so we must assume that some medications taken to individuals’ rooms is left for them to take and signed for as being administered without actually witnessing the medication being swallowed. This as a potential to put people at risk. The home needs to look at how practice can improve so that individuals are always properly supervised to take their medications. The Manor House Lynmouth DS0000070220.V372867.R01.S.doc Version 5.2 Page 13 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): 12-15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at The Manor House have choice and control in their lives and are enabled to stay in contact with family and friends. EVIDENCE: Staff spoken to said that they ensure that individuals routines and preferences for getting up and going to bed are supported and gave examples of individuals who preferred to get up later, have their breakfast later and others who liked to be up early, have a morning cup of tea in bed. Individuals who live at The Manor House said they could come and go as they please, one person said ‘’I go out with some local clubs and do a little bit of work here to help out so I am quite happy.’’ Another said ‘’yes you can have visitors when you like, my family are down this week and I very much hope to be well enough to go out with them on Thursday.’’ The manager said they are looking at ways they can ensure that individuals’ social needs are met, and said that the staff are able to do some activities in the afternoons and gave examples of staff doing quizzes, making some cakes and bingo. They are also looking at what individuals might be able to access outside of the home. They have recently received details of a social club being The Manor House Lynmouth DS0000070220.V372867.R01.S.doc Version 5.2 Page 14 run locally and will see if they can assist some people to attend. The manager would like to look at having more staff time dedicated to activities once they have been able to increase their numbers and looked at more realistic fees for the existing people funded by the local authority. A sign in the communal hallway says that visitors are welcome at anytime and the book for visitors to sign in shows that regular visits are made by individuals’ family and friends as well as the local community nurse team. The home have recently employed a new chef who is producing high quality meals and hopes to introduce more choice or individuals over the coming months. The chief said he is afforded a good budget and buys all local produce in fresh. The lunchtime meal was well presented and very tasty. People gave a high level of satisfaction for he meals. One person did comment hat they would like a weekly menu on the table so that they could easily make choices. This comment was passed onto the manager who said they were looking at ways they could have menu choices made more easily available to individuals. The Manor House Lynmouth DS0000070220.V372867.R01.S.doc Version 5.2 Page 15 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals’ views and concerns are listened to and acted upon. EVIDENCE: The home has a stated complaint procedure, which is posted in the hallway and copies given as part of the service users guide. The home need to make sure that the contact details for CSCI are amended to reflect the commission’s central contact address. People spoken to who live at the home were mostly confident that their concerns would be listened to. There have been no complaint issues since the last inspection and CSCI have had no further concerns raised by the community nurse team since the last inspection. The home has a robust recruitment process that ensures staff have all checks completed in order to protect residents. Staff have had training in looking out for abuse, and this is covered as part of induction. Records relating to individuals finances were not available for inspection as these are kept by the registered provider who was not available during this inspection. The Manor House Lynmouth DS0000070220.V372867.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manor House provides a clean homely and relatively safe environment for the people who live there. EVIDENCE: The Manor House has two lounge areas and a separate dinning room, which provides ample communal space. The rooms are made homely with fresh flowers and it is evident that ancillary staff work hard to keep the home clean and fresh smelling. The trip hazard identified during the last inspection has been clearly marked so people are aware of a change in gradient in one of the hallways. One issue identified during the previous inspections has not yet been resolved, which is the installation of a separate wand-washing sink in the laundry area. This has been due in part getting a tradesman to complete this work. The manager has assured us that this will be done as a priority. This will ensure The Manor House Lynmouth DS0000070220.V372867.R01.S.doc Version 5.2 Page 17 that infection control in not compromised. The home should also consult the clinical nurse specialist for infection control on best practices for dealing with the sluicing of commode pans. The Manor House Lynmouth DS0000070220.V372867.R01.S.doc Version 5.2 Page 18 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): 27-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff group are experienced and sufficiently trained and supported to ensure the needs of the people who live at the home are well met. EVIDENCE: The staffing levels are sufficient to ensure that the personal needs of the people who live at the home are met. Normally there is two staff on each morning shift and two for the afternoon staff with one waking night staff. The home also employs a cleaner five mornings per week and a chef six days per week. The manager will look to increase staffing levels and team numbers once they have been able to fill vacancies of people living at the home. They currently have a small core of staff who are able to cover the day shifts. The registered providers cover the waking nights and sleep in cover. Staff records show that staff have updated training in areas of health and safety to ensure they can do their job safely and effectively. The manager is looking at ways she can ensure that further NVQ training is available to all staff. The staff files of the two newest members of staff were seen and relevant checks and references had been taken up to ensure that individuals were suitable to work with vulnerable adults. The Manor House Lynmouth DS0000070220.V372867.R01.S.doc Version 5.2 Page 19 The Manor House Lynmouth DS0000070220.V372867.R01.S.doc Version 5.2 Page 20 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of the people who live there. EVIDENCE: The home have a new manager in post who has worked at the home for just over two months and has been able to effect good changes to ensure that they are meeting standards and requirements set during previous inspections. The manager is qualified and has a proven track record of managing other registered care homes, although not with older people. She now needs to complete the registration process so that she becomes the registered manager for the home and will then take on the legal responsibility for how the home is run. We are impressed with her commitment to making improvements in the home and she has been able to ensure that the rating has gone from poor to good, a two star service. The registered providers would not have been able to The Manor House Lynmouth DS0000070220.V372867.R01.S.doc Version 5.2 Page 21 achieve this without her support, as they did not have the experience, knowledge or qualifications to manage the home. Information provide by the home prior to the inspection shows that they have up to date policies and procedures in place for all safe working practices, staff have training in these areas to ensure both they and the people they support are safe. The manager showed us the induction programme she has introduced and this covers all areas as outlined in national guidance. She has also begun the process of ensuring that all staff are offered regular recorded one to one supervision sessions. This helps the staff group to understand their role and identify additional training. The manager now needs to look at how they can ensure that quality assurance fully involves the people who live at the home in reviewing the support and care offered. This process has begun with new surveys being given to individuals. The results of these now need to be collated and used to help inform the programme for any improvements. The Manor House Lynmouth DS0000070220.V372867.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X 3 3 The Manor House Lynmouth DS0000070220.V372867.R01.S.doc Version 5.2 Page 23 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 OP26 Regulation 13(3) Requirement The registered provider must ensure that suitable arrangements are in place to prevent infection. This relates to having a separate sluice for commode pans and separate hand washing facilities in the laundry area 9Previous date set for compliance 30/09/08) The home must ensure that all staff administering medications record only once they have witnessed medication being taken. Timescale for action 30/12/08 2 OP9 13(2) 30/12/08 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 OP16 Good Practice Recommendations That the home’s Complaints Procedure is amended to DS0000070220.V372867.R01.S.doc Version 5.2 Page 24 The Manor House Lynmouth include the Commissions new contact details 2. OP33 The registered person 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.V372867.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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