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Inspection on 24/07/06 for The Manor House Nursing Home

Also see our care home review for The Manor House Nursing Home for more information

This inspection was carried out on 24th July 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There was evidence that Service Users at the home are made to feel at home very quickly after admission. The robust team of professional Nurses and Carers work well together to provide good quality care and attention to the individuals. One Gentleman told the Inspector that he felt so settled at the home and he enjoyed the freedom of being able to do what he wanted, once he had discussed it with the Manager. Care plans were in good order, being up to date, signed by staff and relatives and they reflected the current condition of the Service User.

What has improved since the last inspection?

What the care home could do better:

A new Service User and their relatives informed the Manager that they felt the Service Users Guide could be more helpful and together with the Manager they are compiling a new format with a checklist. The activity coordinator is also keen to commence a Newsletter for the Service Users and Relatives and this is in the process of being drawn together. The Manager hopes to continue to improve the Service Users day by continued stimulation through suitable activities and one to one intervention. The Manager is also monitoring `communication` as she feels there is always room for improvement and the staff must be conscientious with regard to Service Users and relatives needs. Staff files have been reorganised and one member of staffs` references was not in their file. This staff member had worked in the home for many years and the Inspector advised the Manager to give the member of staff a reference and ask the provider to add one also.

CARE HOMES FOR OLDER PEOPLE The Manor House Nursing Home Hyde Lea Stafford Staffordshire ST18 9AT Lead Inspector Mrs Joanna Wooller Key Unannounced Inspection 24 July 2006 08:00 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 DS0000022349.V304979.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 DS0000022349.V304979.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Manor House Nursing Home Address Hyde Lea Stafford Staffordshire ST18 9AT 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) 01785 241351 F/P 01785 251824 cleaver42@hotmail.com Hyde Lea Nursing Home Limited Mrs Kathleen Ann Cleaver Care Home 43 Category(ies) of Physical disability (43), Physical disability over registration, with number 65 years of age (43), Terminally ill (4) of places The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Thirty one PD Minimum 60 years of age on admission 12 PD to be accommodated in designated unit of which six PD- may be intermediate care 30th January 2006 Date of last inspection Brief Description of the Service: Manor House is a 43-bed care home, which offers 24 hour nursing care. The house is in a rural area on the outskirts of Stafford town. It has a bus route close by. Set in its own grounds, the service users enjoy a very attractive view from all sides of the home. The home is owned by Hyde Lea Nursing Home Limited, and Managed by Mrs Kathleen Cleaver, a Registered Nurse with a wealth of knowledge and experience. A registered nurse is on duty 24 hours a day and the home is also staffed with well-trained carers and experienced ancillary staff. Four of the beds are registered for palliative care service users, six beds are designated to intermediate care services and four other beds are registered for service users between the age of 18 and 60yrs who have physical disabilities. The home is split on two levels with bedrooms upstairs and down. First floor access is available via two passenger lifts and stairs. There are several lounges within the home, at the rear of the building is a large airy lounge which has a smaller cosy lounge situated to the side of the area. The dining room is situated within the beautiful conservatory. There are 31 single and two double bedrooms. All bedrooms (except one) have en-suite facilities, which include WC and sink. The environment improvements have been completed to a high standard. Fees Range for £426 to £1,200 per week as at the time of this report. The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Lead Inspector, Joanna Wooller, carried out this unannounced Key Inspection. The visit was commenced at 08.00 and the Inspector met with the Night Sister and listened to the end of the night report. There were 33 Service Users in the home and 6 staff was on duty including two Registered Nurses, one of these being the Manager, Kathy Cleaver. Two carers had rung in sick that morning and one shift was covered within an hour of the calls. Service Users occupancy was low, as the building work had caused areas of the home to be closed. The inspector evidenced care records, all necessary documentation and inspected all the environment, including the kitchen, laundry, offices and the Service Users bedrooms. Ongoing building work was evident, with the installation of a passenger lift in progress. Clear signage was in place on arrival at the home and all safety aspects had been risk assessed. A new Cook started at the home on the day of the inspection. Service Users spoken to at the visit were content and felt loved by the staff. They felt they were able to make choices and their individual needs were met. One lady said she loved the staff and they would do anything for her. The environment was very clean and clutter free. The Inspector observed breakfast being served by the staff in the dining room, Service Users were offered discreet assistance and promotion of independence was encouraged. Some Service Users were served breakfast in bed or in their rooms as desired. Plenty of drinks were served throughout the time at the home including fresh fruit chunks at coffee time. Feedback cards were complimentary about the service and the staff. Comments included “Caring staff and lovely home” “ My Mother is very content in the home, we are very impressed”. What the service does well: There was evidence that Service Users at the home are made to feel at home very quickly after admission. The robust team of professional Nurses and Carers work well together to provide good quality care and attention to the individuals. One Gentleman told the Inspector that he felt so settled at the home and he enjoyed the freedom of being able to do what he wanted, once he had discussed it with the Manager. The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 6 Care plans were in good order, being up to date, signed by staff and relatives and they reflected the current condition of the Service User. What has improved since the last inspection? 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 Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 7 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 DS0000022349.V304979.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 This quality outcome is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make an informed choice about where to live and this is available in the Statement of Purpose. Each service user has a signed contract, which confirms their needs will be met whilst in the home. EVIDENCE: It was again very evident to the inspector that the staff were individually and collectively able to demonstrate they have the skills and experience to deliver the services and care which the home offers to provide. The statement of purpose and service user guide is available for all to read and discuss at any time. Information within the Service Users Guide is being changed and updated as present including a new admission checklist. Prospective Service Users are given ample opportunity for staff to meet them in their own homes or current situation and they are welcome to visit the home on a trial basis. The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 9 Each Service User has a written contact with the home and it is confirmed in writing that his or her individual needs will be met at the home. The home had one service user on Intermediate. The care lady said she thought the home was marvellous and all the staff are so good to her. The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 11 This quality outcome is good. This judgement has been made using available evidence including a visit to this service. Service Users health care needs are identified and evidenced as being met within care records. Intervention from the GP is as required along with the Multidisciplinary team and Clinical Nurse Specialists as necessary. Medication administration closely follows the homes policies and procedure. Care of the Dying training has been completed. EVIDENCE: Individual health care needs are identified in individual care plans and reviewed monthly. Short-term care plans are introduced in some circumstances to ensure closer assessment of the Service Users condition. Risk assessments and individual needs are documented within the care record. The care staff continue to maintain the personal and oral hygiene of each Service User and support their individual self-care capacity. Access to NHS services is made available to all residents and this is recorded in the care records. The chiropodist visits the home. Care records and monthly observation charts were well-documented and up to date with involvement from relatives. The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 11 Cot side risk assessments evidenced on the day of the inspection were found signed. Manual Handling risk assessments were also in place in the care records, which list individual requirements such as particular hoist and slings. On the day of the visit it was very warm and the Service Users were seated in airy lounges and well-ventilated bedrooms, drinks were continually on offer and staff were walking some Service Users outside to get some exercise and fresh air. Clinical Nurse Specialists are welcomed into the home and their advise sought as required. The GP’s are regular visitors to the home and whilst talking to the Inspector previously has always had lots of praise for the staff and their professional manner and care delivery. A recommendation was made to further extend individual communication care plans. The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 -15 This quality outcome is good. This judgement has been made using available evidence including a visit to this service. Service Users life histories are discussed and used as a basis for individualised social care offering choice and support. Service Users relatives are welcomed into the home and encouraged to participate as they wish. A wholesome balanced diet is offered with consideration for personal preferences and dietary needs. EVIDENCE: The Service Users continue to greatly benefit from the enthusiastic input given by the homes activity coordinator. She is knowledgeable in the art of social care and recreational activities for all the service users and their individual preferences and hobbies. Service users spoken to continue to enjoy her input and say they would not want to do much more. The Inspector identified that one to one sessions were not detailed as to the actual activity that had taken place and this should be noted. Individual religious needs are met and there was evidence that any diverse needs due to faith and culture would also be identified through the admission procedure and met as required. The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 13 Entertainers are booked and welcomed at the home to give a variety of performances. A recent summer fete raised funds for the activities and days out were also planned. A trip to the local Monkey Sanctuary in Trentham was the next planned outing. Notice boards were evident throughout the home with events photographs and thank you letters, which were very complimentary to the care offered to their loved ones. Relatives and visitors are welcome at any reasonable time; although the inspector did not see any visitors during the visit. Meals are planned on a four weekly rota to avoid repetitive meals and offer a wide variety of choice. A choice of two meals is offered at each mealtime and a choice of drinks. Food diaries and fluid charts are used if individual Service Users dietary intake is poor or of concern. The Inspector noted that the kitchen was looking tired and the room itself was very hot. Although it was a warm day there was little ventilation and the area was dark. The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 - 18 This quality outcome is good. This judgement has been made using available evidence including a visit to this service. A complaints procedure is visible in the home and used as necessary by relatives and Service Users. Service Users legal rights and protection from abuse are supported through staff training and open management of the home. EVIDENCE: One complaint had been received by the CSCI and this had now been resolved with a positive outcome for the home, as staff are now more aware of the need for greater communication between multi agency services. The complaints process and procedure remains in place at the home. Staff training is given relating to vulnerable adults procedures and abuse, which ensures staff are aware of the need to be vigilant for signs of abuse and they are able to report it. Individual legal rights are protected through family involvement or advocacy services. The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 25 & 26 This quality outcome is good. This judgement has been made using available evidence including a visit to this service. The service users live in a clean, safe and well-maintained environment. Specialist equipment is made available as required to assist individuals with mobility or independence. EVIDENCE: The environment of the home was again at this visit found to be exceptionally clean, hygienic and tidy in all areas inspected. No malodours were noted. There was evidence available for the inspector to demonstrate that the home is well maintained, with a maintenance folder of records available to demonstrate this. Well-maintained specialist equipment is evident in the home. Pressure relieving mattresses in varying forms are on each bed in the home. The Manager undertakes a mattress audit at least annually. Individual Service Users independence is encouraged and promoted throughout the day with assistance given as required. Each service user is able to The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 16 personalise their bedroom as they so wished and there was evidence that this is appreciated. One lady said she loved being able to bring her personal possessions with her. Communal areas were light and airy with varying seating arrangements. The dining area remains in a designated area; dining tables have cloths and flowers on them that most Service Users like to see. The nurse call system is in all service users areas and the cordless telephone system has proved beneficial. Outside in the grounds, gazebos and garden furniture were in use to enjoy the recent warm weather. The gardens were very well maintained and pleasing to the eye. Service Users had enjoyed short spells sitting in the shade in groups, in one to ones with staff or with visitors. The Inspector noted that the bedrooms were beginning to look a little worn and would benefit from redecoration and refurbishment. The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 This quality outcome is good. This judgement has been made using available evidence including a visit to this service. The staff in the home has been carefully recruited to ensure that they are competent and professional in their manner. The staff training provided is relevant and benefits the Service Users in the home. EVIDENCE: Staffing levels are monitored to ensure that the needs of the service users can be met. Staffing levels and staff competence are considered when staffing rotas are prepared. Most of the staff are first aid trained and have a food hygiene qualification. Two to three trained nurses are on duty for each shift, supported by care staff. Each trained nurse has a responsibility to a specialist subject such as continence and wound care. This link nurse role promotes current good practice within the home. Staff training is recorded and monitored by the Training Co-ordinator who is a trained nurse. The inspector was shown evidence of appropriate training being organised, and carried out. The trainer arranges teaching sessions which are appropriate and necessary for the staff working in the care setting. The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 18 A robust recruitment procedure is in place, which demonstrates the managers’ commitment to employing and developing highly qualified and professional staff. Issues of diversity are covered in the NVQ training and staff are fully aware of ways to record individual needs and ensure they are met. The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 This quality outcome is good. This judgement has been made using available evidence including a visit to this service. The home continues to be run and managed for the benefit of the service users. The staff are suitably supervised and they and the service users are safeguarded by the policies and procedures in home. The health, safety and welfare of service users and staff are promoted. EVIDENCE: It was evident to the Inspector whilst in the home, that the home is run in the interest of the service users. Staff and relatives confirmed that the service users wishes and choices are promoted within the home. Service users spoken to said that they felt secure in the home and they were made to feel very welcome from day one. Financial issues were all satisfactory and policies and procedures protected service users financial interests. The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 20 The ethos and leadership within the home is positive and open. The manager and her team are highly thought of by service users and their relatives/representatives. Staff supervision is now in place and up to date. The Inspector was able to evidence the minutes of the Staff meetings. The health, safety and welfare of staff and service users is promoted and protected by the rigorous testing, recording and monitoring of systems within the home. The maintenance person maintains the home in a professional manner and the records seen by the inspector evidence this. The following issues were raised relating to Health and Safety issues: • One fire door on a room containing equipment, should have been locked but was found open. • The back door which is a fire door was found damaged and awaiting replacement • Garden furniture must be risk assessed when used by the Service Users The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 21 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 18 3 3 3 X 3 X X 3 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 3 3 X 2 The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP38 OP38 Regulation 13(4) 23 (4c) v Requirement Risk assessments must be completed and signed for use of Garden furniture. Adequate fire precautions must be taken, fire doors which protect rooms with equipment and are signed ‘beep locked’ must not be left open. Fire escape doors made good as soon as possible. The working conditions must be made reasonable in the kitchen. 1) Better ventilation and reduction in heat levels 2) The kitchen must be redecorated Timescale for action 24/08/06 07/08/06 3 OP15 16 (2g) 24/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP24 OP7 Good Practice Recommendations Service Users bedrooms should be included in the ongoing refurbishment at the home. Service Users individual communication care plans should DS0000022349.V304979.R01.S.doc Version 5.2 Page 23 The Manor House Nursing Home 3 OP29 be further extended. Staff files should all have two references. The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Manor House Nursing Home DS0000022349.V304979.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!