Inspection on 21/11/07 for The Manor House Nursing Home

This inspection was carried out on 21st November 2007.

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

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

Other inspections for this house

The Manor House Nursing Home 08/11/06

The Manor House Nursing Home 07/03/06

The Manor House Nursing Home 06/09/05

The Manor House Nursing Home 15/12/04

The Manor House Nursing Home 13/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton 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 Nursing Home Bridge Road Chatburn Nr Clitheroe Lancashire BB7 4AW Lead Inspector Jane Craig Unannounced Inspection 21st November 2007 09:30 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 Nursing Home DS0000022504.V351116.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 Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Manor House Nursing Home Address Bridge Road Chatburn Nr Clitheroe Lancashire BB7 4AW 01200 441394 01200 440507 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) www.manorhousechatburn.co.uk Mr Chris Harrison Mrs Janet Harrison vacant post Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50), Physical disability (50) of places The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with Nursing - code N, to people of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP. Physical disability - Code PD A maximum of 19 people requiring Nursing Care can be accommodated, The maximum number of people who can be accommodated is: 50 Date of last inspection 8th November 2006 Brief Description of the Service: The Manor House Nursing and Residential Home is privately owned by Mr and Mrs Harrison. The home is registered to provide long or short term care for up to 50 people, nineteen of whom may have nursing needs. The Manor House is a converted 17th Century property situated in the village of Chatburn. The home has recently been extended to increase the number of overall places. The Manor House is close to local amenities such as the Post Office, village hall, churches and pubs. The local bus service to Clitheroe is nearby. The home comprises four connecting units. Each unit has its own staff team and unit manager. There is a passenger lift and stair lift providing access to bedrooms on the upper floor. Other aids and adaptations are available to assist service users to move around the home independently. A number of the bedrooms have en-suite facilities, some have en-suite shower rooms. There are accessible bathrooms and toilets throughout the home. There are three lounges, a large conservatory and three dining rooms. The communal spaces are furnished in a homely way and to a good standard. Information about The Manor House is sent out to prospective residents when they enquire about admission. Copies of the latest CSCI inspection reports are The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 5 available. At 21st November 2007 the fees ranged from £421.00 to £894.00 per week. Supplements were charged for en-suite rooms, patio rooms and double rooms with single occupancy. There were additional charges for newspapers, hairdressing and some therapies. There was also a fee for staff escorts to appointments and for private transport. The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at The Manor House on 21st and 22nd November 2007. At the time of the visit there were 41 people living at the home. The inspector met with a number of them and asked about their views and experiences of living at The Manor House. Some of their comments are included in this report. Four people living at the home were case tracked. This meant that the inspector looked at their care plans and other records and talked to staff about their care needs. As part of the key inspection a number of surveys were sent out to residents, relatives, staff working at The Manor House and visiting health professionals. There was a good response from all groups and information received on the surveys has been taken into account when compiling the report. During the visit discussions were held with both the owners, the management team, members of the staff and visitors to the home. The inspector looked round the home and viewed a number of documents and records. This report also includes information from the Annual Quality Assurance Assessment (AQAA), which is a self-assessment that the provider has to fill in and send to the Commission every year. What the service does well: Before anyone moved into the home a senior member of staff visited them to assess what care they needed and to make sure that their needs could be properly met at The Manor House. Most people who returned surveys indicated that they were given enough information about the home to help them to make a choice about whether it was the right place. People who returned surveys indicated that they received the care and medical support they needed. People spoken with at the time of the visit also said they were well cared for. One person described the care as, “second to none.” Health professionals who returned surveys indicated that the staff always sought appropriate advice and acted upon it to improve people’s health. Staff understood the principles of promoting privacy and dignity. One relative wrote, “All the staff have a caring, polite nature and treat all clients, family and friends with respect.” A health professional commented that staff were compassionate and residents were treated with dignity. The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 7 Staff supported residents to be as independent as possible and to make choices about their daily lives. A number of residents said they were happy and content living at the home. A relative also wrote that the home gives people an excellent quality of life. There was a choice of activities for people to join in a morning and afternoon. The programme was well thought out to appeal to a wide range of interests and tastes. Residents had opportunities to go out. A relative wrote that they were very impressed that staff had listened to the requirements of the residents and catered for them. There was an open visiting policy, which meant that people could see their relatives at any time. Visitors said they were made to feel welcome. People living at the home were offered a varied and nutritious diet. Most people were complimentary about the meals. One person wrote that the meals were, “Good, plentiful, served graciously and with a smile.” A relative wrote that one of the strengths of the home was, “excellent food all made on the premises and cups of tea all day.” People living and the home knew who to speak to if they were not happy about anything and they knew how to make a complaint. One resident said, “if I don’t like something I just say and they don’t mind.” On the day of the visit the home was clean and tidy. There were no unpleasant odours. A number of residents and relatives commented on the environment. They described it as homely, spotless, comfortable and warm, with a relaxed atmosphere. New staff had a good level of training to make sure that they understood their roles. Other staff were encouraged to attend courses to update their knowledge and skills. Over half of the staff held a nationally recognised qualification in care. The home was well run by the registered person and a management team. health professionals who filled in surveys said the service was organised and well managed. People living at the home had opportunities to say what they thought of the service. The managers and staff listened if they made suggestions for changes. Fire safety equipment and electric and gas systems were serviced regularly. This helped to make the home safe for the people who lived and worked there. What has improved since the last inspection? The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 8 A new extension to the home provided extra bedrooms and communal space. The whole home was decorated and furnished to a good standard but the new bedrooms and en-suite facilities were of an exceptionally high standard. Several people using the service commented on the new rooms. One person said they were very happy in their old room but their new one was, “splendid.” 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 Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 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 Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People thinking of moving into the home received sufficient information to help them to make a decision and staff received sufficient information to understand the person’s needs. EVIDENCE: People who completed questionnaires said that they received enough information about the home to help them make a decision about moving in. A number of people said they had respite admissions so knew the home and the staff very well. One person said they had kept on extending their stay until they decided to come in for good. Everyone who funded their own care had a contract with the home. The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 11 Detailed information about people’s needs was obtained prior to them being offered a place at the home. Senior staff visited people who were thinking of using the service so that they could be sure that the staff and facilities at The Manor House could meet their needs. Assessments from health and social services’ professionals were also available on people’s files. Staff had access to the written assessments and also had opportunities to discuss the needs of new people with seniors. Standard 6 was not applicable. Intermediate care was not provided at The Manor House. The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Despite shortfalls in care plan records, people’s health and personal care needs were met in accordance with their wishes. Some shortfalls in the management of medicines increased the risk of medication errors. EVIDENCE: Four sets of care records were inspected as part of the case tracking process and others were looked at in less detail. Care plans for newly admitted residents were usually drawn up using information from their pre-admission assessments but this did not always happen. For example, one person had on-going psychological health care needs but there was no written plan to support them. This meant that staff were reliant on verbal instructions, which can be open to misinterpretation and create misunderstandings. The standard and style of care plans varied greatly. Some were uninformative and did not provide enough direction for staff to meet the resident’s needs in The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 13 the way they preferred. Others were highly personalised and gave excellent instructions that were detailed enough to ensure that staff provided care in a consistent manner. In most cases people using the service, or their relatives, had signed their agreement to at least some of the plans. Most relatives who returned surveys indicated that they were always kept up to date with any important issues. Relatives were invited to a care review after the resident had been in the home for a number of weeks. Staff were working towards repeating this at least annually. The system for monthly reviews had not improved. Staff checked the care plans every month but did not write evaluation notes or outcome statements. A number of the plans were no longer relevant or had out of date information on them. This had not been picked up during reviews. Despite these shortfalls in written plans, people using the service said they received good care. One person described the care as “second to none.” Another person said, “Everybody’s very helpful.” Survey results also showed that residents received the care and support they needed. Each care file included health care risk assessments and, where necessary, guidance for staff on how to manage the risk. The risk assessments for the use of bed rails were not specific enough to ensure that all potential hazards associated with their use were looked at. People’s ongoing health care needs were monitored and they were referred to outside agencies as necessary. Advice from other professionals was added to the relevant plan so that it became part of everyday care. One resident said, “They look after my health very well and if there is something they can’t deal with they get the doctor.” Only one relative who returned a survey was not completely satisfied with the level of health care their relative received. Health professionals who returned surveys indicated that the staff always sought advice and acted upon it to improve people’s health. One wrote that staff were pro-active in seeking health advice in a timely manner. Another commented, “I have always been impressed by the standards in this care home.” Requirements made at the last inspection to improve the way medicines were handled had been addressed but there were still some shortfalls. Administration of medicines for residents who did not require nursing care had been delegated to care staff. The staff had received appropriate training and had been assessed as competent to handle medication. People who administered their own medicines had risk assessments and staff said they carried out regular checks to ensure that the resident remained safe. The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 14 There were clear records of medicines received and waste medicines disposed of. Medication Administration Record (MAR) charts were generally complete although there were a few gaps without explanation. MAR charts were generally clear. However, a few charts had been altered to show a change in the dose or frequency of administration of the medicine. On some charts there was no evidence that this had been authorised by the person prescribing the medication. At least two handwritten entries did not accurately reflect the instructions on the medication packaging. Instructions had also been altered instead of making a new entry. This could increase the risk of confusion and can lead to errors. There were very clear directions for staff to alert them when to administer medication that was prescribed “to be given when required”. This reduced the risk of under or over medicating. A random check found that the stocks of medication in the monitored dose system accurately tallied with the records. It was not possible to carry out an audit of this nature on medicines that were not in blister packs. The lack of records to show how much stock had been carried forward meant that senior staff could not be sure that any medication left at the end of the month was because stock had accumulated over previous months or because it had not been given. Medicines were stored securely. Storage areas were clean and maintained at the correct temperature. Controlled drugs were stored safely and stocks were accurate as per the controlled drug register. Staff received training in core care values including promoting residents’ privacy and dignity. Staff gave examples of how they respected privacy by knocking on doors and ensuring they closed doors when they were assisting with personal care. One member of staff said they made sure they asked people how they wished to be helped and always gave them choices. During the course of the inspection staff were seen to treat people with respect. A number of relatives who returned surveys also commented that staff were polite and treated their relatives with respect. A health professional wrote that staff respected people’s privacy and dignity to a great extent and commented, “They will keep me waiting to see a patient until they are happy they are in a suitably private situation.” The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 15 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 excellent. This judgement has been made using available evidence including a visit to this service. Staff met people’s individual needs, expectations and preferences. The routines in the home revolved around the residents, who said they were happy with their lifestyle. EVIDENCE: Information about preferred daily routines, interests and religious needs was usually recorded in assessments and resident profiles. Some of the information was transferred to care plans and activity programmes. At the time of the visit people said they were satisfied with their life at the home. One person said, “I have no complaints at all, I am very happy,” another person said they were very content and appreciated the, “personal touch.” People also described flexible routines and choice in every aspect of their daily lives. One person said, “They know I like to be up early and in bed early.” Another said, “I have never been told I must do anything or go anywhere. I am still my own boss.” A relative also commented on the level of choice residents had. There was an extensive programme of therapeutic, social and recreational activities for people to choose from. In addition to the usual groups and The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 16 games, the staff tried to keep people’s interest by introducing them to new interests and hobbies, such as reading plays. Staff also supported people to pursue individual interests. There was a computer with Internet access in one of the lounges, which anyone could use. A few people also had their own computers. Information included on the Annual Quality Assurance Assessment (AQAA) indicated that each bedroom had a network connection for residents’ own computers. A number of residents and relatives commented on the activities. One person said, “we had a brilliant day on Friday for Children in Need.” Another said they were looking forward to Christmas because they had a wonderful time at The Manor House. One relative wrote, “The daily activities for each person is 100 ,” and another commented, “I am very impressed that they listen to the requirements of their residents and cater for them.” Only one relative commented that more entertainment was needed. There was an open visiting policy. Several relatives mentioned that they felt welcome. One wrote, “I always feel at home when visiting my father.” Other relatives commented that the staff were good at keeping them informed and there was good communication. There were strong links with the local community and the home held the Community Mark. People from the village were invited to join residents to celebrate any special events. Some residents attended local churches and groups. One person mentioned that in the summer months staff regularly took them out to the village as well as other outings further afield. Records of meals showed that people were offered a varied and nutritious diet. The catering team were aware of the healthy eating initiatives and gave people opportunities for the recommended portions of fruit and vegetables. For example, they offered plates of bite size fruit as an alternative to biscuits and cakes. There was a choice at each meal and people could have something different if they wanted. Each unit had tea and coffee making facilities for the use of residents and visitors. Dining rooms were spacious to allow for people with wheelchairs and walking aids. Tables were attractively laid with full place settings. A new kitchen had been installed in the basement. There had been some initial difficulties in serving the meals and a few surveys made mention of meals not being as hot as they should be. This had been resolved by the time of the visit, when everyone spoken to said they enjoyed the food. The Manor House Nursing Home DS0000022504.V351116.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 good. This judgement has been made using available evidence including a visit to this service. People using the service were safeguarded by the complaints and protection procedures that were followed by staff. EVIDENCE: There was a clear complaints procedure on display. Residents and visitors also had access to a concerns and grumbles book. The management team took a pro-active approach to complaints and records showed that even minor concerns were investigated and appropriate action taken. Most residents and relatives who completed questionnaires indicated that they knew who to speak to if they were not happy and they knew how to make a complaint. During the course of the visit one resident said, “if I don’t like something I just say and they don’t mind.” A relative said that although they had never had cause to complain they would feel comfortable approaching the owner. Staff who returned surveys indicated that they knew what to do if anyone raised concerns about the service. All staff had received recent training in safeguarding adults. They also had access to written guidance and procedures. Staff spoken with during the inspection were aware of their roles and responsibilities in reporting any allegations to their line manager and outside the home if necessary. The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 18 A programme of training in the Mental Capacity Act 2007 is due to be rolled out in the next few weeks. The aim is to ensure that staff are aware of residents’ rights with regard to decision making. The Manor House Nursing Home DS0000022504.V351116.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 excellent. This judgement has been made using available evidence including a visit to this service. The environment provided people with a safe, well-maintained and comfortable home, which encouraged them to be independent. EVIDENCE: A tour of the premises evidenced that the home was well maintained. All parts of the building were decorated and furnished to a high standard. Bedrooms in the new extension were larger than recommended in National Minimum Standards. The en-suite wet rooms were large enough for staff to be able to provide assistance. There was a plan for on-going renewal and refurbishment of the older parts of the home. There were also firm plans for improving the outdoor space. The owners had installed tracking hoists in three of the new bedrooms and a bathroom. One of the residents said this made transferring more comfortable. The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 20 Other rooms were fitted with grab rails and there was equipment throughout the home to assist people to be independent. Many of the bedrooms were highly personalised. Those people who were asked were satisfied with the environment. One person said, “I have a lovely room on the front, I can see the road and it makes me feel part of the community.” Another person said they were happy in their old room but their new one was, “splendid.” Two people said they had been offered new rooms but were happy where they were. A number of relatives commented about the homely environment. One wrote, “The premises are clean, warm, bright and welcoming with a pleasant atmosphere.” There was a housekeeper on each of the four units. At the time of the visit the home was clean, tidy and free from unpleasant odours. Residents said it was always like that. One resident said, “Everything is spotlessly clean.” Another wrote, “You cannot fault this home for cleanliness.” Several relatives also remarked on the hygiene. One said, “the cleanliness is excellent at all times in all parts of the home.” The majority of staff, including the housekeepers and person responsible for the laundry, had completed infection control training. The manager had the latest infection control guidance and was using it to audit practices. A new laundry had been installed in the basement area. The laundry was well equipped for the size of the home and on the day of the visit was tidy and organised. There were hand washing facilities and liquid soap. A disposable towel dispenser was installed during the visit when the manager was made aware that one had not been fitted. The person responsible for laundry said that there was a system for sorting laundry to minimise the risk of infection, and that all staff adhered to it. The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 21 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 good. This judgement has been made using available evidence including a visit to this service. People living at the home were supported by a well trained staff team, which helped to ensure their needs were understood and met. Recruitment practices did not provide complete safeguards. EVIDENCE: Each of the four units had a staff team led by the unit manager. Some staff said that this arrangement meant that they got to know the residents very well and it increased consistency of care. However, one of the residents said they were not happy with the new way of working because they had to wait for staff from their own unit. This had been discussed during a resident committee meeting and the management team had responded by pairing up the units so that residents had a larger staff team. People using the service had mixed views about staffing levels. Two residents and a relative who returned surveys indicated that there were not always enough staff. At the time of the visit one person said they were sometimes kept waiting too long. Others said that although staff were busy there was always someone around. One person said, “you just have to use your buzzer and they are there.” Another said that the buzzer was usually answered within minutes. The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 22 The management team and staff said there had been some difficulties with staffing levels, in the main because of the length of time taken for Criminal Record Bureau checks to be carried out. A new team of ancillary staff had been employed which meant that care staff were able to concentrate on care giving tasks. The files of three new employees were looked at. One member of staff only had one written reference, which had been supplied by a friend. This meant that the manager did not have any written information about the carer’s employment record and there was no objective view of the carer’s suitability for the post. Not all of the applicants had provided a complete employment history and there was no evidence that this had been explored at interview. All other pre-employment checks had been carried out and all the required documents were on files. There were systems in place to check the status of registered nurses and to ensure that registration was kept up to date. New staff all received a three-shift induction regardless of their grade or experience. The induction covered issues specific to The Manor House, including emergency procedures and introduction to working practices. Staff who did not have an NVQ went on to complete the 12 week common induction standards. All areas of the training were assessed before the carer was deemed to be competent. Other forms of training were available for care staff who may have difficulties with traditional methods because, for example, of literacy or language. Most care staff went on to complete NVQ level 2 or 3. Information included on the AQAA indicated that 98 of care staff were qualified. There were good opportunities for further training. The new unit managers had received in-house management training and were all enrolled on NVQ level 4 courses in management. Any staff without up to date training in the safe working practice topics had dates planned for refresher courses. There were other courses relevant to the resident group, such as dementia care and continence. The management team were trying to access clinical courses for registered nurses. A number of residents, relatives and health professionals made very positive comments about the attitude, skills and competence of the staff team. One resident said the staff were “wonderful” and another described them as “considerate.” The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 23 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and staff benefited from a well managed home. There was a good level of consultation, which meant that people were able to contribute to service development. EVIDENCE: One of the registered providers managed the home on a day to day basis. She was supported by a management team who each took responsibility for a different area of the service. In addition to holding two nursing qualifications, the registered person was qualified to NVQ level 4 in management. She kept up to date by attending courses, self directed study and networking. Two of the health professionals who returned surveys commented that the home was well organised and had good managers. The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 24 Residents had opportunities to make their views about the home known. They had regular meetings of the residents’ committee. The chair of the committee showed the inspector the minutes of the latest meeting, which would be fed back to the management team. According to information on the AQAA, several changes had been made to meals and mealtimes as a result of listening to the views of people using the service. Themed surveys had been sent out to residents about activities, meals, the admission process and residents’ expectations. There were no results available at the time of the inspection. The management team carried out audits on a number of procedures and practices, for example, maintenance, infection control and accidents. Action plans were put into place to address any shortfalls. The staff did not handle any finances on behalf of residents. Those who were able were encouraged to manage their own money and their families acted on behalf of others. Any expenditure for residents over and above the fees was paid by the home and residents or their families were billed every three months. Records were kept of all transactions and receipts were available. Staff had received fire safety training. Staff who were asked were aware of the fire procedure. Fire drills were usually carried out every six months. Discussions took place with the registered person about increasing these until all staff were familiar with the layout of the new part of the building. Fire systems and equipment had been serviced. According to the AQAA, servicing and maintenance of other installations and equipment was up to date. Maintenance certificates were available at the inspection. The maintenance person serviced the portable hoists annually. Although the records showed that thorough checks were carried out, there was no evidence that the maintenance person had been assessed as competent to carry out the checks. The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 25 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 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 3 X X 4 X X X 4 STAFFING Standard No Score 27 3 28 4 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 15(1) Requirement To ensure that staff do not have to rely on verbal instructions, everyone using the service must have a care plan to address all personal, health and social care needs. The plan must be kept under review and amendments made so that staff have up to date and accurate directions about the care to be provided. (Timescale of 30/06/06 not met) 2. OP29 19(1) In order to safeguard people living at the home the registered person must ensure that all required pre-employment checks are carried out and all the required information and documents are obtained before the new employee starts work at the home. 30/11/07 Timescale for action 31/01/08 The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 27 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 OP7 Good Practice Recommendations To ensure the health and safety of people using the service risk assessments for use of bed rails should be further developed. To enable audits/checks to be carried out, there should be a system to show when a new package of medicine has been started. In order to reduce the risk of errors, handwritten instructions on MAR charts should accurately reflect the instructions on the medication packets. The instructions should be dated and clear and show evidence of having been checked. In order to safeguard people living and working at the home, the registered person should check with the appropriate authorities that the person currently servicing the hoists is competent to do so. In order to safeguard people living and working at the home, the registered person should increase the frequency of practice fire drills to ensure that all staff are familiar with the fire procedure and the layout of the new part of the building. 2. OP9 3. OP9 4. OP38 5. OP38 The Manor House Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Nursing Home DS0000022504.V351116.R01.S.doc Version 5.2 Page 29 - 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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