Inspection on 29/04/08 for The Old Manor House

This inspection was carried out on 29th April 2008.

CSCI found this care home to be providing an Adequate service.

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 Old Manor House 30/08/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Old Manor House 6 Regent Terrace Penzance Cornwall TR18 4DW Lead Inspector Alan Pitts Unannounced Inspection 29th April 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Old Manor House DS0000070049.V363642.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 Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Manor House Address 6 Regent Terrace Penzance Cornwall TR18 4DW 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) 01736 363742 Mrs Mary Allison Anson Mr John Robert Anson Mr Kevin Barrie Edgar Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places The Old Manor House DS0000070049.V363642.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 providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 14. 30th August 2007 Date of last inspection Brief Description of the Service: The Old Manor House is a care home registered to provide accommodation and personal care for up to 14 older people. It is in a quiet elegant terrace a short distance away from the sea front and to the centre of Penzance. It is a fine example of impressive listed Regency terraced town house. Some rooms have sea views. Most of the rooms provide single accommodation and currently there are no residents sharing a room. Access to the front of the building is via a set of railed steps. The building has four storeys. The upper three floors can be accessed via a serviced lift or stairs. Access to rooms in the basement, however is only via external steps that pass through the kitchen or by lift. The home has a small front garden with seating for residents, a lounge and separate dining room. Fees range from £355.00 to £415.00 per week. Additional charges are made for People who wish to have hairdressing, chiropody, dental services, opticians, and personal items such as confectionary and daily newspapers. The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place over the course of approximately 5 hours on 29th April 2008. The registered manager was present throughout the inspection. We looked at documentation, such as care plans, toured the building, met with staff and residents, and took note of responses from residents about the care they received. At the time of writing the home has not completed its Annual Quality Assurance Assessment, which was sent to them on 6th August 2007 followed by letters of reminder. It is a legal requirement for registered services to fill in an AQAA. The home has been under new ownership for approximately 10 months now and the new registered providers have made substantial financial investments in the home (e.g. rewiring). Overall, there is no doubt that the home offers individualised care that meets the care needs of the people that live there. The registered manager’s approach creates an open, positive and inclusive atmosphere. The overall quality rating is lower than might be expected primarily because of the attention needed to safeguarding practices and staffing arrangements at night. What the service does well: Although there were some natural concerns expressed by residents in respect of changes in staff personnel since the home was bought, overall they said that the change had been positive and that everything was improving. Residents are able to choose to either have their meals served to them in their own rooms, or to dine in the home’s attractive main dining room, which is next to the kitchen. All of the residents in the home said that they feel safe there and all said that they are satisfied with the care provided to them by the staff. Visitors are welcome and there are plenty of people coming and going from the home so residents are not isolated. Lifestyle is determined by the residents as much as possible. The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 6 The home provides residents with a pleasant and restful environment, though there is a lot of work still to be done to rectify some areas where the décor is looking tired. Most of the home’s staff are qualified to NVQ and above or working towards achieving formal qualifications so that residents can have confidence that they are competent to work with them. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and prospective residents are provided with a combined Statement of Purpose and Service User Guide, though this needs reviewing. Prospective residents are assessed prior to admission. The home does not provide intermediate care. EVIDENCE: There is a combined Statement of Purpose and Service User Guide, which is provided to residents. This document is dated February 2007 and needs to be reviewed. It does not currently contain the home’s complaints procedure. Examination of the care documentation of the person who most recently moved into the home shows that a pre-admission assessment was carried out by the registered manager and the referring social worker. The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 9 The home does not provide intermediate care, but every reasonable effort is made to promote each residents’ independence. The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. 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. Residents’ health care needs are met. There is an appropriate medicine procedure, though this needs reviewing. Residents are treated with respect. EVIDENCE: Three care plans were inspected, and were found to be informative and accurate, providing individualised care interventions. The care documentation for each resident includes: personal details and photo; a range of assessments (e.g. moving and handling); a care plan; and a risk-assessment. Care plans are reviewed regularly. The registered manager is introducing a new system for recording care plans and related documentation, a sample of which was seen at the time. This is not fully operational as yet, though the changeover to the new system has commenced. Daily entries are informative and clearly show that the residents determine their own lifestyle. There is a record of GP visits, and visits from other health care professionals. Residents said that they were quite satisfied with the care provided, and commented that the staff are “friendly and cooperative”. The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 11 Some of the home’s procedures indicate ownership by another of the homes owned by the registered providers, and this includes the home’s medicine procedure. Whilst it is logical to standardise policies and procedures across the three homes, each should reflect the individuality of the specific home. The home operates the direct dispensing system and receives regular inspections from the pharmacist. Medicines are stored securely. Medicine Administration Records were not inspected on this occasion, though this was satisfactory at the previous inspection. The people that live at The Old Manor House live largely independent lives and are able to determine their own lifestyle, and as such would resent too much interference from staff. The residents are able to voice their wishes and play an active part in the day-to-day running of the home. There is clear evidence from the care documentation and comments of residents that the home is run flexibly to accommodate the changing needs of the residents. The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 12 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. Residents are satisfied with the lifestyle they experience and are able to have control over their lives. Residents receive recreational opportunities in order that they can experience a more varied and stimulating life. Visiting arrangements are flexible in order that residents can maintain their relationships. A varied and balanced diet is planned and residents are satisfied with the choice available. EVIDENCE: Many residents are satisfied with the lifestyle they experience and commented they felt in control of events. One residents described the assistance being provided so positive changes could be made to their circumstances. Residents said they go shopping in the town, attend religious opportunities outside of the home, and enjoy sitting in the garden. One residents did ask that there were more opportunities for trips out (transport being made available), but this was received by the others with mixed views and wasn’t felt to be of great importance as all have regular visitors and alternative opportunities. Many residents make use of local taxi services. The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 13 There are flexible visiting arrangements in place and residents are able to determine where they meet with their visitors. Residents aid that visitors were always welcome and well received by the staff. Deliveries of fresh meat, and vegetables arrive regularly, and on the day of the inspection the residents changed their lunchtime orders from ham to sausages as a fresh delivery had just been made. A varied menu is offered, and there is a record of food provided (including specifying details such as “own butter and marmalade”). Care staff also assists in the preparation of some meals and the staff concerned have basic food hygiene training. The equipment in the kitchen is regularly serviced, maintained, and appropriate health and safety measures are in place. The dining tables were nicely presented with attention to detail on the tables. The registered manager said the dining chairs are going to be replaced with suitable dining chairs. The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 14 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 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure, though this needs reviewing and distributing more effectively. Residents are protected from abuse, but more needs to be done to ensure this. EVIDENCE: There is a complaints procedure though this needs reviewing as it does not make it plain that people can approach agencies, such as Department for Adult Social Care and Commission for Social Care Inspection, without first going to the registered manager or registered provider. The complaints procedure is not included in the home’s Statement of Purpose. The residents are a vocal group, who are well able to voice any concerns. Residents also said that they had confidence in the registered manager and staff to deal with any issues that were raised. There is a safeguarding (abuse) procedure, but this is not accurate and does not provide clear instruction to staff. One member of staff, when asked, was not aware of any external agency involvement in investigations of allegations of abuse. Only 3 staff have undertaken the local authority safeguarding training. The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 15 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): 19, 26 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable environment, and the registered providers are committed to improving the fabric and décor of the building. The home is clean, pleasant and hygienic. EVIDENCE: Areas to be improved include the redecoration and refurbishment of the premises both internally and externally. Internally and externally The Old Manor House is showing signs of age and is in need of repair and rejuvenation. The home still offers a comfortable, pleasant environment, and the registered providers have already made significant financial investments in the property (e.g. rewiring) with more to be made (new roof planned in the summer months). The registered providers have also made a planning application to install a hydraulic lift at the outside entrance to improve access to the home, and this would be of benefit to current and future residents. The home would The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 16 benefit from a thorough audit so that work identified can be properly prioritised. There are sufficient toilets and baths in the home, which are spread out over four floors. Toilets are within easy reach of resident’s private and communal living space. Bedroom accommodation is spread out over all four floors. The home was warm throughout, well lit and well ventilated. All resident’s bedrooms are individually and naturally ventilated and upper floor windows are fitted with safety restrictors. Central heating is provided throughout the home and radiators are guarded. Lighting is domestic in character and sufficiently bright. The home has a passenger lift to enable access to all four floors. The home appeared clean and tidy and was entirely free from offensive odours throughout the inspection. There are written procedures on the control of infection and staff are provided with suitable equipment and training to prevent the risk of the spread of infection. All laundry is laundered on the premises. Suitable hand washing facilities and protective clothing are available for staff. The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are well served by the numbers and skill mix of staff during the day, though there have been inevitable changes since the new owners took over. Residents are in safe hands and are protected by the home’s recruitment practices. Staff are trained to do their jobs. EVIDENCE: There is usually some degree of change following a home’s purchase by new providers, and this is the case here, though the registered providers and registered manager have done well to minimise the effect on the residents. Overall, the residents were very positive about the new management arrangements. There is currently 9 staff, including the registered manager, and the home normally functions with 11-12 staff. However, the registered manager said he was interviewing two new staff shortly, and is hoping to be able to identify a senior carer amongst the existing staff team. At the time of the inspection the registered manager and two carers were on duty. The registered manager generally works Monday to Friday 9am-5pm in a managerial capacity, though the inspector was advised that he is working more ‘on the floor’ at the moment. At night there is only one waking member of staff, supported by the registered manager who is on-call. The registered manager is currently on-call 7 nights per week, which is not acceptable. The on-call support requires staff The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 18 to travel in from home at short notice and the distances involved mean that support in an emergency is not a realistic proposition. Of the 9 staff, 5 have achieved NVQ Level 2 or above, and a further 3 staff are booked on this training or have started it. One staff personnel file was inspected and seen to show the home’s adherence to a robust employment procedure. The file also showed a record of training undertaken. An example of a completed National Training Organisation compliant induction training programme was also seen, though it was noted that this did not contain any notes or comments on the individual’s training. The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 19 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, 33, 35, 38 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A person who is fit to be in charge, of good character, and able to discharge his duties and responsibilities fully, manages the home. Formal quality assurance systems have been set up to demonstrate that the home is run in the best interests of the residents. The home’s accounting and financial systems ensure that resident’s needs are met. The health and safety of residents is promoted. EVIDENCE: The manager has been registered for approximately 10 months and has achieved the Registered Managers Award. The residents said that he looks after them well and is responsive to their needs. The registered manager was observed to interact with residents and staff in a relaxed, professional manner. The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 20 Quality assurance surveys were sent out, and responses received in 2007. The registered manager has yet to publish a summary of the findings from this (see comments regarding the review of the home’s Statement of Purpose and Service User Guide). The home has no involvement in handling residents’ monies, and holds no money for them. The registered providers ensure that there is sufficient cash flow to provide for residents day-to-day needs and there is evidence of investment to secure ongoing improvements to the home’s physical environment (see comments under the environment section of this report). There is appropriate insurance in place and regular and frequent maintenance and safety checks of equipment (documentation seen). The registered provider’s have made a significant investment in rewiring the home, and the registered manager said that the electrical system was inspected two weeks ago and undertook to forward a copy of the certificate. An external company has provided an environmental risk-assessment, including fire risk, which the registered manager is in the process of completing. The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 21 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP16 Regulation 22 Requirement The registered manager must review and amend the home’s complaints procedure and make it readily available to residents. The registered manager must make arrangements for staff to receive training in safeguarding procedures. The registered manager must review and amend the safeguarding (abuse) procedure to ensure that it provides clear instruction to staff. The registered provider must audit the premises, identifying work to be done, and provide a written report to the Commission for Social Care Inspection (including timescales), which prioritises any action required. The registered provider must keep staffing under review, especially at night, to ensure the safety and welfare of residents and staff. This requirement was identified at the previous inspection. The Old Manor House DS0000070049.V363642.R01.S.doc Version 5.2 Page 23 Timescale for action 01/06/08 2. OP18 13 01/08/08 3. OP19 23, 24 01/08/08 4. OP27 18 01/06/08 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 OP1 Good Practice Recommendations The registered manager should review and amend the home’s Statement of Purpose and Service User Guide to ensure the combined document includes all required information, and is current. The registered manager should publish a summary of the findings of the home’s quality assurance questionnaires, including anonymous comments from those asked, and any action taken as a result of the findings. 2. 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