Inspection on 07/03/06 for The Manor House Nursing Home

This inspection was carried out on 7th March 2006.

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

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

Other inspections for this house

The Manor House Nursing Home 21/11/07

The Manor House Nursing Home 08/11/06

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 7th March 2006 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.V280476.R01.S.doc Version 5.1 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.V280476.R01.S.doc Version 5.1 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 Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31), Physical disability (19) of places The Manor House Nursing Home DS0000022504.V280476.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Under Annex 2, a max of 19 service users requiring Nursing Care who fall in the category of either OP or PD A maximum of 31 service users requiring personal care of the category of OP Staffing for service users requiring nursing care will be in accordance with the Notice issued dated 3 August 2001 6th September 2005 Date of last inspection 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 31 residents, nineteen of whom may have nursing needs. The Manor House is a converted 17th Century property situated in the village of Chatburn. It stands in large, well maintained gardens with patio areas. There are parking spaces in the grounds. The home 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 two floors. There is a passenger lift and a 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. There are twenty eight single bedrooms and two shared rooms. Twenty rooms have en-suite facilities. There are accessible bathrooms and toilets on both floors. There are three lounges, a large conservatory and two dining rooms. The communal spaces are furnished in a homely way and to a good standard. The Manor House Nursing Home DS0000022504.V280476.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day. The previous statutory inspection was done on 6th September 2005 and information on the findings of this can be obtained from the home or from www.csci.org.uk There had been no additional visits to the home. At the time of the inspection there were 28 residents living at the home. The inspector met briefly with many of the residents and seven agreed to talk about their experiences of living in the home. Some of their views and comments are included in this report. Discussions were held with one of the owners of the home, two of the management team and six other members of staff. A partial tour of the premises took place and a number of records and documents were viewed. Detailed notes were taken, which have been retained as evidence of the inspection findings. What the service does well: What has improved since the last inspection? There were improvements in the way staff were recruited. The manager made sure that all new staff had thorough background checks. This provided greater protection for residents. Staff had received refresher training in safe working practices. This meant that they were better equipped to protect their own and residents’ health and safety. The Manor House Nursing Home DS0000022504.V280476.R01.S.doc Version 5.1 Page 6 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 DS0000022504.V280476.R01.S.doc Version 5.1 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 DS0000022504.V280476.R01.S.doc Version 5.1 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): EVIDENCE: None of the above standards were assessed during this inspection. Standard 3 was assessed and met during the inspection of 06/09/05. The Manor House Nursing Home DS0000022504.V280476.R01.S.doc Version 5.1 Page 9 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, 8 and 9 Care plans did not always address residents’ personal, health and social care needs. The lack of accurate and up to date information may result in inconsistencies in care. Shortfalls in the way medicines were managed may place residents at risk of harm. EVIDENCE: Care plans for three residents were inspected as part of the case tracking process. Others were viewed in less detail. One resident, who was admitted for short term care, did not have any assessments, risk assessments or care plans relating to their current admission. The plans for the other two residents showed lack of regular reviews. Some care plans were out of date others did not address current needs that were highlighted in the resident’s daily notes. Residents’ healthcare needs were not always recorded. The daily notes for one resident made several references to his low mood. Although the doctor had been consulted, there was no care plan to direct staff as to what care they should provide. The moving and handling plan for a resident had not been updated when his needs changed. There were some references in the daily notes to the use of the hoist but because of lack of details the staff were not The Manor House Nursing Home DS0000022504.V280476.R01.S.doc Version 5.1 Page 10 clear about how he should be assisted and were using different techniques. One resident, who had a history of falls, had not been further assessed. There was no care plan in place to minimise the risk of pressure sores for one resident who had been assessed as high risk. Wound care assessments and plans were not up to date. Despite these shortfalls, residents said that they were well looked after. One resident said, “I am much healthier now than when I came in” and another said, “if you are not well they rally round and attend to you.” The records of medicines received into the home were not complete, which meant that a full audit could not be undertaken. Instructions on handwritten Medication Administration Record (MAR) charts did not always accurately reflect the instructions on the medication labels. Handwritten amendments were not always signed and witnessed. There were some gaps on MAR charts with no explanation as to why medication had been omitted. One handwritten MAR chart was very poorly written. Its use had led to confusion and discrepancies on the next MAR chart and in the Controlled Drug Register. Although the balance of controlled drugs matched the stock, the records were not clear. Stocks of controlled drugs no longer in use had not been disposed of. The Manor House Nursing Home DS0000022504.V280476.R01.S.doc Version 5.1 Page 11 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, 13 and 14 Residents were satisfied the level of choice and control they had in their daily lives. The programme of activities met residents’ social and recreational needs. Residents had links with the local community and were supported to maintain contact with family and friends. EVIDENCE: All the residents spoken with said the home lived up to, or exceeded their expectations. One resident said, “I am very settled here, this is my home.” Another said, “I couldn’t be anywhere better.” Residents said there was plenty to do. They talked about arts and crafts, discussions, games and quizzes. One said, “there’s always something going on.” Another commented, “it’s nice to talk to people who remember things from years back.” A previous recommendation to provide activities for residents who were unable to join the main group had been actioned. There was a good programme of activities with choices for residents and sufficient staff to ensure they were carried out. The home had very strong links with the local community and held the Community Mark Award. Residents from the home participated in local events. One resident talked about concerts they had attended at churches, schools and the community hall. Likewise, events in the home were open to residents in the community. One resident said it was good to have this contact and commented, “you get to know what’s going on in the village.” Residents said The Manor House Nursing Home DS0000022504.V280476.R01.S.doc Version 5.1 Page 12 they were able to have visitors at any time. One said that visitors were always made to feel welcome and that staff “always make a pot of tea for guests.” Residents were satisfied with the routines in the home. One said, “they don’t bother what time you get up.” Another said, “you can have breakfast in bed if you want to.” One resident commented that the home was “very free and you can go out whenever you want.” Many residents were able to make their own choices about their day to day lives. One said, “everyone does what they want.” Staff said that if they had to make choices on behalf of other residents they were based on information from the resident’s family and by getting to know residents very well. Care plans contained some information about residents’ likes and dislikes in order to assist this process. The Manor House Nursing Home DS0000022504.V280476.R01.S.doc Version 5.1 Page 13 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): EVIDENCE: None of the above standards were assessed during this inspection. Standards 16 and 18 were assessed and met during the inspection of 06/09/05. The Manor House Nursing Home DS0000022504.V280476.R01.S.doc Version 5.1 Page 14 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): EVIDENCE: None of the above standards were assessed during this inspection. Standards 19 and 26 were assessed and met during the inspection of 06/09/05. The Manor House Nursing Home DS0000022504.V280476.R01.S.doc Version 5.1 Page 15 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 and 29 There were sufficient numbers of staff on duty to meet the needs of the residents but ineffective use of staff time led to shortfalls in some indirect care activities. Recruitment practices provided safeguards for residents. EVIDENCE: Extra staff had been recruited to work specifically with people who attended for day care. From discussions with residents and staff it was evident that there were sufficient numbers of staff on duty at all times to meet the needs of residents. One resident said that they were never kept waiting for attention. Another said “I just press the buzzer and they come.” There were some concerns that the registered nurses took responsibility for too many issues rather than delegate tasks to senior care staff. This included responsibility for care plans, medication and health care referrals for all residents. The nurse did not have enough time to make sure these indirect care activities were carried out to a high standard. The file of a new employee showed that pre-employment checks were carried out as required following the last inspection. All the required documents and information were retained on file. The Manor House Nursing Home DS0000022504.V280476.R01.S.doc Version 5.1 Page 16 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 and 38 Residents and staff benefited from a well managed home. Regular training in health and safety topics provided safeguards for residents and staff. EVIDENCE: One of the registered providers managed the home on a day to day basis. A management team, who each took responsibility for a different area of the service, supported her. In addition to holding two nursing qualifications, the registered person was qualified to NVQ level 4 in management. Her training profile evidenced that the registered person attended a wide range of courses designed to update both clinical and managerial skills. Residents were clear about the management structure and said the home was well managed. One resident said, “she makes sure everything runs just so.” A previous requirement to provide updated training in safe working practice topics had been implemented. The Manor House Nursing Home DS0000022504.V280476.R01.S.doc Version 5.1 Page 17 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 3 The Manor House Nursing Home DS0000022504.V280476.R01.S.doc Version 5.1 Page 18 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. 2. Standard OP7 OP7 Regulation 15(1) 15(2) Requirement Care plans must outline how residents’ personal, health and social care needs are to be met. Care plans must be reviewed regularly and amended as and when residents’ care needs change. Care plans must record any incidence of pressure sores and treatment provided. Any unnecessary risks to the health or safety of the resdents must be identified and so far as possible eliminated. This would include risk of falls. Care plans must identify the resident’s moving and handling needs and how they are to be met. MAR charts must provide an accurate record of medication given. (Timescale of 30/09/05 not met) Instructions on MAR charts must accurately reflect the instructions on medication labels. Records of medication received into the home must be complete. Entries in the controlled drug DS0000022504.V280476.R01.S.doc Timescale for action 30/06/06 30/06/06 3. 4. OP8 OP8 17 & Schedule 3(n) 13(4)(c) 30/06/06 30/06/06 5. OP8 15(1) 30/06/06 6. OP9 13(2) 31/03/06 7. 8. 9. OP9 OP9 OP9 13(2) 13(2) 13(2) 31/03/06 31/03/06 31/03/06 Page 19 The Manor House Nursing Home Version 5.1 register must accurately reflect information on the MAR charts. 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. Refer to Standard OP7 OP9 OP27 Good Practice Recommendations Residents’ daily notes should provide an accurate record of care provided. Handwritten amendments to MAR charts should be signed and witnessed. Staff roles and skill mix should be reviewed to ensure that enough staff time is allocated to indirect care activities. The Manor House Nursing Home DS0000022504.V280476.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB 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 DS0000022504.V280476.R01.S.doc Version 5.1 Page 21 - 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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