Inspection on 23/08/05 for The Manor Nursing and Residential Home

This inspection was carried out on 23rd August 2005.

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 Nursing and... 28/09/07

The Manor Nursing and... 30/05/07

The Manor Nursing and... 30/05/06

The Manor Nursing and... 16/11/05

The Manor Nursing and... 10/05/05

The Manor Nursing and... 17/11/04

The Manor Nursing and... 03/06/04

The Manor Nursing and... 11/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Manor Nursing & Residential Home 78-80 Lutterworth Road Aylestone Leicester LE2 8PG Lead Inspector Mrs Janet Browning Unannounced 23 August 2005 09:00 am rd 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 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 & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Manor Nursing & Residentail Home Address 78-80 Lutterworth Road Aylestone Leicester LE2 8PG 0116 2990225 0116 2990257 Telephone number Fax number Email 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 (CRH) 49 Category(ies) of Old age, not falling within any other category registration, with number (OP) 49 both, Physical disability (PD) 49 both, of places Physical disability over 65 years of age (PD(E)) 49 both, Dementia (DE) 49 both, Dementia over 65 years of age (DE(E)) 49 both, Mental disorder, excluding learning disability or dementia (MD) 23 both, Mental disorder, excluding learning disability or dementia - over 65 years of age (MD(E)) 23 both, Learning disability (LD) 23 both, Learning disability over 65 years of age (LD(E)) 23 both. The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 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 the 55 years of age who falls within categories DE, MD, PD, or LD may be admitted to the home. Date of last inspection 10th May 2005 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 now 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 are en-suite. 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 & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place fifteen hours over two and half days on the 23rd, 24th and 25th August 2005. A pharmacy inspector also attended for six hours over 24th and 25th August 2005. When undertaking inspections, the Commission for Social Care Inspection (CSCI) focuses on the outcomes for clients living in a home. To support this, four residents living at The Manor were ‘case tracked’. This means that the care records of four clients were checked; the clients themselves were spoken with where possible, as well as three members of staff supporting their care. Opportunity was taken to speak to five other residents in the home and three relatives/visitors visiting the home at the time of the inspection and some of the home’s documentation was also examined. A second pre-inspection questionnaire, sent out to the home prior to the inspection, was not returned back to CSCI as requested, and no comment cards were received from residents or relatives. An additional visit inspection also took place on 10th June 2005. The recommendations and requirements arising from this inspection are a direct result of case tracking and other observations made by the inspector during and after the inspection. What the service does well: The home encourages community contact and endeavours to build up relationships with relatives and visitors. Residents are encouraged to bring personal belongings for their rooms and the rooms are well furnished. As mentioned from the previous inspection, there is an excellent activities organiser working at the home. The home is kept clean and tidy, and there is a good maintenance programme with the maintenance person being flexible and well trained to meet the requirements of the home. The laundry room appears well run and organised. The home actively supports career development for senior carers who wish to leave to take up nurse training. Newly promoted senior carers demonstrate good awareness of their role. The residents and relatives spoken to during the inspection gave mainly positive comments about their care. The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: There is a definite difference in atmosphere in the two sides of the home. The home does not feel like one home. Care plans have improved with plans to change all the care plans to a new format. However, the care plans currently in use still do not have adequate detail to enable staff to have clear instructions as to how to meet their needs. Care plans are not always evaluated monthly, or changes in care reflected in new care plans. Some care staff feel that they are not allowed to read or contribute to the care plans. Indications are that continence assessments are not initiated or continence always promoted. Wound care has improved, but further improvements could be made to be in-line with best practice. The pharmacy inspector inspected medication and serious shortfalls were discovered. These were surrounding the administration and recording of medication, the auditing of medication and medication storage. The staff administering medication did not have training or updates on medication to ensure that they understand this role and the potential problems involved with medication administration. Mealtimes are different on each side of the home with one side having a sociable atmosphere with residents seated around tables, but on the other side the indications are that residents routinely have their meals sitting in their armchairs. New dining chairs have been brought, but there is a question as to their suitability for the residents. Residents requiring assistance with their meals are sometimes wearing undignified plastic aprons to protect their clothes and the large number of residents requiring assistance and prompting with meals is such that it is difficult for the numbers of staff to meet all residents’ needs adequately. The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 7 The mix of experienced and inexperienced staff is inadequate to ensure that residents’ needs are being met. Liquidised meals are available, but presented with all parts of the meal liquidised together. It is not documented whether this is to residents’ choice. The indications are that residents who are able to mobilise with support of carers, are routinely wheeled in a wheelchair. Residents need to be offered the chance to exercise and residents are not always asking for assistance to go outside of the home due to staff previously not having the time. Residents’ preferences and usual daily routine are not always documented, which is important for those unable to voice their own choices. The home has not developed an adequate system for monitoring the quality of the service it offers, including residents’ and relatives’ views. This includes not having regular team meetings and providing formal supervision of the staff. Relationships between some junior and senior staff is not helpful in creating a pleasant atmosphere in some parts of the home. Risk assessments must be performed immediately on residents who require bedrails and/or bumpers and all staff must be aware of the correct moving and handling procedures for all residents. The general risk assessment used in the home is not relevant for the category of residents living in the home. 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 & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 9 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 standard(s) 3, 4 and 6 The assessment procedure is adequate in identifying residents needs but not all staff are fully trained to meet specialist care needs identified and therefore there is no assurance that all needs can be fully met. EVIDENCE: The residents’ care plans examined contained a full assessment of needs. The assessment documentation is detailed, but also lengthy and repetitive, making it difficult to read. However the content and detail had improved from the last inspection and a plan of care could be developed from the information obtained from the assessment. Some of the senior carers have left for career development and junior carers have been promoted, which has left the home with some unqualified staff who have not received training to meet the specialist needs of some of the residents, such as dementia care and challenging behaviour. Intermediate care is not provided. The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9 and 10 Lack of sufficient detail in some care plans and poor practice in the medication procedure, places residents’ health and welfare at risk. Generally, the approach of the staff is such that residents feel that they are treated with dignity and respect. EVIDENCE: Care plans have improved, but some care plans still do not have adequate information to give carers exact details as to how to provide the care and varied from one side of the home to the other. For example, on talking with carers it was evident that they were not sure when a catheter bag for one resident was to be changed, deciding that they would change it every two or three days or if it leaked or looked “dirty”. There are best practice guidelines on catheters and bags, which were not documented in the care plan. Care plans are not completed for moving and handling requirements. Care plans are not always reviewed monthly or changed to reflect changes in care needs. Generally, evaluations of care plans had improved providing the reader with sufficient information as to the effectiveness of the care being delivered. Some care staff are under the impression that they are not allowed to look at the care plans for guidance. Staff comments were; The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 11 • • • “I’ve looked at some care plans, but have been told that we are not allowed to.” “I need to know more about the residents, but I was discouraged from reading the care plans.” “I look at care plans and also write in them.” (Senior carer) The registered manager demonstrated new care plans that are being developed for all existing residents and for new residents as they are admitted to the home. These were of a good quality with adequate and individual detail, which is what is lacking in the core care plans still being used. There was evidence of other professional involvement, with the Cardiac Failure Specialist Nurse visiting during the inspection. Indications are that care plans for wound care are of a good quality, but that the nurses providing the care for residents on the old residential side of the home are not documenting when they have performed the care or evaluating the effectiveness i.e. there was no indication if the wound was healing or deteriorating. There was evidence that full continence assessments were not taking place or that continence was being promoted on residents who were previously continent prior to admission to the home. Another resident, who was seen getting up out of his chair and walking, was put into a wheelchair to be taken to the toilet. The care records stated that he was able to walk. Residents who were able to talk with the inspector, indicated that they were happy with the care they received; • “I can’t complain.” • “I am well cared for.” A relative stated; • “I am happy with the care.” Staff were observed treating residents with respect with evidence of staff knocking on doors before entering. Residents stated; • “The staff are lovely and friendly.” • “Staff all kind and nice.” • “Staff knock on the door before they come in.” However, residents in the upstairs lounge were wearing white plastic aprons around their necks as bibs, when cloth aprons were being used downstairs. The Pharmacist Inspector reviewed the medication administration record (mar) sheets for four residents case tracked by the Lead Inspector. Two areas of serious concerns were highlighted and an immediate requirement was issued. These were surrounding the following; • Incorrect administration and recording of medication e.g. a nurse had administered a dose of eye drops from a bottle that was out of date, tablets were found on top of medication trolley which had been signed as given. C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 12 The Manor Nursing & Residential Home • • • • • • • • The recording of medication coming into the home e.g. medication found in a bag which could not be accounted for. Administering medication not as prescribed. e.g. the nurse had already signed to state that this resident had taken her Ascorbic acid tablet but then stated verbally to the Inspector that these “where still in the blister and had not been given” Not all staff designated as being able to administer medication receiving accredited training, giving medication unsupervised. Incorrect storage of medication in the fridge that did not require cold storage. Temperatures on fridge not being recorded. Incorrect information recorded in the returns book for medication i.e. not recorded to each individual resident. Food supplements not being used for the individual resident it was prescribed for. Temazepam not being stored in controlled drugs cupboard. Plus many other issues that required the home to address. All Controlled Drugs on the premises were audited and were found to be correct. The CD register appeared to be in order. The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 13 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 standard(s) 13, 14 and 15 The varied selection of foods available generally meets residents taste and choice, but lack of adequate assistance could potentially put some residents at risk of not receiving sufficient nutrition. Community contact is promoted by the home ensuring contact is maintained for residents. EVIDENCE: Relatives and visitors are encouraged to visit the home and there are no restrictions unless requested by residents themselves. The home encourages good relationships with relatives, which was evident from seeing visitors pass through the reception area and chatting with the manager whilst signing in. Local groups are invited into the home and the home held a garden fete in June, which was well attended. Residents are offered choice in their routine, but daily routine is not documented in the care records for those residents who are unable to voice their preferences. For example, preferred times of going to bed or getting up is not documented, so it is difficult to know if getting up at 6 or 7am is usual for some residents. Advocacy is mentioned in the statement of purpose but there wasn’t any information displayed for residents, relatives or visitors of local advocacy services and relatives were not aware of this service. The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 14 Two residents expressed preferences to go out; • “I wish I could go out for fresh air, I’d love to go in the garden…I’ve stopped asking now, ‘cause they (the staff) are not able to.” A varied diet is offered in the home with the kitchen being downstairs. This does mean that if extra hot drinks are wanted, carers from upstairs have to come downstairs for the drinks. The indications are that the cook is very experienced and will provide different diets to suit different needs. Many residents require liquidised diets, which were served all mixed up together and did not look appetising. The cook explained that having each item liquidised separately on the plate was tried before but residents did not like it. This preference was not documented in care records and therefore difficult to establish the preferences of residents who had difficulty communicating. Comments from residents were; • “Most of the food is good.” • “I have liquidised food. It’s nice and all mixed up.” • “Food’s good, good vegetables.” Many residents required assistance with feeding on one side of the home, with five residents upstairs and three residents downstairs. It was noticed that with only four carers to feed eight people as well as serve and supervise the rest of the residents, the carers were struggling and residents were left for quite a while with their hot food in front of them getting cold. There is a marked difference in atmosphere between the two sides of the home with one side having mostly all residents sitting at the dining tables socialising and the other side only having two residents. The reason given was that residents required feeding, but not all required assistance. There was no evidence provided as to why residents could not be offered the choice of where they sit. The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 15 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 standard(s) 16 and 18 Complaints recording and staff awareness of adult protection procedures is sufficient to ensure that residents and relatives are confident that concerns will be listened to and that residents are protected from risk of harm. EVIDENCE: The home has improved the recording of complaints with a new complaints book being developed. The one complaint within the book had investigation and action taken recorded. This was a requirement from the last inspection. Two relatives indicated that they were aware of the complaints procedure and had been given a copy. The complaints policy does not give assurances of complaints being responded to within a specific time frame. The manager stated that it is the home’s aim to be open and transparent. A new member of staff spoken to understood fully about the adult protection procedures as outlined in the Department of Health “No Secrets” guidance. She had received training during her induction and gave a full response on reporting procedures. This is an improvement from the last inspection. The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 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 standard(s) 19, 20, 24, 25 and 26. Generally maintenance and cleanliness within the home is such that residents have a safe environment and are protected from the risk of infection. EVIDENCE: A tour of the premises demonstrated that generally the home is well maintained with a maintenance person who has been on training courses to ensure that he is able to tackle most jobs within the home and provides routine maintenance. The garden is large with a sloping lawn, making it inaccessible for some residents, but has benches for sitting on a patio area. The carpets have only been recently replaced in the home but are very stained in some places. The home is intending to replace them again. The indications are that the home meets both fire and environmental health regulations. New chairs and tables of a modern design were delivered during the inspection. Carers were seen struggling to push a resident sitting in one of the chairs closer to the dining table. None of the chairs had arms. The home needs to be assured that the design of the chairs is suitable for residents, especially those with complex needs. The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 17 The individual rooms of residents case-tracked were pleasant and well furnished with many having new electrical beds. All beds seen were of a suitable height. Records indicated that lighting and hot water temperatures were regularly tested. A random test performed during the inspection indicated that hot water temperatures were within that recommended. The home was well ventilated on a warm day. The maintenance person routinely checks air mattresses and has been trained to repair any that are broken. Indications were that laundry was being performed safely, with adequate infection control policies in place and adequate gloves and aprons apparent on trolleys. Staff are having a course on infection control commencing in September. The wash hand basin in the sluice room upstairs was no longer being blocked with equipment. This was a requirement at the last two inspections. Staff were seen wearing adequate protection when dealing with clinical issues. The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Staffing levels at peak times and skill mixing are such that the needs of the residents are not being met. EVIDENCE: The home has training courses coming up for staff but staff working in the home have not always had adequate training or the skill mix is not utilised safely. During the inspection, a new carer to the home was working with an agency carer with residents with highly dependent physical and dementia care needs upstairs, whilst a senior carer and a more established member of staff was working downstairs. The new carer was not communicating with the residents, but had not received training in dementia care, which would include communication. Again this is different in one side of the home than the other. The indications are that senior carers receive adequate training and the indications were that they had knowledge and experience of caring for people with dementia. Staff comments were; • “Sometimes I think I know what to do, sometimes I don’t.” • “I want to do NVQ3 training - my name is being put forward.” • “If carers were trained properly, we would be able to provide the specialist care the residents need.” • “More training would stop staff leaving and not bring the home down.” One senior carer had left and another is going to leave to do nurse training after completing NVQ3 following encouragement and support from the registered manager. The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 19 New members of staff receive a one weeks induction with a mentor, but the indications are that they do not receive an in-depth induction foundation. The registered manager demonstrated a new induction folder, which is going to be introduced. New members of staff were working with highly dependent people requiring dementia care without being adequately trained. The manager stated that it had been difficult due to senior carers leaving. The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 36, 37 and 38. There is no formal quality assurance system or staff supervision in place, which results in the quality of care provided not being monitored and some staff not feeling supported. Some current practices in the home do not promote or safeguard the health, safety and welfare of the people using the service. EVIDENCE: The registered manager is approachable for staff and relatives/visitors and endeavours to create an open atmosphere. The general office is in one side of the home and the door is always open for staff to talk with him. Staff comments were; • “Manager is very helpful, has given me information on dementia care.” • “The manager comes across to speak with us and to see how we are.” A relative commented; • “An incident was dealt with by the manager to my satisfaction.” The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 21 Staff meetings are not routinely held for the whole of the home therefore staff do not have the opportunity to put forward their point of view or to contribute to home improvements. Staff comments indicated that they felt staff meetings were important. Staff still do not receive any formal supervision, which is important in monitoring the quality of care the residents are receiving and also for providing support for carers. Staff comments were; • “I would like one-to-one support.” • “The manager asks me how I’m getting along when he comes over.” Although the comments received from staff were that the team interacted well together, there was evidence during the inspection of some senior staff not promoting professional relationships with some junior members of staff leaving some junior staff feeling concerned and unsupported. This was evident in the general atmosphere on one side of the home and is not conducive to the welfare of the residents. The manager was aware of this and was going to address this. The general risk assessments used are more suited to people who are residing within their own home rather than a care home. Some individual risk assessments were either missing or incomplete. For example, the residents receiving nursing care did not have risk assessments in place for the use of bedrails. During the inspection two carers were observed performing an unsafe moving and handling technique, which was different to that documented in the risk assessment. There was no care plan. The carers stated that they did not read the care records as they thought they weren’t allowed relying on this information from the handover from the nurses. The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 3 x x x 3 3 3 STAFFING Standard No Score 27 2 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 2 1 3 x 1 2 1 The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 23 Yes 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. Standard 4.4 Regulation 18 (1) (a) Requirement All care staff employed in the home must be sufficiently trained to meet the specialist needs of residents. Further improvements must be made to ensure resident care plans are in sufficient detail to provide guidance to staff on the actions to be taken to meet all their health and welfare needs. (Previous timescale of 02/07/05) Staff must be encouraged to read the care plans. The home must ensure that care plans are reviewed monthly and updated to reflect changing needs and actioned. Ensure that all service users are administered medication as instructed by the prescriber. Maintain an accurate record for all medicines entering and leaving the premises for each resident. Medication administration sheets must only be signed once witnessed administration has been taken place. Medication trolleys should be stored in a location where the Timescale for action 07/10/05 2. 7.2 15 (1) 19/09/05 3. 7.4 15 (2) (b) (c) 12(a)(b), 13(2),17( 1)(a) &18(c)(i) 13(2)& 17(1)(a) 13(2)& 17(1)(a) 13(2) 07/10/05 4. 9 25/08/05 5. 9 19/09/05 6. 9 12/09/05 7. 9 12/09/05 Page 24 The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 8. 9 9. 9 The Medicine Act 1968 & 13 (2) 13(2)&18 (c ) (i) 10. 15.9 12 (1) (a) (b); 18 (1) (a) 11. 27.1 room temperature is maintained at 25 C or less and should be secured to the wall when not in use Medication that is precribed (includes food supplements) must only be administered to the person it was issued for. Only staff that have the relevant assessment of competency to administer medication are allowed carry out this task unsupervised. The home must ensure that proper provision is made to supervise and assist residents at mealtimes. The home must ensure that staffing numbers and skill mix of both qualified and unqualified staff are appropriate to the assessed needs of the residents and the lay-out of the home at all times. The home must ensure that there are additional staff on duty at all times of increased activity e.g. meal times 25/08/05 19/09/05 19/09/05 19/09/05 12. 27.4 18 (1) (a) 07/10/05 13. 30.2 18 (1) ( c) Staff must receive training appropriate to the work they perform, especially regarding the particuar needs of the service user group and that training records are kept accurately. 24 (1) (2) (3) 07/10/05 14. 33 15. 38.1 13 (2) Systems must be established for 07/10/05 reviewing, improving and maintaining the quality of care, including nursing care, within the home. (Previous timescale 02/07/05) Risk assessments must be 19/09/05 perfomed and be detailed on all pieces of equipment that residents have access to and all activities. Bedrails and bumpers Version 1.40 Page 25 The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc 16. 38.2 13 (5) must not be used until a risk assessment has been carried out. All staff must be aware of the correct procedures for moving and handling. Immediate RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard 7.2 7.3 8.6 8.8 9 9 Good Practice Recommendations It is strongly recommended that the reading of care plans is promoted for all carers. It is recommended that care plans for wound care follow best practice guidelines. It is strongly recommended that all residents are provided with continence assessments and professional advice is sought on continence promotion. It is strongly recommended that all residents assessed as mobile are giving the opportunity for exercise and not routinely transferred by a wheelchair. All Controlled drugs on the non-nursing unit are stored in a cabinet that conforms to the Misuse of Drugs Act 1973. A British National Formulary of no older than 2 years be used as a medical reference and to identify possible sideeffects. This is addition to retaining the product information leaflets of all medicines supplied Record daily the maximum and minimum teperature of clinical fridges in use. All staff who handle medication to have regular assessments of competency by a nurse or Pharmacist. All staff to have Pharmacist-led training on the on the current medication handling guidelines issued by the Royal Pharmaceutical Society. Management to carry out regular medication handling assessment/ audits, report actions taken on any anomalies found and measures taken to prevent reoccurrences. Maintain accurate medication profiles in each resident’s care plan. It is recommended that residents wear appropriate covering at mealtimes that respects their dignity. C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 26 7. 8. 9. 10. 11. 12. 9 9 9 9 9 10.1 The Manor Nursing & Residential Home 13. 14. 15. 16. 17. 18. 19. 14.1 15.1 15.4 16.2 20.7 32.3 32.7 20. 21. 36 38.1 It is strongly recommended that residents have assistance to be able to go outside of the home when they wish and choose to. It is recommended that mealtimes be taken in a congenial setting and all residents are offered the choice of being able to eat meals at the dining table. Residents who require liquidised meals should be offered the choice of how it is presented. It is recommended that the homes complaints procedure has an assurance that complaints will be responded to within a maximum of 28 days. It is recommended that the home assures itself that the furniture in the dining room is suitable for the range of residents in the home. It is strongly recommended that regular staff meetings are held for the whole of the home and minuted. It is strongly recommended that all staff work under the standards set in the General Social Care Council, especially in regard to staff welfare and harrassment in the work place. It is strongly recommended that all staff receive formal supervision at least six times a year. It is recommended that a risk assessment tool is used that is appropriate for the home and category of service users. The Manor Nursing & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 27 Commission for Social Care Inspection The Pavilions 5 Smith Way, Grove Park Enderby, Leicestershire 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 & Residential Home C51 C01 S1919 The Manor V238906 230805 Stage 4.doc Version 1.40 Page 28 - 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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