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Inspection on 15/08/07 for The Manor Nursing Home [Bishop`s Hull]

Also see our care home review for The Manor Nursing Home [Bishop`s Hull] for more information

This inspection was carried out on 15th August 2007.

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

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

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

What the care home does well

One visitor commented when asked what the home does well replied, "The care they give here is second to none" and another stated, "This is a home from home". All surveys received and comments made, stated that the staff provide a good standard of care. It is clear from these comments that the home makes every effort to support both the residents and their relatives. One comment from a person using the service was "I feel lucky to be in a place like this " and a relative stated, "I am always made welcome and kept up to date with any changes ". The manager has a positive leadership style, which reflects on the staff who stated they feel supported by the management of the home. People spoken with, all confirmed that the quality, quantity and variety of food is good, although there were issues with the food up until recently. There was evidence that individual preferences are catered for.

What has improved since the last inspection?

The home has been through a somewhat difficult time with a succession of managers in the recent past. This matter has now been rectified with a stable management team now in place. This has lead to a number of improvements at the home. At the last inspection requirements were made to ensure that all people had an assessment of their needs prior to moving into the home. This is to ensure that the home is able to meet any needs identified and to ensure that all parties are happy for the placement to proceed. Since the last key inspection all people moving into the home now have the opportunity to meet a member of staff from the home and discuss their individual needs. In addition since the last inspection the information available to people has improved. The "statement of purpose" and "service user guide" have been updated and now reflect the care and support available at the home. Since the last inspection a new care planning system has been introduced. The plans detail the individual`s likes and dislikes and preferred routines. The plans detail the care and support needs of the individual in detail but are easily followed and read. The staff team is now stable and has been rearranged into teams to allow for continuity and consistency. Staff training opportunities are now good and the induction of new staff has improved. Staff supervision and appraisal has been developed and introduced. This ensures that all staff are aware of their job roles and responsibilities. Some on going maintenance to the home has occurred with several of the bedrooms being decorated and new carpets laid. Some of the communal areas have also been refurbished.

CARE HOMES FOR OLDER PEOPLE The Manor Nursing Home Haydon Close Bishops Hull Taunton Somerset TA1 5HF Lead Inspector Justine Button Unannounced Inspection 15th August 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Manor Nursing Home DS0000003300.V349248.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) Linda Stella Hallett 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.V349248.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) and Physical disability (Code PD) The maximum number of service users who can be accommodated is 86, which includes a maximum of 20 service users with a physical disability. 2. 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 home’s current fees are £470-580 per week for the older people living at the home. Fees for the younger people are determined upon the assessed needs of an individual The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was carried out over one day by two inspectors. A tour of the home took place and a selection of the bedrooms and both communal areas were seen. There were 57 people currently residing at the home. The inspector spoke to people using the service, visitors and members of staff, the Registered Manager and the Deputy Manager were available throughout the inspection. As part of this inspection the inspector surveyed the opinions of a random selection of people using the service and their representatives, GP’s, District Nurses and Care Workers. Surveys were sent to people using the service and/or relatives and 8 responses were received. The inspector spent time talking to people within the home, visitors and staff and observed that on the day of inspection, residents appeared relaxed and comfortable in all areas of the home. It was evident from this observation that the people looked well cared for. All people using the service spoken to, and who were able, spoke of the staffs kindness and support, one person said, “ They treat me with dignity “. All stated they were happy with the care they received. Surveys from staff stated they felt supported by the management of the home. Staff were happy to tell the inspector that they enjoyed working at the home and felt that the standard of care given was high. Records relating to care including care plans, staff files, finances and health and safety records were examined The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home has been through a somewhat difficult time with a succession of managers in the recent past. This matter has now been rectified with a stable management team now in place. This has lead to a number of improvements at the home. At the last inspection requirements were made to ensure that all people had an assessment of their needs prior to moving into the home. This is to ensure that the home is able to meet any needs identified and to ensure that all parties are happy for the placement to proceed. Since the last key inspection all people moving into the home now have the opportunity to meet a member of staff from the home and discuss their individual needs. In addition since the last inspection the information available to people has improved. The “statement of purpose” and “service user guide” have been updated and now reflect the care and support available at the home. Since the last inspection a new care planning system has been introduced. The plans detail the individual’s likes and dislikes and preferred routines. The plans detail the care and support needs of the individual in detail but are easily followed and read. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 7 The staff team is now stable and has been rearranged into teams to allow for continuity and consistency. Staff training opportunities are now good and the induction of new staff has improved. Staff supervision and appraisal has been developed and introduced. This ensures that all staff are aware of their job roles and responsibilities. Some on going maintenance to the home has occurred with several of the bedrooms being decorated and new carpets laid. Some of the communal areas have also been refurbished. What they could do better: Although the home has seen a number of improvements the following issues were identified at this inspection. On the day of the inspection the sluice areas were observed to be unlocked. The sluices contained chemicals which would be harmful to health if ingested. In addition 12 tubes of denture tablets were found in the bathroom. One person living at the home had been assessed as being identified as being at risk of drinking or ingesting substances. The chemicals and denture tablets therefore posed a serious risk to the individual’s health. An immediate requirement was therefore issued at the end of the inspection. Since this time the home has confirmed that the sluices are now locked and that the denture tablets have been removed. Although the care planning system has improved significantly people living at the home or their representatives are not involved oin the development or review of the plan. Involvement in this way would ensure that the plans truly reflect the likes, dislikes and preferences of the individual and would ensure communication between all parties with regard to the health needs of the individual. The home has a key worker system however it could not ascertained how effective this system is a large percentage of people who live at the home were unaware of who their key worker was. During the inspection a number of people did not have access to the nurse call bell. In addition the call bell rang for significant period s of time before being answered by staff. The management need to keep both of these areas under review. The feedback and observation of food at the home demonstrated that the menu is good and that mealtimes are an enjoyable experience for people living at the home. A recommendation has been made however with regard to the provision of snacks and food between meals. Cakes and biscuits are currently The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 8 available. The management need to consider extending this range to ensure that foods are available for people on specialist diets or for those who have swallowing difficulties. 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 summary of this inspection report can be made available in other formats on request. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12345 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home continues to be able to provide prospective residents and relatives with sufficient information in the format of brochures, the Service User Guide and Statement of Purpose for them to make an informed decision about the home. All prospective residents receive a pre admission assessment by the registered manager to ensure the home can meet the assessed needs identified. Not all people living at the home have a copy of the terms and conditions of their stay. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 11 EVIDENCE: The home has updated the Statement of Purpose and Service User Guide since the last inspection to ensure that it reflects a clear and accurate picture of the home. Copies are made available to service users, prospective service users and their representatives. The home provides a welcome pack to all new people moving into the home. These documents are also displayed in the reception area of the home and include a copy of the home’s last CSCI inspection report. The manager provided the CSCI with pre-inspection information which stated that the home’s current fees are £470-580 per week for the older people living at the home. Fees for the younger people are determined upon the assessed needs of an individual. Any ‘Free Nursing Care’ element awarded is added to the fees and is not refunded to the service user. Extra charges are met by service users for newspapers, hairdressing, trips/outings, personal toiletries/items and special requirements. In addition medical charges may be incurred if applicable for dentist, optician or chiropody. The homes statement of purpose states that either party requires four weeks notice. The manager or her deputy visit the majority of prospective service user and carry out an assessment to ensure that the assessed needs and aspirations of the individual can be met by the home. The care plan for the individual who had recently moved into the home was viewed this showed that the manager had completed a full pre admission assessment. This assessment was in addition to the assessment undertaken through the care management arrangements. Assessments from other professionals were also seen in care records. Prospective service users and/or their representatives are invited to visit the home prior to making a decision. Service users move to the home initially on a 4 week trial period. This is to ensure that all parties are happy with the placement. Copies of service user contracts/financial agreements are maintained at the home. This document states out clearly the terms and conditions of stay and the room to be occupied. In two files viewed the contract/financial agreements The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 12 have not been issued to people who are funded via the local authority. This is not in line with recent guidance issued by the Office of Fair Trading. The guidance states that all people however they are funded should be aware of the terms and conditions of their stay at the home. It is recommended therefore that Barchester Healthcare ensure that all people who live at the home have a copy of this document. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All people living at the home have a plan of care which details their health and personal needs. The plans need to continue to be developed to fully reflect all care and social care needs. The home ensures that service users have access to appropriate healthcare professionals. Service users are treated with respect. The home’s procedures for the management & administration of medication is generally good. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 14 EVIDENCE: Six service users were case tracked at this inspection. This involved meeting with the service users, examining care and related records and viewing their bedrooms. Care plans contained up to date assessments, which included moving and handling, reducing the risk of pressure sores & falls. Care plans had been developed for any assessed needs. Some of the plans were slightly ambiguous containing comments such as “ensure footwear is appropriate” and “ensure regular nightly checks” Staff need to ensure that comments made in the assessments and care plans are detailed and give clear instructions to the care staff. The plans reflect the home’s move toward a person centred approach. Likes and dislikes were well documented in all the plans seen. Some of the plans did not have input from the individual or their representative in the development or review of the plan. Involving the individual in the development and review of their plan of care would enhance the individuality of the plans and ensure that they are truly person centred. . The care plans seen confirmed that people living at the home have access to a range of health care professionals. This included input from district nurses, GP’s, Social workers & palliative care specialists. Physiotherapy is available through a GP referral. The home however is currently developing an “in house” physiotherapy service. One staff member who was recruited from overseas is a physiotherapist in her country of origin. The staff member however is required to complete a period of supervised practise in the UK in order to become registered in this country. The local Health Authority in conjunction with The Manor is supporting the staff member to undertake the work required. The staff member is therefore currently working as a physiotherapy assistant under the guidance of registered physiotherapist to offer a physiotherapy service at the home. During the inspection people living at the home were observed to be sitting in non specialist wheelchairs for long periods of time. Wheel chairs do not provide good postural support. Staff should ensure that people are supported to sit in arm/easy chairs when ever possible. During this inspection it was noted that all people had access to fluids at all times. Not all people had access to a nurse call bell during the inspection. It would be difficult therefore for these people to summon the assistance of staff members should this be required. It was also apparent during the inspction that the call bells appeared to be ringing for a relativly long period of time. A number of people living at the home stated that they often had to wait for The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 15 staff when they rang the bell. The management need to keep this under review and ensure that staff answer the bell as quickly as possible. A large percentage of people living at the home are frail and as such were nursed in bed during the inspection. People nursed in bed or those at risk of the development of pressure ulcer had a regular change of position. Sitting or lying in one place for a long period of time contributes to the risk of pressure damage. People who are unable to move freely or have mobility issues need to support by staff to change position regularly. Service users who were able to express a view were very positive about the care they received. Staff interactions with service users were noted to be very warm, professional and respectful. Interventions were observed to be ‘unhurried’. Staff were heard explaining interventions to service users before carrying out. Service users appeared relaxed and comfortable throughout the day. This was also the view expressed in the feedback forms which were returned to the CSCI prior to the inspection. The homes procedures for the management and administration of medication was examined at this inspection. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). The registered nurse on duty administers medicines. All medication was stored in line with good practise guidelines. The documentation of medication including control pain relief was viewed. The documentation was of a good standard and a clear audit trail was evident. There was evidence of good recording in the Medication Administration Records, recording of blood sugar and pulse levels, recording of variable doses and all hand trancribed medications were signed by 2 staff to ensure no errors in recording. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a wide range of opportunities for social stimulation and residents are supported to join in with organised activities or pursue their own interests. The meals in the home are of a good quality and a wide range of choice is available. Visitors are made welcome People living at the home are treated with respect. EVIDENCE: The home provides a service to both older and younger people. When surveys asked if there were activities arranged in the home all stated that there were. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 17 The inspector spent time talking with people using the service and observed people reading newspapers and chatting to staff. The planned activities are advertised on a newsletter, which is produced monthly. The people using the service advise the inspector that activities were available if you wished to participate, these included DVD’s, bingo, reminescence and quizzes. The information received by the home prior to the inspction stated “we provide a range of activites to suit the needs of the indivdual.” The findings of the inspection confirms this. The home also provides a range of complementary therapies. A number of people living at the home attend day services including head way. In addition a number of people attend a local college. The home is currently researching the possibilty of provinding swimming The home has it’s own transport which is in use daily. The home has just employed a dedicated driver to ensure access to the transport is more readily availble. Three visitors confirmed to the inspector that visiting was not restricted and they were made welcome at all times. People’s rooms were seen to be personally decorated and people confirmed that they were able to bring small items af furniture and personal belongings within the scope of the room size. The people using the service confirmed that within reasonable timescales they were able to get up and return to bed at a time of their choice. The home operates a key worker system. A key worker is a member of staff who has an increased knowledge of and input with the person living at the home than other members of staff. The key worker undertakes duties such as ensuring the indivdual has toiletries and adequate clothing. The key worker can also act a link member of staff for relatives and friends of the person living at the home. A number of people spoken to during the inspction were not aware of who there key worker was. In order for this system to work effectivly the management need to review these arrangements and ensure that all people living at the home and their representatives are aware of the keyworker system and how this works. The staff serve breakfast each morning to the people in their bedrooms. The main meal of the day is at lunchtime and there is a large pleasant dining room. The tables were nicely laid with a choice of condiments and drinks to have with their meals. An alcoholic drink including sherry and wine is available at meal times. Service users with specific dietary needs and preferences were catered for and contact with the Community Dietician is made as and when required. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 18 When asked if they liked the meals all people stated that the food was of a good or excellent standard. It was evident from some people that there had been some issues with the quality of the meat in the past. This had been rectifed by the manager who had changed suppliers. People using the service confirmed that choice is made available. The inspector observed lunch being served both in the dining room and in bedrooms and it appeared to be enjoyed by all. People who required assistance were helped in a dignified and discreet manner. A menu is on display outside the main dining room. One person who uses a wheel chair stated that she had difficulty in reading the menu as it was at the wrong height. People spoken to prior to lunch stated that they could not remember what they had chosen for lunch. The possibility of placing the menu on the tables was discussed with the manager at the end of the inspection. The manager stated that this would not be difficult to do as an activities timetable is already displayed. The menu could be printed on the back of this. This would enable people be reminded of the meals on offer. On the day of inspection lunch was a choice of soup or prawn cocktail as a starter. Pork in sauce and rice or scampi and chips. There was a range of vegetables including leeks, carrots and peas. Dessert was served from a sweet trolley and included fruit crumble, yoghurt, fresh fruit and yoghurt. All purée diets were served individually and the meal looked plentiful and appetising. The evening meal is the lighter meal of the day and the menu stated that tomato soup, sandwiches or meatballs and spaghetti. People spoken to during the inspection stated that a cooked breakfast is also available. Drinks were served throughout the day. A range of cakes or biscuits were available. It is recommended that the range of snacks available be reviewed to ensure that snacks are available for those with swallowing difficulties or those at risk of losing weight. Foods such as yoghurts, milk shakes, fruit etc should be made available. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure which is in line with good practise guidelines. The home takes appropriate steps to reduce the risk of harm or abuse to service users. EVIDENCE: The Home has a Complaints Procedure that is clearly written and contains the contact details for CSCI. The manangement of the home confirmed that this can be made available in a number of formats (including other languages, large print, etc) to enable anyone associated with the service to complain or make suggestions for improvement. CSCI has not received any complaints about The Manor and the home has no ongoing complaints. Three people using the service and visitors to the home confirmed that they would raise any concerns with the management of the home and felt confident to speak to any staff about any worries they may have. They were confident that any concerns would be dealt with promptly. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 20 The Home is able to offer people using the service information and telephone numbers for contacting independent people, who will act as advocates on the their behalf where the person prefers the help of an independent person. The home uses the age-concern advocacy services. All people using the service are registered to vote. The policies and procedures regarding protection of residents are of a good standard, which include complaints, recognising signs of abuse and whistleblowing. It is recommended that the policy regarding whsitleblowing includes the contact details for CSCI. The policies should be reviewed regularly and signed to say that this process has been undertaken. All staff receive a Criminal Record Bureau check prior to commencing employment ,as part of the recruitment procedures used at the home, to protect people using the service from the risk of abuse. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 21, 22, 23, 24, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. All parts of the home were clean and pleasant at the time of this inspection. Infection control measures in place were adequate. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 22 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. Since the last inspection a number of the bedrooms have been redecorated and new carpets fitted. The small dining room has also been refurbished. 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. 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 although these were not fitted with handrails. Many bedroom doors have automatic fire door closures. All bedrooms seen were individual and personalised. Residents spoken to were happy with their rooms. None of the residents’ rooms have locks to enable privacy. The homes statement of purpose states that this is due to the age of the building. Locks can be fitted at the request of the resident. 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’. In addition to the bathrooms shower/wet rooms are available on each floor of the building. 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. This issue was raised at the last inspection and the management now need to ensure that appropriate action is taken to rectify this issue. Overall the home was clean and pleasant. Infection control measures were in place and staff were seen using correct techniques. 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. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 23 The home has a communal garden. There are plans to develop the garden in the next 12 months. The call bell system is available for use for people who want to access the garden independently. The home offers a computer system with broadband for people living at the home who wish to access this facility. LCD televisions have also been installed in all the communal lounges. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27; 28; 29 and 30 Quality in this outcome area is, good. This judgement has been made using available evidence including a visit to this service. Staffing levels are appropriate to the numbers and needs of current service users. The training opportunities available to staff are good. The home follows appropriate staff recruitment procedures. EVIDENCE: The Manor is a care home which caters for people of differing ages and needs. The home is split into four distinct areas which enables people to live in areas with people of a similar age or need. Each of the areas has it’s own staff team with a registered nurse in charge of each area. Splitting the staff team in this way ensures consistency and continuity. The home has a stable staff group and uses a low level of agency staff. Staff rotas were viewed during the inspection and these demonstrated that there are adequate numbers of staff on duty to meet the needs of the people living at the home. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 25 The home also employs kitchen staff, domestics, laundry staff and a maintenance person. The home now has a system of regular staff meetings. All staff have undetertaken an annual appraisal. Three staff recruitment files were examined. These contained all appropriate information as required in Schedule 2 of the Care Homes Regulations 2001. Enhanced CRB checks and POVA checks were in place. Staff comment cards confirmed that staff felt they had received adequate induction and were clear about what activities they must not undertake. Furthermore staff confirm that they receive regular training updates and staff supervision. Staff induction is a programme of videos and supporting information with regular updates and staff confirmed that they were supernumerary whilst this induction took place. This induction is in conjunction with the Skills for Care Common Induction Standards. External training opportunities are also available for staff and staff explained that staff meetings are also used as a learning opportunity. Staff are also encouraged and supported to undertake NVQ qualifications. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a registered manager since the last inspection. Residents and staff like the manager and feel she is managing the home effectively. 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. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 27 EVIDENCE: The Registered Manager is Linda Hallet. She has vast experience in elderly care, young physically disabled care and management. At her Fit Person’s Interview, undertaken 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. Quality assurance and monitoring is in place. Annual Surveys had recently been sent to service users, their relatives/representatives or other stakeholders to gain their views on the conduct of the home. 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 and evidence of this was seen. The following compromised health and safety at the home: • Oxygen was not stored securely in one treatment room and was in use in a number of the bedrooms. The signage in the room where the oxygen is stored was not in line with the Health and Safety Executive guidelines. The manager has since informed the inspector that this has been rectified. • It was observed during the inspection that the sluice doors were not locked and accessible to people living at the home. The sluices contained substances hazardous to health. In addition 12 tubes of dental tablets were seen in the bathroom. One person at the home had been identified as at risk of accidental ingestion. An immediate requirement was left at the end of the inspection with the manager. The immediate requirement detailed the action to be taken to ensure the safety of the people living at the home. Since the inspection the home have confirmed that both these areas of concern have been rectified. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 28 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.V349248.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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 2 The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15 (1) Requirement It is required that service users and or their representative are involved in the development and review of the plan of care The registered person must ensure that residents can access a call bell at all times to allow them to summon assistance. This requirement is unmet from the last inspection. Previous timescale 14/06/06 3. OP38 13(4) 13 (6) The registered person must 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 the storage of substances hazardous to health under COSHH regulations and the storage of oxygen. This requirement is outstanding from the last inspection. Previous timescale 14/06/06 30/09/07 Timescale for action 30/10/07 2 OP22 12(1) 13(6) 30/09/07 The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP8 OP15 Good Practice Recommendations It is recommended that people are supported to access suitable seating which provides good postural support and does not compromise pressure area care. It is recommended that a range of snacks be made available for those who cannot eat cakes and biscuits or who have special dietary requirements. The Manor Nursing Home DS0000003300.V349248.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V349248.R01.S.doc Version 5.2 Page 33 - 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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