Inspection on 14/06/06 for The Manor Nursing Home [Bishop`s Hull]

This inspection was carried out on 14th June 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 Nursing Home [Bishop`s... 05/11/08

The Manor Nursing Home [Bishop`s... 15/08/07

The Manor Nursing Home [Bishop`s... 13/03/06

The Manor Nursing Home [Bishop`s... 06/09/05

The Manor Nursing Home [Bishop`s... 03/02/05

The Manor Nursing Home [Bishop`s... 25/05/04

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE The Manor Nursing Home Haydon Close Bishops Hull Taunton Somerset TA1 5HF Lead Inspector Caroline Baker Key Unannounced Inspection 14th June 2006 09:25 X10029.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 Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. 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 Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Manor Nursing Home Address Haydon Close Bishops Hull Taunton Somerset TA1 5HF 01823 336633 01823 346072 manor@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Limited 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) Mrs Susan Margaret Iddon Care Home 86 Category(ies) of Old age, not falling within any other category registration, with number (86), Physical disability (20) of places The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Elderly persons of either sex, not less than 60 years, who require general nursing care Twenty-one places for persons of either sex, in the age range of 20-59 years, who require general nursing care, to include one named service user, as detailed in the letter dated 20th December 2004. To reduce to twenty (20) places when a younger adult is discharged. Up to three places for personal care. Registered for a total of 86 places in categories OP and PD. One respite care place allocated to a named younger adult, as stated in letter dated 24/08/04. 13th March 2006 3. 4. 5. Date of last inspection Brief Description of the Service: The Manor Nursing Home was purpose built and is set in attractive landscaped gardens with ample car parking space. Accommodation is mainly provided in single bedrooms all of which have en-suite facilities. Corridors are wide and equipped with handrails. There are a variety of communal areas, which are comfortably furnished; one lounge is set aside for the use of younger residents. Residents are free to spend time where they wish and with whom they wish; visitors are welcome at the home without appointment. The home employs registered nurses, carers, activities staff, and catering and housekeeping staff to care for residents. The current fees are: £575 to £725 per week. Hairdressing, aromatherapy, chiropody and theatre trips are not included in the fee. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was conducted by three inspectors, Caroline Baker, Judith Roper and Jane Poole (24 inspector hours). Prior to the inspection the registered manager had completed a questionnaire about the service and eight residents had completed and returned commission questionnaires. The commission sent surveys to sixteen residents. Eighty-four residents were living at the home, which includes twenty-one younger physically disabled residents, and one resident in hospital. The majority of National Minimum Standards (NMS) were assessed under Younger Adult (YA) and Older Persons (OP) standards. One of the inspectors specifically assessed the NMS for the younger adults at the home. An assessment of the premises took place where a selection of bedrooms and communal areas were seen. At least fifteen service users, five visitors and seven staff were consulted with. The registered manager was on leave at the time of this inspection, however the nurse in charge was available throughout. Throughout the day the inspectors were able to observe interactions between staff and residents. Records relating to the care of the residents, staff and health and safety were examined. The inspectors would like to thank the residents, and staff for their help and time during the inspection. What the service does well: Service users looked well cared for on the day of inspection. Those seen were well attired and the majority complimented the staff at the home stating that they were well cared for and that the food was very good. Staff work very hard to maintain a high standard of personal care at the home given that sometimes there are staffing shortfalls. The atmosphere at the home was relaxed and happy. The interaction between staff and service users was generally good. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 6 Service users in particular younger residents, are able to access the community and go to the local college and go out on organised trips. A mini bus is available with a designated driver. The home ensures where possible that all service users have access to appropriate health care professionals and will offer support to attend appointments where appropriate, however this may be charged for. Families can visit at any time and are made welcome at the home. The home and grounds are well maintained. Overall the home was clean and pleasant. Infection control measures in place were good. What has improved since the last inspection? What they could do better: Prospective residents and their representatives would have a better informed choice if the Statement of Purpose and Brochures were not misleading, for example, photographs in the brochures appear not to relate to the home. Residents admitted to the home would benefit more if the home established their individual care and specialised needs before admission to ensure the home could meet their needs. Residents would benefit more if they were in a position to influence the routines at the home and staff were in sufficient numbers to be able to meet individual residents levels of dependency and specialist needs. Residents would be at a lesser risk of harm if medication administration was recorded correctly and prescribed medication for example creams had dates of opening or expiry dates on them. Residents would be at a lesser risk of harm if substances hazardous to health and oxygen cylinders were stored securely. Residents would benefit and be able to have extra privacy if they were able to lock their rooms as stated in the homes Statement of Purpose. Residents would benefit from a range of specialist bathing facilities to suit the individual needs and if able to use their own en-suite baths. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 7 Residents would be at a lesser risk of harm if they were able to access a call bell to summon assistance at all times. Residents would benefit if their carpets were kept clean and free of offensive odours – two rooms assessed needed attention. The home should be working towards meeting the environmental standards for the younger physically disabled residents for April 2007 and the CSCI has requested that a plan of action be submitted outlining the company’s intentions. A meeting took place with representatives of the care home on Friday 21st July 2006 to discuss elements of this report with the CSCI, and the report was amended accordingly as a result of the meeting. 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 Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1; 2; 3 and 4. Quality for this outcome group was adequate. Residents are able to make an informed choice from the Statement of Purpose and brochures available, however they are corporate documents and do not contain full details about The Manor. Residents were not always assessed prior to admission to ensure the home can meet their needs. Residents have a contract of terms and conditions. Staff individually and collectively had the skills to meet the needs of the current residents. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home has updated its Statement of Purpose since the last inspection to include the registered manager. Its contents are in line with legislation, however they do not fully reflect the service offered at the home. The Statement of Purpose must be adjusted to allow for an informed choice. The homes brochures are corporate and contain some photographs that do not pertain to The Manor care home. Eight care plans were assessed as part of the case tracking process, three being of the most recent residents admitted to the home. One resident, with a primary specialist need (dementia), according to their admission sheet, had recently been admitted. They had been admitted without any assessment undertaken by the home or other healthcare professional prior to admission. This would make it difficult for the home to know whether they could meet their individual needs. One resident was expecting physiotherapy according to their pre-admission assessment however there is no physiotherapist employed by the home; but according to the Statement of Purpose and homes brochures physiotherapy can be accessed through PCT referral. All service users must be assessed prior to admission in line with the homes Statement of Purpose, which states: ‘Prior to admission a pre-admission assessment is carried out to ensure that the Home is able to meet the needs of residents……’ and ‘admission to a care home follows a careful assessment of your personal care and nursing care needs and we ensure that before you come to the home………’ The home’s ‘Residents Terms and Conditions’ has been updated since the last inspection. It forms part of the Admission Agreement with the home, which becomes ‘legally binding’. Fees are reviewed in April each year. The first four weeks of the residents’ stay is regarded as a trial period and either party can terminate the agreement by written notice of 48 hours. Surveys received from residents indicated that they had received a contract. According to the Nurse in Charge, speaking with staff and training records seen some specialist training has been provided. Evidence was seen of one certificate in Huntington’s disease and according to the Nurse in Charge three staff had received dementia awareness training. It was difficult to evidence staff training in all areas as records are being updated, and there was no recorded evidence of any specialist training, therefore this will be followed up The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 11 at the next inspection. Registered Nurses are employed 24 hours per day, which include RGN’s and RMN’s. Over 50 of care staff have a care qualification – see ‘Staffing’. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are 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; 9 and 10. Quality in this outcome group was adequate. Care planning practice was generally good however some areas in regard to residents’ physical and personal care needs needed improving. Evidence was seen of input from the resident and/or their representative. The management of medication within the home improvements to ensure residents are not at risk of harm. requires further Residents are unable to have total privacy in their own rooms, as there are no locks on their doors. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 13 EVIDENCE: Eight care plans were sampled as part of the case tracking process and seven of the residents were met. They all showed evidence of residents having been offered opportunity to be involved in their development and mostly reflected residents personal preferences. Many residents consulted however, indicated to inspectors that the staff dictate the routine of the home. One care plan stated that the resident wanted to get up ‘early’ each morning however following a discussion with staff had agreed to 10:30 hrs. This was discussed at a meeting with the representatives of the home on Friday 21st July 2006, when it was explained that the home would endeavour to assist residents to get up when they would like to, however at times a compromise was sought given the care needs of all residents at the home. Care plans seen reflected how residents’ personal and health care needs should be met. Care plans reflected residents need to be supported to lead active lives; most did not provide adequate description of how this should be done (See ‘Daily Life and Social Activities’). Care Plans did not always reflect specialist needs for example epilepsy. They should reflect these medical needs with a clear plan set out with detailed actions for staff to follow, and diabetes plans should be clearer to reflect the normal BM range for the individual resident. Daily records were assessed and should be monitored along with care practice and competencies of staff, as some entries seen were inappropriate for example: ’08:30 bottom half washed, 10:15 top half washed’. Individual risk assessments were seen on individual residents care plans. They contained details of the risk and how it was to be managed by staff. On examination of the medication systems and at least 44 Medication Administration Records (MAR) at the home the inspectors identified the following: Gaps in signing for the administration of prescribed medication at the prescribed times, were seen on a number of occasions on 14 of the 44 MAR charts sampled. Blister packs sampled had had tablets taken out on differing days to the MAR making it confusing to audit whether the tablets had been given or not. In six of the en-suite bathrooms assessed prescribed creams and emollients in either tubs or tubes were seen some without a name and none with an opening or expiry date. Topical prescribed creams were not signed for on MAR charts sampled and care plans sampled did not identify where specified care staff had applied creams. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 14 Oxygen was seen in the treatment room downstairs un-securely stored. An Immediate Requirement Notice was issued. The Controlled Drugs systems assessed evidenced good practice. All hand transcribed medications had been witnessed. The treatment rooms had medicines stored at the correct temperature for example 21oC. Eye drops seen were dated on opening. Medicines seen in the fridge were stored correctly and correct temperatures had been maintained. Policies were in place for crushing medication, self-medication and homely remedies. One resident was self-medicating however had stored the medications in an un-locked cupboard. This was brought to the attention of the nurse in charge who spoke to the resident who agreed to store them in the lockable space available. For those residents prescribed ‘digoxin’ pulses had been recorded on MAR charts however there was no record of when or when not to give digoxin and this should be considered, to enable staff to know the normal range for the individual resident. Residents spoken to during the inspection mainly indicated that the staff treated them with respect and maintained their privacy. Staff were heard addressing residents appropriately and were also seen knocking on doors before entering rooms. Curtains were drawn across door windows when care was taking place however on one occasion a resident was seen sat in a bath, clothed, washing their legs and the door was wide open which raised privacy and dignity issues The homes Statement of Purpose highlights the fact that every effort will be taken to retain residents’ privacy and dignity, it states: ‘In many respects a care home is similar to a hotel; for instance, you can keep your room locked at all times’. It was concerning therefore to note that none of the residents private accommodation was furnished with a lock. This must be reviewed without delay. In a discussion with representatives of the care home on Friday 21st July 2006 it was agreed that individual residents would be asked whether they would like a lock on their private accommodation or not. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the 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; 14 and 15. Quality in this outcome group was good. Younger adults at the home benefit from good support, which enables them to learn and develop skills, enjoy a range of leisure activities and to access local community facilities. Older adults benefit from help to take part in activities and entertainments, but more work is needed to ensure opportunities are available for those residents who spend their days in bed to suit to each individual. Residents maintain links with their families and friends. Routine at the home appeared to be led by the staff not through the residents’ choice. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 16 Service users are offered a choice of nutritious well-balanced menus promoting their health and well being. EVIDENCE: “Social Activities Assessments” were seen in resident’s care plans assessed however they were not completed. Two care plans sampled had a life history outlining the residents past occupation and hobbies, which is best practice. The home programme of activities available seen was varied and include trips out of the home. Records were seen of when residents had participated in activities but were very limited and it was not possible to see whether residents had been offered the opportunity to take part in activities and had declined the offer. Of eight residents completing commission questionnaires 25 stated the home always provided activities they could take part in, 50 stated they usually do, one resident stated that the home never provided activities that they could take part in and one resident stated they were unable to take part. Residents spoken to during the inspection praised the activity provision. One comment received via a survey was ‘ Excellent trips out, hairdresser, activities x 2 daily, functions in the evening – all work very hard’. There are four Activities Co-ordinators employed, two full time and two part time, who lead specific interventions with service users. Inspectors discussed activity provision with the activity co-ordinator, who told inspectors that 1 to 1 social care for those residents nursed in bed does take place, but not as often as they would like, however had not been recording it and agreed to do so in future. The home has a mini-bus used to transport residents to appointments and the local college. The mini-bus and driver support access to local amenities in Taunton and the surrounding area. Staff support is normally given to service users who are able to go out which can incur a charge. No residents of The Manor are currently employed. Speech and language therapy is accessed via the NHS, on referral by the GP. Aromatherapy is available on a fee-paying basis. Family and friends of service users are welcomed to The Manor. Visiting is ‘open’ and would be at the request of the service user. Visitors seen at the home and consulted were generally satisfied with the overall care provision. Comments received from families via residents surveys included:’ My relative has been very well cared for’ and ‘staff are always friendly and helpful’. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 17 The home produces daily menus, which are varied and appear nutritious. The lunchtime meal was observed. Residents’ able, access the main dining room on the ground floor, which was furnished to a high quality and tables, were laid to a high standard. There was a choice of starter, main meal and dessert. There was also a choice of drinks to include soft drinks, beer and wine. All residents have nutritional assessments carried out and those requiring gastric PEG feeding have specialist community dietary support. Residents spoken to in the dining room were complimentary about the food. They were given a choice at the table, which is good practice. There were mixed comments from other residents nursed in their rooms or who have a soft diet as part of their plan of care. Inspectors were told that there is no choice of soft diet. Other comments included concerns that the last hot drink is at 19:30 hours; staff told inspectors that drinks are available on request after that time. Many residents told inspectors that the food is ‘excellent’. Eight surveys received from residents indicated that 62 felt that they usually liked the meals at the home, 25 never liked the food and one resident did not comment. Other comments included: ‘Would like more diabetic choice of puddings’. Many residents need assistance with meals which takes time therefore breakfast does not always finish until 09:30 hrs and one resident told inspectors that those wanting to be toileted and get up often have to wait and ‘fit in’ when staff are available (see ‘Staffing’). The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16; 17 and 18 Quality in this outcome group was good. Complaints are acted upon appropriately. Appropriate steps were being taken to reduce the risk of harm or abuse to residents. EVIDENCE: The home had a complaints procedure, which was available to service users, staff, and visitors. It forms part of the Service User Guide and is detailed in the Statement of Purpose. The CSCI address however needs amending now CSCI Taunton is inspecting the home. Service users who were able and staff spoken with informed the inspectors that they would not hesitate in raising concerns and have done so. No complaints had been received by the home since December 2005. The CSCI had not received any against the home since the last inspection. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 19 Complaints records were maintained and appropriate action had been taken and records maintained for the complaint received. Staff spoken to understand the lines of communication should they suspect any form of abuse. Abuse and challenging behaviour training has now been provided as required at the last inspection. Staff spoken with and training records seen confirmed this. POVAFirst checks had been undertaken before staff had commenced working at the home. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19; 22; 24 and 26 Quality in this outcome group was good. The home is well maintained. Residents are able to personalise their rooms with their favourite items and have the specialist equipment required to meet their individual needs, however specialist bathing provided may not meet some individual residents assessed needs. Baths in en-suite facilities had been disabled. Residents have a good choice of pleasant communal areas to sit and socialise in. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 21 Not all parts of the home were clean and pleasant at the time of this inspection. Infection control measures in place were adequate. EVIDENCE: All communal areas and at least twelve bedrooms were sampled at this inspection. The home was well maintained and complied with the local fire and environmental health authorities. The majority of service users are accommodated in single bedrooms, which are fitted with en-suite baths, wash hand basin and toilets. All en-suite baths seen were disabled as they had been assessed as not being able to be used by the residents, the inspectors were told. It was concerning therefore that a newly admitted resident who had not been assessed prior to admission told inspectors they would be able to use the bath with supervision. The home should review access for more able residents to the en-suite baths to allow for choice and to promote independence. The inspectors assessed one shared room, in use. Bedrooms are situated on the first and second floor and are accessed by two passenger lifts and stairs. There are a number of communal sitting areas throughout the home giving a choice to residents. Corridors are spacious with handrails throughout. Many bedroom doors have automatic fire door closures fitted but one was seen wedged open with a knife. All bedrooms seen were individual and personalised. Residents spoken to were happy with their rooms. As mentioned previously none of the residents’ rooms have locks to enable privacy. All rooms do have a lockable space to store valuables, medications or monies. All communal baths are ‘parker’ type baths which may not meet the individual specialised assessed needs of some of the residents and should be reviewed in line with the homes Statement of Purpose which states: ‘specialist equipment is also provided to enhance quality of life’. Some residents told inspectors that they had not been able to have a bath for sometime due to their disability. One shower was out of order and had been for sometime which meant residents on the ground floor wanting a shower had had to go upstairs. The shower on the ground floor was being fixed during the afternoon of the inspection. During the assessment of the premise it was noted that three residents could not access their call bells to summon assistance if they needed to putting them at risk of harm. An immediate requirement notice was issued. Overall the home was clean and pleasant however one room - was noted to have a stain on the carpet by the bed and another room had a strong The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 22 malodour. The home was informed of the rooms in question. Infection Control measures were in place and staff were seen using correct techniques. Inspectors were told that a large number of residents at the home had ‘MRSA’ which appeared to be being managed adequately. The health protection unit were aware and staff spoken to were aware of which residents had ‘MRSA’. The inspectors discussed ways of alerting visitors and staff in a discreet way to which residents had MRSA. Alcohol hand gel was available throughout the home. The most recent staff employed by the home told inspectors that they were aware of infection control measures in place. Comments received via surveys received from residents included: ‘the management and staff work hard to make this home a warm, caring and safe environment, you can never get it 100 but they try – its 95 ’ and 100 indicated that the home is always fresh and clean. In regard to the Younger Physically Disabled (YPD) residents at the home the company must submit a plan to the CSCI outlining how it intends to meet the Environmental NMS (24.3) for Younger Adults (YA) for 1st April 2007, with particular regard to specialised bathroom facilities for YPD. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27; 28; 29 and 30 Quality in this outcome group was adequate. Residents like the care staff but cannot be confident that staffing levels are maintained at a level to meet their individual personal, physical and social care needs. Staff with NVQ qualifications was at 57 . Specialist training to meet complex needs of individual service users had not been provided to all staff. Residents are protected by robust recruitment procedures. EVIDENCE: Staff spoken with were clear about their own roles and the roles and responsibilities of others. Feedback from service users consulted were mainly positive about the support they received from the registered manager, and staff. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 24 Comments received via surveys received included: ‘the staff are marvellous’, staff are very accessible and helpful (relative)’ and ‘staff are always busy – call bells can take a long time to be answered – 15/20mins’. 50 indicated that they always receive the care and support they need and 50 indicated that they usually did. 12 indicated that staff are always available when they needed them, 62 indicated they usually were, 12 indicated that they were never available and one person did not comment. Residents spoken to during the inspection told inspectors that the staff are normally kind and caring but at times are ‘rushed’. Inspectors noted that this was a theme throughout the day. Staff told inspectors that they felt ‘rushed’ at times and often sickness is not covered which was evident on the day of inspection when two care staff were off sick and cover was not available. Agency staff are used to cover any shortfalls according to the duty rotas. There were three overseas staff recently recruited shadowing senior care staff during the morning of the inspection. There was one domestic and one laundry assistant on duty on the day of inspection due to holidays and sick leave. There are normally three domestics Mon-Fri with weekend cover. A member of domestic staff was brought in to assist from The Old Manor mid-morning. It was concerning to note that many residents were still being assisted with personal care at 12:30 hrs and comments from residents included: ‘there is a choice of when we get up and go to bed’, ‘sometimes I am yanked where it hurts when they are in a rush, but generally the staff are very kind’, ‘I lie in till they get me up’, ‘there is a pecking order’ and ‘there is no choice of when I get up or go to bed, I have to suit the staff’. Other comments included: ‘they don’t have enough staff’ and ‘they never have time to talk’. The home develops duty rotas on a weekly basis and copies of the last two weeks were given to the inspectors. On the day of inspection there were 16 care staff, including three being shadowed, and five Registered Nurses, including the Nurse-in-Charge in the managers absence. The home has three units and staffing (according to the duty rotas) is split into the units for example during the day two registered nurses and four care staff on the first floor ‘Hestercombe’, two registered nurses and five care staff on ‘Vivary’ and one registered nurse and five care staff on ‘Victoria’. Overnight there are three registered nurses and five care staff. Staffing levels must be reviewed to ensure levels are adequately meeting current residents individual personal, social and complex needs given the comments received from residents and staff. According to the pre-inspection questionnaire received and training records seen 57 of care staff have gained a qualification in care, which exceeds the NMS. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 25 Four staff recruitment files were assessed which evidence robust recruitment procedures for the protection of vulnerable adults. Staff spoken to confirmed receipt of induction and all have recently received manual handling and fire training as required at the last inspection. The three newly recruited staff confirmed induction and mandatory training. As previously mentioned training records were in the process of being updated therefore recorded evidence of induction was not available and will be followed up at the next inspection. Training needs assessments have begun which should include staff who haven’t already received training in specialisms to be able to access and receive training to enable them to understand and meet the needs of residents with complex needs. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) 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; 32; 33; 35; 36 and 38. Quality in this outcome group was adequate. The home has a registered manager since the last inspection. Residents and staff like the manager and feel she is managing the home effectively. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 27 Residents are protected by the systems adopted by the home to look after their personal finances. Residents can be confident that since the last inspection, staff have commenced receiving the supervision and support they need to ensure they are always working effectively and in the best way. The home was failing in some areas to ensure the health and safety of residents. EVIDENCE: The Registered Manager is Susan Iddon. She has vast experience in elderly care, young physically disabled care and management. At her Fit Persons Interview undertaken on 3rd May 2006 by the CSCI she demonstrated a good knowledge base and understanding of Person Centred Care, and had a good awareness of the legislation and her role under the Care Standards Act 2000. Staff and residents spoke very highly and were complimentary about the manager. Staff told inspectors that she is approachable and improvements have been made at the home since she had been managing it. Residents were pleased that she makes every effort to visit them especially those in their rooms on a regular basis. The CSCI has received Regulation 26 reports from the Operations manager who visits the home on a monthly basis or more if required. Staff meetings and resident meetings have taken place. It was disappointing to read that residents are told what any refurbishment plan for the home is without consultation with them re choice of colours for example. Quality assurance and monitoring could not be fully assessed. Surveys had not recently been sent to service users, their relatives/representatives or other stakeholders to gain their views on the conduct of the home and this will be followed up at the next inspection. Finances kept on behalf on residents by the home were sampled and good practise was observed. Records of all transactions are maintained and two staff always sign as witnesses to transactions. All receipts are kept. Staff supervision has commenced at the home the inspectors were informed and evidence of this was seen in one of the ten training files sampled. This will be followed up further at the next inspection. The following compromised health and Safety at the home: a bedroom door was wedged open with a knife as previously mentioned, Oxygen was stored insecurely in one treatment room and COSHH substances were accessible to residents. An Immediate requirement notice was issued in regard to: Substances hazardous to health were found un-securely stored in en-suite The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 28 bathrooms, communal bathrooms and a corridor to include denture cleansing tablets (steradent), disposable uncapped used razors, tablets of soap, open ‘sharps bins’, and a blood’s kit, including needles left on a chest of drawers. All service records were up to date, maintenance records were well maintained, and all fire equipment had been checked in line with Fire Regulations. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 29 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 2 3 3 2 4 2 5 X 6 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 1 23 X 24 2 25 X 26 2 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 3 33 3 34 X 35 3 36 3 37 X 38 1 The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 30 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 OP1 Regulation 4 Requirement The registered person must ensure that the Statement of Purpose and the where possible, home’s brochures are fully reflective of the facilities and the provision that the home offers; to allow for prospective residents and their relatives and/or representatives have an informed choice. A copy of the updated versions must be sent to the CSCI. Timescale for action 30/09/06 2 OP3 14 YA2 The registered person must not admit a resident to the care home without first gaining an assessment of their individual personal, physical, social and specialised assessed needs. 01/07/06 The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 31 3 OP7 12(1)[a] [b] YA6 The registered person must ensure that individual residents care plans reflect their current needs and staff are aware and act on the residents preferred wishes for example: times of getting up and going to bed. Also daily records must be appropriately written in line with the homes policies and procedures. 25/07/06 4 OP8 12(1)[a] [b] YA19 The registered person must 20/07/06 ensure that care plans reflect individual specialist needs with a clear plan set out with detailed actions for staff to follow; in particular with regard to epilepsy and diabetes. 5 OP9 13 (2) YA20 The registered person shall make 14/06/06 arrangements for the safe administration, recording and storage of medicines in the care home. An Immediate Requirement Notice was issued. (Previous timescale of 13/05/06 was partly met.) 6 OP10 YA16 12(4)[a] 16(2)[c] The registered person must 30/09/06 ensure residents have a right to privacy in their own rooms in line with the Statement of Purpose and with consultation with individual residents provide locks for their doors. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 32 7 OP22 23(2) YA24 OP24 The registered person must 30/09/06 review the specialised bathing equipment and facilities at the home to ensure it meets individual residents specialist needs. The company must submit a plan of action of its intentions on how it will meet the NMS YA (24.3) environmental standards for April 2007. 8 OP22 YA29 12(1) 13(6) The registered person must ensure that residents can access a call bell at all times to allow them to summon assistance. An Immediate Requirement Notice was issued. 14/06/06 9 OP26 YA29 12(1)[a] 23(1)[d] The registered person must 30/06/06 ensure that the rooms identified at inspection with a malodour and stained carpet are cleaned and kept free from malodour. The registered person must 30/07/06 review staffing levels at the home and ensure that levels meet the individual personal, social, physical, specialist and dependency needs of the current residents. 10 OP27 YA33 18(1)[a] The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 33 11 OP38 YA42 13(4) 13(6) The registered person must 14/06/06 ensure that the home is conducted in a way that protects the health and safety of the residents at all times. In particular regard to items used to wedge doors open, the storage of substances hazardous to health under COSHH regulations and the storage of oxygen. An Immediate Requirement Notice was issued. 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 OP4 YA3 Good Practice Recommendations Specialist training should be provided to all staff to allow them to understand and meet the complex needs of some of the residents admitted to the home, in particular those with specialist needs including for example, dementia, epilepsy, and Multiple Sclerosis. Care plans should set out in detail action that should be taken by care staff to ensure that all aspects of social care needs of residents are met. Records when activities are offered to residents need to be improved. This was previously recommended at the last inspection and has been re-issued. 2 YA14 OP12 The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 34 3 OP30 YA35 The registered person should ensure that there is a staff training and development programme which meets National Training Organisation (NTO) workforce targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. All members of staff should receive induction training to NTO specifications within 6 weeks of appointment to their posts, including training on the principles of care, safe working practices, the organisation and worker roles, the experiences and particular needs of the service user group, and the influences and particular requirements of the service setting. All staff should receive foundation training to NTO specifications within the first six months of appointment, which equips them to meet the assessed needs of the service users accommodated, as defined in their individual plan of care. All staff should receive a minimum of three paid days training per year and have an individual training and development assessment profile. This was previously recommended at the last inspection and has been re-issued, as recorded evidence was not available. The Manor Nursing Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Home DS0000003300.V290700.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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