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Inspection on 16/11/05 for The Manor Nursing and Residential Home

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

This inspection was carried out on 16th November 2005.

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

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

Daily records, are accurate and reflect the care plans of individual residents. Residents have the opportunity to participate in a varied range of social activities provided by the Activity Organiser.

What has improved since the last inspection?

Care plans continue to be developed, and contain a more detailed record of resident`s physical and health care needs. Staff are currently accessing training in Infection Control, in addition nursing staff are undertaking training in Communication. Staff have accessed a half day course regarding medication facilitated by the homes dispensing Pharmacist. The Registered Person is in the process of recruiting both nursing and care staff.

What the care home could do better:

Care plans could further be developed to encompass an holistic approach to care, by incorporating where appropriate the mental health needs of individuals residing at The Manor to include the affect on this has on individuals day to day lives and the role of staff in supporting residents. Social and recreational needs of individuals could also be incorporated, with an individual record of participation being available. Dining chairs appropriate to the individual needs of residents to be provided to afford all residents the opportunity of being able to sit at a dining table for their meals. The Registered Person to consider the provision of training to all staff in areas such as Alzheimer`s disease, Mental Health, Dementia and Stroke Awareness should be considered, along with other medical conditions to which residents are diagnoses. This would enable staff to deliver tailored care, and ensure that care plans are informative. The following comments are as a direct result of the Complaint investigation. Confidentiality regarding resident`s care and the promotion of their rights could be improved. Residents, who are not assessed as being in receipt of nursing care, are to access health care from external practitioners. The consistency of resident`s care could be improved by all nursing and care staff being aware of the needs of all resident`s within the home, by the reading of care plans and by working with all residents.

CARE HOMES FOR OLDER PEOPLE The Manor Nursing and Residential Home 78-80 Lutterworth Road Aylestone Leicester Leicestershire LE2 8PG Lead Inspector Linda Clarke Unannounced Inspection 16th November 2005 10:00 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 Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 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 Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Manor Nursing and Residential Home Address 78-80 Lutterworth Road Aylestone Leicester Leicestershire LE2 8PG 0116 2990225 0116 2990257 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) Mr Bassir Jugon Mr Howard Michael Kelsall Care Home 49 Category(ies) of Dementia (49), Dementia - over 65 years of age registration, with number (49), Learning disability (23), Learning disability of places over 65 years of age (23), Mental disorder, excluding learning disability or dementia (23), Mental Disorder, excluding learning disability or dementia - over 65 years of age (23), Old age, not falling within any other category (49), Physical disability (49), Physical disability over 65 years of age (49) The Manor Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. No person may be admitted to the home who also falls within the category / combined categories MD, MD(E), LD, LD(E), when 23 persons who fall within any category / combined categories are already accommodated within the home. No person under 55 years of age who falls within categories DE, MD, PD or LD may be admitted to the home. 23rd August 2005 2. Date of last inspection Brief Description of the Service: The Manor Nursing and Residential Home is a large purpose built establishment situated on the Lutterworth Road close to the centre of Leicester. It is within easy reach of Leicester by public transport or car. The home offers accommodation for up to forty-nine residents with nursing, residential, mental health, and learning disability needs. The accommodation is based between two buildings, which are one unit, joined by a small corridor. The home also offers respite care facilities and is set in extensive mature gardens, which are mainly laid to lawn with shrub borders. There is a large conservatory and also a covered area, which is occasionally used for activities or as a quiet area for visitors. The home has a lounge diner on each floor and on one side of the premises a second large lounge is located. The home has a number of shared rooms and some bedrooms have en-suite facilities. Both floors are accessible to residents by either a passenger lift or a stair lift. All rooms are fitted with smoke detectors and nurse call systems. There are ample parking spaces and a number of local hotels and public amenities are within close proximity of the home. The Manor Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection has undertaken a third Inspection at this home due to areas of concern raised at previous Inspections. The Inspection focused on previous requirements, the development of care plans and the investigation of a complaint received by the Commission for Social Care Inspection. The complaint investigation has been recorded within one section of the report titled ‘Complaints and Protection. This was an unannounced Inspection that took place between 10.00am and 3.00pm. The Registered Person and the Deputy Manager facilitated the Inspection. The Inspector interviewed five members of nursing and care staff, along with the Activity Organiser and Handyperson. The Inspector also observed the lunchtime meal delivery to residents. As part of the Inspection process the Inspector viewed two resident care plans including daily records. What the service does well: What has improved since the last inspection? Care plans continue to be developed, and contain a more detailed record of resident’s physical and health care needs. Staff are currently accessing training in Infection Control, in addition nursing staff are undertaking training in Communication. Staff have accessed a half day course regarding medication facilitated by the homes dispensing Pharmacist. The Registered Person is in the process of recruiting both nursing and care staff. The Manor Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 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 Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 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 Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 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: Standards within this section were not inspected on this occasion. The Manor Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 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 Care plans could further be developed to reflect all aspects of resident care. EVIDENCE: The care plans of two individuals were viewed, improvements have been made as to the information recorded regarding residents care needs, and the guidance to staff in the delivery of care. Care plans could further be improved if they were to reflect a holistic approach to care. Care plans currently focus on physical health and personal care, this could be extended to include where appropriate the mental health of an individual and the impact this has on their day to day lives, and the role of staff in offering support. For those individuals in receipt of nursing care, it is recommended that care tasks which are the specific responsibility of nursing staff to identified. The Inspector interviewed five members of nursing and care staff. Nursing staff and senior carers are responsible for the development and reviewing of care plans. All staff interviewed confirmed that they had access to care plans. The Manor Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 Page 10 An agency member of staff was also interviewed, he stated he relied on permanent staff to gain information as to a residents individual needs, however he was aware as to the location of care plans. Staff interviewed stated that they were confident as to the level of care offered within the home, some members of staff felt the level of care was on occasions compromised due to the number of agency staff on duty. A significant number of staff felt that resident care could improve with additional staffing. The Manor Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 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 and 15. Various formal and informal activities meet the individual and collective needs of residents. The provision for the eating of meals does not meet all residents’ needs. EVIDENCE: Upon arrival the Activity Organiser was sitting with a group of residents in a lounge area, supporting them in an arts and crafts sessions. Music was playing in the background and residents were being encouraged to sing-along. The Inspector interviewed the Activity Organiser, who through the course of the conversation demonstrated enthusiasm for her role, and the promotion of resident’s dignity. The Activity Organiser advised that in house activities include craftwork, exercises sessions, sing a longs, reminiscence sessions, poetry readings, snakes and ladders and card games. In addition to this the Activity Organiser also organises a wide range of external entertainers. These have included Church Groups who visit the home for both Church of England and Catholic services. The Royal Leicester Dance Academy for ballet and other performing arts. A summer fete was held earlier in the year, at which various activities took place, which included a dog show and a Barbeque. The Manor Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 Page 12 External trips have included organised trips to ASDA supermarket for individual residents and group events at Christmas. A group trip to Dobbies’ garden centre in Warwickshire has also taken place. Future trips to Bradgate and Abbey Park are being planned along with an excursion to see the Christmas Lights in Leicester. The Activity Organiser currently records the participation of residents in activities collectively; it is recommended that a separate record be used for each resident. Recreational and social activities could form the part of a residents care plan consistent with a holistic approach to care. The Inspector observed the serving on the main meal at lunchtime, which appeared appetising. In one dining area, only two residents sat at the dining table whilst seven remained in armchairs, with ‘table trolleys’. An explanation to this practice was given, which was that the residents in question require supportive seating, which could not be met by the existing dining chairs. It was evident that some residents struggled to sit comfortably and eat their meals, and therefore it is necessary for appropriate dining chairs to be provided to ensure that residents can sit at the dining table. An additional benefit is they would experience a different seating position, and outlook. The Registered Person stated that new dining chairs are to be ordered; this will be followed up at the next inspection. The Manor Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 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): Standards within this section were not inspected on this occasion. The Inspector has used this section of the report to detail the outcome of the complaint investigated by the Commission for Social Care Inspection. EVIDENCE: The Commission for Social Care Inspection received a complaint, which investigated as part of the Inspection. The complaint covered four points. 1. The proprietors verbally abuse/shout at staff in the presence of residents and visitors. The Inspector interviewed five members of nursing and care staff, and in addition the Activity Organiser and Handyperson. Of the seven individuals spoken with four confirmed that one of the proprietors shouted at staff in front of residents and visitors, one member of staff stated that they did not contest the content but the presentation of the information. For those staff that confirmed such practices occurred, confirmed that the contents of such exchanges were usually with reference to resident care. Whilst one member of staff was aware that a proprietor had apologised to visitors, for being unprofessional when raising her voice to a member of staff en-route to the office. The Manor Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 Page 14 The Inspector spoke with the Registered Person, and advised as to the staffs’ responses to this issue. This part of the complaint is therefore upheld. 2. The lack of managerial support in the absence of the Registered Manager. It was confirmed by the Registered Person that the Registered Manager has been off from work for a period of time, in his absence the Deputy Manager has been undertaking managerial duties. The staff roster does reflect that part time nurses are employed and recently two additional part time nurses have been recruited and are waiting commencement dates for their employment. Staff interviewed did not confirm that there was a lack of managerial support but that there was a deficit in nursing staff on occasions. The Inspector spoke with the Registered Person, and advised as to the staffs’ responses to this issue. The Registered Person is currently reviewing measures to ensure appropriate managerial support. This part of the complaint is therefore not upheld. 3. The inappropriate use of nursing staff to administer flu inoculations to some non-nursing residents. The Inspector spoke with a member of nursing staff and both proprietors. A member of the nursing staff stated they had refused to administer the inoculations to non-nursing residents, and only did so upon the direct request of a Doctor. The Registered Person was not aware that the flu inoculations were intended for some non-nursing residents. This part of the complaint is therefore partially upheld. 4. Deficient staffing levels, and the high proportion of agency staff on duty. The Inspector interviewed five members of nursing and care staff, of which four confirmed the heavy use of agency staff. Although The Manor Nursing and Residential Home, is now considered to be one home, in the comments received from staff it was very clear that they still view the home as operating as two separate entities. Staff felt that the level of agency staff used on the ‘residential side’ did not impact on care, as an agency member of staff would work with two permanent staff. The Manor Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 Page 15 Whilst on the ‘nursing side’ often two or three members of agency staff work with one or two permanent members of staff, which can impact on the level of resident care. The Inspector spoke with the Registered Person, sharing the comments received from staff. The Registered Persons view is that the home operates as one unit, and as far as he is aware the deployment of staff supports this. However through discussions it is evident that the staff team are split into two teams. The Registered Person shared with the Inspector current recruitment measures. This part of the complaint is therefore partially upheld. Where the complaint has been upheld a requirement or recommendation has been made. The Manor Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Standards within this section were not inspected on this occasion. The Manor Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 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): Recruitment processes are robust. Residents care could further be developed if staff were to access a wider range of training. EVIDENCE: The recruitment records of two members of staff were viewed and were found to contain all the relevant information. The Criminal Record Bureau clearance had been requested, prior to the commencement of the staffs’ employment. Staff training was viewed; all members of staff have completed an ASET course in Moving and Handling, and are current undertaking an ASET course in Infection Control. Nurses in addition are working towards a course in Communication. The dispensing Pharmacist has also undertaken medication training with all staff since the last Inspection. It is recommended that nursing and care staff receive training with reference to individual resident care needs, to include Dementia, Alzheimer’s disease, Mental Health and Stroke Awareness. Staffing arrangements were in part addressed within the Complaint Investigation; information can be found within the section Complaints and Protection. The Manor Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 Page 18 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): EVIDENCE: Standards within this section were not inspected on this occasion. The Manor Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 Page 19 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X The Manor Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP16 Regulation 12(4) Requirement The Registered Person to ensure that all persons employed within the care home conduct themselves so as respect the privacy and dignity and confidentiality of residents. The Registered Person to ensure that individuals not in receipt of nursing care, have their health care needs met by external health care professionals. Nursing and care staff employed in the home must be training to meet the specialist needs of residents. Previous timescale of 07/10/05 not met. Timescale for action 30/11/05 2 OP16 12(1) 30/11/05 3 OP30 18 31/01/06 The Manor Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 Page 21 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 It is recommended that residents care plans reflect the mental health needs of residents. Detailing the affect that mental health has on the daily lives of the residents, and outlines the role of staff in offering support. It is recommended that care plans detail where care needs are to be met solely by nursing staff. It is recommended that appropriate dining chairs be provided, enabling all residents to have the opportunity to sit at the dining table for meals. It is recommended that the deployment of staff within the home be reviewed; to ensure that all staff work with and are familiar with the care needs of all individuals within the home. 2 3 4 OP7 OP15 OP16 The Manor Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX 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 Nursing and Residential Home DS0000001919.V258359.R01.S.doc Version 5.0 Page 23 - 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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