Inspection on 05/10/09 for The Manor House Lynmouth

This inspection was carried out on 5th October 2009.

CQC found this care home to be providing an Poor 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 28/10/08

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 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Manor House Lynmouth The Manor House Lynmouth Devon EX35 6EN Lead Inspector Jo Walsh Key Unannounced Inspection 09:00 5 and 6th October 2009 th DS0000070220.V377605.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Manor House Lynmouth DS0000070220.V377605.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 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.V377605.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. 28th October 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 £295 to £395.00 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.V377605.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 0 stars. This means the people who use this service experience poor quality outcomes. This is primarily due to the fact that the home currently does not have a registered manager in place and the registered providers do not have sufficient knowledge, skills or qualifications to manage the home. This key inspection was completed instead of an annual service review as we had received a number of complaints and concerns which are being investigated as part of a wider safeguarding process. We wanted to assure ourselves that people were not at risk and reassess the quality outcomes for people by looking at all the key standards in light of various concerns raised. We had also been made aware that the home had no manager, the manager who was in the process of registering with CQC, left at short notice. The owners have stated that they were aware that the manager would not stay ‘indefinitely’ We did complete a random inspection on the 30th June 2009, to check on compliance of previous requirements set and also to see how well the home was being managed as they still had no registered manager in place. During this inspection we were informed that a new manager was in the process of applying to be the registered manager. She had completed her NVQ4 in care and appeared to be keeping plans of care up to date, ensuring staff training and supervision was in place and that quality outcomes for people were good. At this time, more staff appeared to be employed and a real effort had been made to look at activities and how best to engage the people who live in the home. We did note that they had been offering respite to someone who was outside of their category i.e. someone with dementia and whose primary condition was not old age. We highlighted in this random inspection report that the home must not admit any new people to the service whose primary need fell outside of their registration category. We also made a requirement for the home to ensure that controlled drugs were stored safely in a controlled drugs cabinet that complies with regulations. This key inspection was completed over two days, during the first day the regional pharmacist advisor looked at medication records and practice and on the second day two inspectors looked at the environment, key documents such as assessments, plans of care, staff rotas and menus. We also spent some time talking to people who live at the home and to staff. Prior to the inspection taking place, we sent surveys to people living at the home, and 4 out of 7 were returned. Their views and those given during face to face interviews are included in the main body of the report. The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.2 Page 6 We asked the home to complete an Annual Quality Assurance Assessment, which is something all homes are required to complete each year to help us assess how they continue to meet regulations and National Minimum standards. This was not returned when required, but the owners have since sent it to us. What the service does well: The Manor House provides people with a spacious and homely environment that has lovely views over the village of Lynmouth and towards the sea. People who currently live at the home say that they enjoy the position of the home. Some of the staff have worked with the current people living at the home for some years. They have built up a good rapport and appear to provide care and support in a kind and respectful way. The home provides a good choice and variety of meals, taking into consideration individual likes and dislikes. What has improved since the last inspection? The registered provider has installed a separate hand washing sink in the laundry area, to help with the prevention of cross infection. Staff training has continued and includes all staff having completed or completing National Vocational Training (NVQ) 2 in care, as well as care health and safety areas such as moving and handling and first aid. Surveys to help the service improve its quality have been completed and include more open ended questions to help gain a better view point of people receiving a service at the home. This was a recommendation from the last key inspection. The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.2 Page 7 What they could do better: The home has no registered manager in post and despite two candidates being in post and making good progress in getting the home to meet requirements, both left at short notice and there is no one qualified or competent in post to ensure effective running and management of the home. The registered providers must look urgently to employ a qualified and experienced manager. The registered providers have worked hard to make improvements and are currently providing many of the care hours, including having to work day shifts, waking nights and further day shifts. This can not be sustained for long periods, as it has been. Working long hours with little or no sleep can lead to mistakes and errors being made and can potentially place people at risk. The registered provides must look to employ further staff so that the rota can be covered more realistically. They must also ensure that a fully completed rota is available in the home at all times. They currently do not put down who is covering the waking nights, although we were able to track that most of these nights were covered by Mr Watson the provider, by checking individuals’ daily records. We were informed during the inspection that they were awaiting CRB checks for two new staff members to start. Not all new staff who have recently been employed have been fully checked prior to them commencing employment. This means that they started work before the registered providers had received relevant checks to show they were suitable to work with vulnerable people. This could place people at risk. We saw that despite being told during the last random inspection, the home were admitting people for respite, whose primary needs are outside of their registered category. This includes both privately funded and funded people coming to the home for respite care. Only people whose primary needs are old age should be considered for a placement, unless fully discussed and agreed before hand by our registration team at CQC. We found that not all medicines were stored in accordance with the current regulations and this could lead to medicines not being available to administer to people when they require them. We found that the home had not met the compliance date set for ensuring controlled medications were safely stored, and a shorter timeframe was given to the home to get appropriate storage in place. One of registered providers informed us that he was not aware that we had made this requirement, despite the random inspection report being addressed and sent directly to him. Plans of care need to be kept up to date and reviewed at least monthly to ensure that they remain relevant so that consistent care can be given at all times. Plans must also contain risk assessments for individuals particularly where risks have been identified for pressure areas and use of bedrails. Consent must also be gained, where possible for use of bedrails as this can be The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.2 Page 8 seen as a form of restraint. Individuals’ mental capacity needs to be fully assessed to determine whether they are able to make decisions about all aspects of their lives. Plans should be agreed and shared with individuals where possible so that they are person centred and ensure that their needs, wishes and preferred routines are documented for staff to follow. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 9 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.V377605.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential new people to the service could be at risk, as there is no one qualified or competent to fully assess people’s needs. EVIDENCE: As most of the current people living at the home have been there for some time we looked at the pre admission information for more recent admissions of people who had come to the home for respite care/short breaks. One person who is currently at the home for respite care is being funded by the local authority and we saw that a shared assessment for social services and the primary care trust had been obtained. We saw that this persons primary need are not old age and that the assessment and plan of care lacked sufficient detail for us to be confident that the home could demonstrate that they understood and could plan for their care well. This person has complex The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 11 needs and the assessment and care plan should have given clearer details to inform staff about what they need to look out for should their condition deteriorate. We have shared these concerns with the funding body and asked that they seek a more appropriate placement for this individual. We did speak to the person concerned and they confirmed that they had been consulted about coming to the home and was happy to come here as they could accommodate pets. We saw other examples of where people had been referred to the home for respite care and the funding authority had sent an assessment. Another assessment showed that the individuals’ primary need appeared to be cognitive impairment and another whose primary need was short term memory loss. This home is not registered to take people with dementia. The environment and staffing have not been agreed as suitable to take people other than in their current registered category, i.e. old age. The home does not have a registered manager or anyone qualified or competent to complete pre admission assessments on privately funded people, and should not therefore consider new admissions until they have a qualified and competent person in post. The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals’ personal and health care needs may not be well met due to medication practices not being robust and safe. EVIDENCE: We spoke to six people who live at The Manor House. We also asked them to complete surveys prior to the inspection taking place. Overall we found that individuals were satisfied with the care and support they received at the home. Comments included • Val and Gordon are always at hand, you only have to press your call bell • You won’t get any complaints from us. I have every respect for the owners, they work very hard • Staff are all very good, some new faces and they are all nice. The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 13 Four surveys were returned from people using the service and three ticked always to the question are staff available when you need them? One ticked sometimes to this question. One person ticked sometimes to the question do staff listen to you and act on what you say, the other three ticked always. We saw that individuals could choose where they spent their time, one person told us they always stayed in their room. We saw that individuals were well dressed and one person told us that they always got their clean laundry back in good condition. We spoke to three staff members during the inspection. One was new to the service, and did not therefore have an in depth knowledge of the individuals needs, but when asked knew that this information was available about them in their plans of care. Two other staff members have been at the home for two years or more. They were able to when asked explain the needs of current people living at the home. We saw that they had developed good positive rapport with people and offered assistance with kindness and respect. We looked at the plans of care for three people currently living at the home. We found that the information although clear was not always up to date or detailed enough to enable consistent care to be provided. For example one persons plan stated that they needed support to enable them to move positions so that a pressure area could be healed better. When asked staff explained that this was no longer the case, that the individual no longer needed this support, as their pressure area had in fact now healed. We found that there was no risk assessment in place for this individual in respect to pressure areas. We also noted that one person plan did not give very detailed information about triggers to watch for should their mental health deteriorate. This individual has a history of acute mental health episodes and the plan needs to be clearer about what staff should monitor in order to ensure that their CPN is called or other health care assistance as needed. We spoke to one person whose plan we had looked at in some detail. They were not aware of the care plan and said they had not been consulted about the content or review of it, although they would have been able to do this. We saw that two people had bedrails in use, but neither plan had risk assessments or mental capacity assessments to show whether these individuals could make an informed decision about the use of such equipment. When we looked at one set, they were very unsafe. The knobs were missing from one side and a rough metal edge exposed that could cause serious injury. They were also quite wobberly and we could see that a leg could easily get trapped in the gap between the bed and bedrail. When this was pointed out the registered provider, he immediately changed these bedrails to ones that were The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 14 new and safe. We asked if there was any record of staff checking bedrails on a regular basis and was told that this is not recorded. We found that the home does not have storage that meets current regulations for the controlled drugs that are in the home. This was highlighted during the random inspection on the 30th June 2009. We also found that the controlled drugs register did not have a complete record of those medicines held in the home. This may lead to medicines not being available to administer to people when they need them. When asked one of the registered providers was not aware of the change in legislation regarding storage that had occurred in 2007. A repeated requirement is made to obtain and fit suitable storage to ensure that these medicines are stored safely. We were told that there is no system in place to verify a person’s medicines when they move into the home. This means that the person cannot be certain that they will have their currently prescribed medicines administered to them. We found that some of the Medicines Administration Record charts had hand written amendments made on them to either the dose or the frequency of the dose to be administered. It was not clear from other records kept at the home where the instruction to make these changes had come from. Also not all of these changes had been signed and dated so it was not possible to determine who had made the change or when the change had been made. This means that it was not always possible to identify if people had received the medicines as prescribed. We found that some people were supported to look after their own medicines and that records were made when these medicines were supplied to them. However the risk assessment carried out did not include where these medicines were to be stored. When we asked where they were stored for one person the answer was “locked away in her room somewhere”. This means that people cannot be certain that they would receive their medicines if they were no longer able to look after them safely themselves. During a tour of the building we saw that one person’s medication was sitting on their bedside table and was not locked away. Their bedroom door was open and this means that other people could access their medication. We found that a record is made of the receipt of the monthly supply of medicines, of most administrations and the return of medicines if no longer required. However we found that there was no record made when people took medicines out of the home for social visits or when they moved out of the home. This means that it is not possible to audit all medicines at the home. We talked to 2 people at the home who regularly signed the Medicines Administration Charts about the training they had received. One of them confirmed that he had received training in the safe handling of medicines and had then been observed administering medicines at the home on several occasions before being assessed as competent by the then manager. The The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 15 other person confirmed that they had also received training and that ongoing training was arranged with the supplying pharmacy. This means that people living at the home can be confident that they are receiving their medicines from people who have received training The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are offered a balanced diet with choice and variety, but improvements are needed to ensure that diverse and spiritual needs are met. EVIDENCE: There was evidence of weekly activity programmes in the format of posters up until May 2009. Although a poster for September was produced for a musical afternoon of ‘old time classics’. We spoke with one individual who said there was not a lot to do but they went out with their family twice a week during the week. They also told us very much missed not being able to attend church, that this was ‘important’ to them. When this was fed back to one of the registered providers they said they were not aware that this person wanted to attend church. One person told us that they were quite happy with the level of activity in the home, that staff had more time in the afternoons to sit and chat or to play a game with them. Another person told us that they kept themselves busy reading, doing jobs around the home and accessing the local shops and The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 17 facilities. Four people who completed surveys ticked ‘always’ or ‘usually’ to the question does the home arrange activities that you can take part in if you want. We were told by one of the registered providers that they had done bingo last week and had also recently held a beetle drive and had a paid entertainer in to do a show. He said that they had tried really hard to provide a variety of things for people to do. We saw that the morning were busy with staff assisting individuals to get up, dressed and to have breakfast. Individuals were left in the main lounge areas for quite long periods during the morning time. One person confirmed that they are able to have visitors when they wish, that a telephone was available for them to make calls, and that they received their post daily. Everyone who we spoke to and those who returned surveys said that he meals provided were really good. Comments included • Val is a very good cook, we are well looked after with the meals here • Food is excellent, if I leave any it is because I have a small appetite. • We are asked each day what we would like for our tea and there is always a good choice. • You couldn’t ask for better. The home does not currently follow a set menu, but we saw from what was recorded that individuals have a good variety and choice and meals are planned around individuals’ likes and dislikes. The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals’ views appear to be listened to and usually acted upon, but improvements are needed to ensure that individuals monies held by the home are kept in a separate bank account. EVIDENCE: People we spoke to said that they can talk to the registered providers about any issues that concern them. One person who completed a survey did say they would like a ‘little more sympathy in respect of their mattress’ which was not suitable for their needs. They described it as lumpy and uncomfortable. This was passed onto the registered providers who agreed to look at changing the mattress for them. One person told us they had asked for a key to the side door to enable them to get in and out independently. They had been told this was not possible, but it had not been explained why to them. We were informed by the registered provider that they had not received any complaints in the last year. The Commission have received a number of complaints and concerns from individuals who wish to remain anonymous. The concerns led us to initiate safeguarding processes, involving a multi-agency approach, and these investigations are still ongoing at the time of writing this report. This also led us to complete this key inspection instead of doing an The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 19 annual service review of the home. We wanted to assure ourselves that people were not being placed at any immediate risk and to help the home improve where we have identified risks to people. Staff are aware of what to do if they suspect abuse and longer standing staff have completed NVQ training which involves looking at abuse issues as part of the modules for learning. We are aware that the home only looks after one individual’s personal monies. This is a small amount and records are kept of any transactions made on behalf of the individual. The balance of monies is however held in the homes account. This is in breach of regulation, and the registered provider has been advised to ensure that this money is paid into the individuals own account or held securely as cash for the individual. The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is reasonably well maintained but improvements are needed to ensure that all part of the home are safe including equipment and consistent approaches to infection control procedures. EVIDENCE: During this inspection we looked at all communal areas and most of the individual bedrooms. We saw that efforts had been made to update some of the bedrooms and the communal areas looked clean tidy, fresh smelling and welcoming. We saw that one of the individual bedrooms had a great deal of mould and when reported to one of the registered providers they said they were not aware of this. Weekly checks on the environment would have highlighted this easily as it was a very large area of mould. Since the inspection we have been The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 21 informed that the individual has moved to another room and they are redecorating this bedroom. We saw that some of the soap dispensers were empty and cakes of soap were in place for use instead. There was a blue nail brush in the shower cubicle on the ground floor. This is not good infection control practice. The underside of fixed bath hoist downstairs was black with what appears to be significant mould growth in some areas and yellow deposits of possible bacteria in other areas. This is unhygienic and a cross infection hazard. The bath was wet in the interior suggesting use that day. Care staff on duty confirmed one service user takes baths at the home. The registered provider agreed to clean this as matter of urgency. They also agreed to remove the soap cakes and refill the dispensers with liquid soap and remove the nail brush which they say belongs to one individual. We had been informed by a member of staff that there were issues in relation to the emergency lighting. We referred this onto Devon Fire and rescue service who carried out an inspection at the home on the 25th September and were satisfied the home complied with current legislation. We were told by the registered provider that the environmental health department had also recently completed an inspection and awarded the home four out of five stars, making some minor recommendations. We have already highlighted in previous sections the fact that bedrails were seen to be unsafe and that there was no risk assessments in place or evidence that these were regularly checked to make sure they were safe. The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team is too small to effectively provide all the care and support hours well. Poor recruitment processes put people at risk EVIDENCE: The staff rota we saw for the week of the inspection visit, and those in the managers office from previous weeks, do not give a full account of who is covering the shifts. The waking night care hours are always left blank. One of the registered providers said that they had been getting a great deal of support from existing staff that were covering more hours. We were able to establish that Mr Watson, registered provider was covering afternoon, evening and waking night shifts and then doing mornings. He was working very long days and nights with little or no time to sleep and rest. This could place people at the home at risk as being tired can lead to errors occurring in recording, in ensuring the correct medications are given to people for example. This level of sustained long hours of work appears to have been happening for some time. We were assured that they are about to take on additional staff, and this would ease the pressure for the providers. We saw that one person had been recruited to work at the home before their checks to ensure they were suitable to work with vulnerable people were in place. This relates to checks not being back for The Protection of vulnerable The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 23 people list (POVA First) and Criminal Records bureau check (CRB). They had also only received one reference for this individual. This is in breach of regulation, and can place people at risk. During the random inspection we commented on how hard the home had worked to ensure staff had up to date training, but since the departure of the manager this appears to have slipped a little with individuals not having had supervision. We saw induction training records that although had been ticked to say it had occurred, it was not signed and dated for one individual, so it was unclear as who and when had assisted the person to complete their induction. We were informed that staff had had training in dementia, but when we said that one person should not be using the home for respite care as their primary need was Alzheimer’s one of the registered providers asked ‘is this dementia then because their assessment only says they are pleasantly confused.’ Individuals who live at the home were very complimentary about the staff and comments included ‘The staff are all very good, they look after us, the new girl is lovely, they are all very nice.’ People who returned surveys said that staff were available when they needed them. Staff that we spoke to appeared to know the needs of people who live at the home, or knew to check their plan of care. One staff member said that as it was a small home with only a few people living there, they got to know people well and this is why they enjoyed working at the home. The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We are not assured that the home is well managed or run in the best interests of the people who live there, as there is no qualified registered manager in post. EVIDENCE: The home has no registered manager in post and despite two candidates being in post and making good progress in getting the home to meet requirements, both left at short notice and there is no one qualified or competent in post to ensure effective running and management of the home. The registered providers must look urgently to employ a qualified and experienced manager. The registered providers have experience in providing day to day care for The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 25 people but do not have qualifications or knowledge to effectively manage the home. We made requirements during the last random inspection, and some of these have not been complied with. The registered providers say they were not aware of these requirements, despite the report being sent to them directly. We have asked the registered providers to provide us with additional information in a form called the AQAA, which they are required to complete by law. To date they have failed to provide this information to us, so we will need to consider taking enforcement action, if this information is not provided. We have already highlighted that one person’s individual monies is currently held in the registered provider’s home account. When we discussed this breach in regulation, they said they were not aware this was a breach. We are aware that staff have had training in areas of health and safety, but we do not know about what policies and procedures they have, as this information is usually contained within the AQAA. We did not see the policies in the home, but they may have been in a place other than the staff office where most of the information is held. We saw that staff record accidents and incidents, and for one person we case tracked notes were made in both accident book and in their plan of care. This helps to establish if there is any pattern to accidents and incidents so that trends can be monitored and risk factors eliminated where possible. We have already highlighted in previous sections that all areas of risk had not been fully assessed, including the use of bedrails and the ongoing monitoring of their safety, risks from pressure areas, and risks from medication not being securely stored by people who self medicate. Recruitment processes are poor putting people who use the service at risk of giving staff unsuitable to work with them at the home. There is currently no one qualified to assess the needs of potential new people to the service. They have in the past admitted individuals whose primary needs are not within the current registration category. They have done this without any consultation with CQC, despite this being highlighted to them during the last random inspection report. The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 26 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 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 17 x 18 2 2 x x x x x x 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 3 x 2 x x 1 The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 27 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 OP3 Regulation 14(1) Requirement Timescale for action 30/11/09 2 OP7 15 3 OP7 13 (c ) 4 OP9 13(2) New people must not be admitted unless their need have been fully assessed by suitably qualified or suitably trained person. This is to ensure that the home can be certain they can meet all assessed needs. Plans of care must be reviewed 30/11/09 at regular intervals to ensure that they contain relevant details that enable staff to provide consistent care and support. Risk assessments need to be in 07/11/09 place to ensure that any risks to health and safety are identified and so far as possible eliminated. This relates to use of bedrails, risk of pressure areas, and risk assessments for self medicating. Arrangements must be made to 07/11/09 obtain and fit a cupboard complying with current regulations for the storage of Controlled Drugs. This is to make sure that these medicines are stored securely and prevent the risk of diversion. The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 28 5 OP9 13(2) 6 OP9 13(2) Arrangements must be made to 07/12/09 record the receipt, administration and disposal of all medicines received into the home. This must include recording when medicines are taken out of the home. All controlled drugs must be kept 07/11/09 secure in controlled drugs cabinet at all times, and records of these should be kept in a book that has numbered pages. (previous date set for compliance 30/09/09) The home must ensure good infection control procedures at all times, including ensuring all equipment is kept clean and hygienic and that procedures are in place to prevent cross infection. This relates to ensuring soap dispensers are kept refilled. Staff must only be employed once all references and checks have been completed to ensure that they are suitable to work with vulnerable people. The registered provider must not pay any service users monies into their own account or that of the home. This is to safeguard the individual’s money. The registered providers must ensure that there are clear lines of accountability within the home, including ensuring that people are aware of who is rostered for each shift within the home 20/11/09 7 OP26 13 c 8 OP29 17 (2) 30/11/09 9 OP35 20(1) 20/11/09 10 OP31 17(2) 30/11/09 The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 29 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 3 4 Refer to Standard OP9 OP12 OP7 OP38 Good Practice Recommendations Any hand written entries made in the medication records should be double signed to help prevent any errors. The home needs to ensure that individuals’ diverse and spiritual needs are identified and met. Consent should be obtained wherever possible for the use of bedrails. Induction training records should be signed and dated. The Manor House Lynmouth DS0000070220.V377605.R01.S.doc Version 5.3 Page 30 Care Quality Commission Care Quality Commission Southwest Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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