CARE HOMES FOR OLDER PEOPLE
The Old Manor House 6 Regent Terrace Penzance Cornwall TR18 4DW Lead Inspector
Stephen Baber Unannounced Inspection 30th August 2007 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.V347970.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.V347970.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.V347970.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. First Inspection under new ownership. 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 £300.00-£355.00 per week. Additional charges are made for People who wish to have hairdressing, private chiropody, sessions from the mobile foot care unit and personal items such as confectionary and daily newspapers. The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) have made changes to the way we inspect services. Known as Inspecting for Better Lives (IBL). We are now more proportionate when reporting our findings, and more focused on the experience of people using services. This was the homes first inspection under new ownership and in all fairness the new owners and registered manager have only been in post for two months. The purpose of the inspection was to ensure that resident’s needs are appropriately met, with good outcomes provided to them. This was a key inspection, which was unannounced. It took place on 30th and 31st August 2007 and lasted for approximately 13 hours. The purpose of the inspection was to ensure that residents’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that residents’ placements in the home result in good outcomes for them. The inspection included interviews, some held privately in residents’ rooms and some in the communal area of the home, with residents and visiting relatives. Five members of staff were interviewed and there were opportunities to directly observe aspects of residents’ daily lives in the home and staff interaction with them. Other activities included an inspection of the premises, examination of care, safety and employment records and discussion with the senior member of staff on duty. The registered provider was also present for part of the inspection. Mrs Anson said that now she has taken over the ownership of the home she is going to completely turn things around and has started by financially investing substantially in the home. e.g. updating of the electrical to make them safe for the people who live. It is accepted that this is something, which you cannot see as a outwardly visible major improvement but will add to the overall safety of the residents. The providers have appointed a registered manager who is responsible on a day-to-day basis for the management and running of the home. Residents and staff benefit from the ethos, leadership and management approach of the home. Residents and staff said to me that the management approach creates an open, positive and inclusive atmosphere. The principle method of inspection was “case tracking”. This involves interviews with a select number of residents; staff caring for them and/or their representatives, and examination of records relating to their care. This provides a useful impression of how the home is working overall. At this inspection two residents were case-tracked, with particular reference to their individual and diverse needs relating to their age, culture and ethnicity, religion, gender, sexual orientation and disabilities. The provider also submitted the AQAA self audit tool. The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
Various residents expressed concern about differences they experienced prior to the new providers taking over. In contrast they have made many positive comments about changes the new providers have made. The improvements
The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 7 now show that the home has deliveries of fresh meat, groceries and milk freeing up the manager to spend time with the residents and staff. Mrs Anson and the manager said to me that they are reviewing all aspects of the business to ensure that the needs of residents are efficiently and effectively met, and to ensure compliance with regulations and standards. The review aims to identify each stage of the process of service delivery and will be informed by policies and procedures. What they could do better:
The manager was given comprehensive feedback on the findings of the inspection. As this inspection took place within the first two months of registration and management assures us that major changes are going to take place. Much of what has been inherited was being used including the previous recording formats. This is going to change in the future. Improvements will be required in the following areas: Assessments Assessments for new residents should consider all of their personal, health and social care needs, including their needs in relation to their background, religion and culture, so that they and the home’s staff can be sure that the home will be suitable for them. Residents should be invited to sign their assessments to show that they agree with the information that is recorded about them. Service user care plans The quality and standard of care plans is varied. Some were noted to be basic and did not appropriately detail the personal and specialist needs of residents. Care plans should contain sufficient detail to direct and inform staff when giving care. Medication and health related activities. A drug error policy should be complied that informs and directs the staff should an error occur. Catering Arrangements. Menu plans should list an alternative for every meal so that residents are able to exercise a greater degree of choice. Individual records of food provided to them should be maintained so that their nutritional needs can be monitored Premises The roof, ongoing maintenance, ceilings, redecoration and refurbishment of the home are going to be prioritised. Already there is evidence of major financial investment.
The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 8 Recruitment, selection and vetting of staff. We were concerned to note that in some instances the recruitment, selection and vetting of staff was not in accordance with the homes policies and procedures, E.g. no proof of I.D. Last ten years of employment recorded on the application form Person specification and notes of interviews were not in place. We understand that some staff files have been taken away and not returned to the home. All records should be kept in accordance with the Data Protection Act 1998. Staff should be employed fairly and according to their suitability to work in a care setting. This is important to ensure the welfare and protection of residents and maintain the good standing of the business. Safe working practices Risk assessments should be reviewed to detail how risk is assessed and, how any identified risk is to be minimised or prevented. Well-written and detailed assessments are essential to ensure staff respond appropriately and work in a safe manner. Records kept in the home. Collation and storage of records was found to be inefficient and disorganised. Management should present the resident and staff files more professionally with files indexed and ordered. Inspectors do not make suggestions about how registered persons manage their business. We do however make good practice recommendations based on standards, regulations and knowledge of good practice. Residents have the right to access their own file held on them at any time. All residents’ files should be maintained in an ordered manner, which is accessible, by them. Supervision Regular supervision and appraisal for staff has commenced. It is important that this is carried out for all staff so that residents are not inevitably at risk. Sparse staff supervision records. We are assured that the management will improve this area of their responsibility Safeguarding Adults A review of the Adult Protection Policy and Procedure should take place. Robust procedures for responding to suspicion or evidence of abuse or neglect (including Whistle blowing) ensure the safety and protection of residents. Staff Training There should be clear records of what training they have and what training they need, so that the home’s manager can plan staff training and ensure there is a suitable combination of trained staff on duty at all times to be able to meet residents’ needs. Fire, Health and Safety
The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 9 The home’s manager should review the fire safety risk assessment and make sure that fire safety records are readily accessible at all times so that he can be fully confident that residents are safe in the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 10 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.V347970.R01.S.doc Version 5.2 Page 11 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): Standards 1,2,3,4,5, and 6 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need to make an informed choice where to live. The assessment arrangements are not satisfactory as insufficient information is obtained to provide a clear picture of needs, preferences and choices. This also limits the manager’s ability to be satisfied that they are able to meet the needs of the prospective residents. New contracts for residents have been drawn up, but still need to be implemented so that they have clear and fair statements of the terms and conditions of their placements in the home. Residents should participate in the assessment process, which should fully consider their needs so that they can be confident the home will be suitable for them. EVIDENCE: A new statement Of Purpose has been written and it sets out the aims, objectives, philosophy of care, services and facilities and terms and conditions of the home. Residents said to me that they have seen the document. The manager assesses each prospective resident before they move to the care
The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 12 home. There is a heavy reliance on ticking boxes with no narrative on obtaining a clear picture of needs, preferences and choices. More detailed assessments would guide and inform staff to ensure they are able to meet the needs of the prospective residents. It is evident the manager and staff meet with prospective residents needs but the records of the assessment were not in sufficient detail and do not provide sufficient detail in certain areas to satisfactorily provide a comprehensive picture of the persons needs, preferences and choices. The limitations of the information also restricts the manager’s and staff ability to make sure the home is able to meet the needs of the person concerned and to develop a suitable plan of care. Residents that had recently moved to the care home confirmed they had been consulted prior to the move and had being given the opportunity to visit the care home. The residents also said they had received a positive welcomed from the staff and residents when they moved to the home. The manager does not offer a dedicated intermediate care or rehabilitation service but every reasonable effort is made to promote each residents independence. There are copies of a new contract for residents, with clear statements of their terms and conditions, attached to service users’ guides for the home. Contracts clearly state that residents will not be subject to room changes without their consent and/ or the agreement of an independent representative. These contracts have not yet been implemented and will be soon. The Old Manor House DS0000070049.V347970.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): Standards 7,8,9,10 and 11 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning arrangements do not provide a comprehensive picture of the residents needs to make sure residents receive the care and support required. The plans are regularly reviewed but the record of the review need to be more detailed to ensure up do date information is available. Positive arrangements are in place to meet and promote residents health needs. The arrangements to administer prescribed medicines is satisfactory but records could be developed further to have a drug error policy and procedure so that residents health is not compromised and staff know what to do if the wrong medication is taken. EVIDENCE: Two residents files were case tracked. Each resident has a care plan to inform the staff of the needs they have and the best way of providing the care and support they require.
The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 14 In some of the plans insufficient or very little information was provided about the resident’s needs and preferences. Care plans need to provide sufficient detail to give staff the information, guidance and direction they require to provide appropriate levels of care and support. The care plans are regularly reviewed with the residents but the records of the review need to be more detailed. This will ensure that everyone at the care home has up to date information about the care and support required. The manager said he is going to upgrade the care plans and will continue to develop and improve the care planning arrangements. The staff appeared to be more guided by the daily records, which they found to be informative and helpful in their work. Residents said that they were generally satisfied with the care and support provided but a number were able to identify areas that could be improved upon. These areas related to the current lack of information, direction and guidance to staff. Collation and storage of records was found to be inefficient and disorganised. Management should present the resident files more professionally with files indexed and ordered. We do not make suggestions about how registered persons manage their business. We do however make good practice recommendations based on standards, regulations and knowledge of good practice. Residents have the right to access their own file held on them at any time. All residents’ files should be maintained in an ordered manner, which is accessible, by them. Residents were very satisfied with the manner in which their health needs are met. During the inspection District Nurses visited the care home. The records at the home indicate that health services are promptly accessed when required. In addition residents said they had confidence their health needs were met sensitively and efficiently. The home operates the direct dispensing system and receives regular inspections from the pharmacist. The last inspection took place on the 27/02/07 when everything was satisfactory. Where staff assist residents the medicines are kept in secure facilities and the staff have all been suitably trained. However refresher training is required for all staff. A drug error policy should be complied that informs and directs the staff should an error occur. Generally residents had confidence in the manner medicines were dispensed. Residents are all very satisfied with the manner in which they are treated and were very complimentary about the staff and the care and attention they
The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 15 receive. Residents said that staff always treated them in a respectful and dignified manner. The Old Manor House DS0000070049.V347970.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): Standards 12,13,14 and 15 were assessed. 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 some residents are satisfied with the choice available. EVIDENCE: All the residents said to me how much they like the new owner and newly registered manager who was very protective of them. Many residents are satisfied with the lifestyle they experience and commented they felt in control of events. Some residents said to me that they go shopping to the town, attend religious opportunities outside of the home and some enjoy sitting in the garden.
The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 17 There are a range of recreational and leisure opportunities provided at the home that reflect residents’ choices and preferences. Some of the residents said they were satisfied with the arrangements. We observed residents going out to family and friends in a taxi. Maintaining community links was very important to some residents. Another resident enjoys going to town to have her hair done rather than use the facilities in the home. The daughter of a resident said how much the atmosphere has improved in the home since the new owners and manager has taken over. 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. The manager said that a big improvement has taken place with the shopping and instead of having to shop for food deliveries of fresh meat, shopping, milk and vegetables is happening. A varied menu is provided and two cooks are employed. Care staff also assists in the preparation of some meals and the staff concerned have basic food hygiene training. Both cooks are experienced, have been appropriately trained, and also work as care assistants. The equipment in the kitchen is regularly serviced, maintained, and appropriate health and safety measures are in place All the residents said to me that they are satisfied with the catering arrangements provided and they also said the manager ensures that their personal tastes and preferences are provided for. The dining tables were nicely presented with attention to detail on the tables. The manager said the dining chairs are going to be replaced with suitable dining chairs. The current ones are used in chapels, can be interlinked, and are not suitable for frail elderly people. The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Positive arrangements are in place to respond to any concerns or complaints. The arrangements for protecting residents against abuse are also satisfactory and make sure that every reasonable step is taken to protect residents. All staff should have training in Safeguarding Adults to protect residents from harm. EVIDENCE: There have been concerns expressed to the Commission about the management of the home. These concerns are still ongoing. The manager has dealt with the concerns efficiently and took appropriate action to deal with the matter. The manager has established a suitable policy and procedure to deal with complaints and residents said there were no barriers to raising any issues or concerns. The complaints procedure requires the addition of contact details for Cornwall Department of Adult Social Care and their complaints procedure. Formal systems to protect them form abuse need to be improved. This includes staff training, written procedures to guide them on what to do should they suspect abuse of a resident and maintenance of records about staff to demonstrate that they are safe to work with vulnerable people in a care setting. Whilst the policy and procedure in place to protect residents from abuse has been updated to ensure it reflects the Department of Health guidance ‘No Secrets’. However the policy and procedure should state that any allegations or
The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 19 concerns are reported to the statutory authorities and investigations takes place where necessary. At present the policy and procedure states that the manager or providers will investigate the allegations. All of the residents confirmed that they feel safe in the home and most were satisfied with the care they receive. The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 20 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): Standards 19,20,21,22,23,24,25 and 26 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to the home both internally and externally must be made to ensure that residents live in a safe, well-maintained home. EVIDENCE: The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 21 The new providers are going to review the premises and invest financially in the home. 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 not being well care for with holes in the roof and ceiling tiles coming away from the ceiling due to the leaking roof. The provider has assured us and the manager there will be a significant improvement in all areas of the home both internally and externally. This will be followed up at the next inspection. 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. The provider said that in addition to the several thousand pound invested in improving the electrics funding is going to be provided to install an hydraulic lift from the outside entrance to access the home. At present access is limited to the very able residents and their family. The home has a shaft lift to enable access to all four floors. Residents have access to healthcare and other professionals in relation to provision of specialist disability equipment as required. Storage facilities are very limited. Bedroom accommodation is spread out over all four floors. The new providers are going to invest in upgrading the bedrooms. 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 twenty-five watt bulbs have been replaced with brighter lighting. 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 residents and the homes laundry is laundered on the premises. Suitable hand washing facilities and protective clothing are available for staff. The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 22 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): Standards 27,28,29 and 30 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and skill mix need to be reviewed so that they meet the assessed and recorded needs of the residents by day and by night to ensure the residents are in safe hands at all times. There needs to be evidence that staff are recruited on the basis of fair, safe and effective recruitment policies and practices and are suitable to be employed in a care setting. There is a lack of evidence that staff are trained and competent to do their jobs. EVIDENCE: Records of staff on duty on the days of the inspection evidenced that two care assistants were supported by the manager to care to the needs of the residents. Care staff may also carry out cooking and domestic duties. There is one waking night staff on duty through the night. The magnitude of care assistants covering four floors and carrying out domestic duties takes them away from caring for the residents. With one waking night staff covering four floors there may be occasions when residents dependency increases or a crisis where another person on the premises to assist would be a great help. There
The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 23 are seven care assistants and two cooks. Most of the care staff either have or are working towards completing qualifications to at least NVQ level 2 in care. The cooks also holds care qualifications. The two files case tracked provided evidence of in-house induction training but the industry standard Skills For Care should be adopted for all new staff.shol It is recommended that day and night staff levels be reviewed to reflect the needs of the residents A written procedure for staff recruitment needs to be developed, to back up good practice. Recruitment needs to be demonstrably fair, with records of selection procedures and interviews retained. It needs to be safe in that checks are made to ensure that staff are suitable to work with residents in a care setting and effective in that staff are selected on the basis of their competence to meet residents needs and suitability, with records to back this up. Evidence that staff are trained and have regular training updates so that they can work safely, skilfully and effectively with residents need to be improved. There should be a whole team staff training plan in place, so that training needs can be readily identified and prioritised for the protection and welfare of the residents. The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 24 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): Standards 31,32 33,34,35,36,37 and 38 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed by a person who is fit to be in charge, of good character and able to discharge his duties and responsibilities fully. 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. Formal systems for supervising staff have commenced but need to apply to all staff so that their skills and competence to work with residents are monitored on an ongoing basis. The home is safer now for residents and staff, but further specific improvements are needed. The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager has been registered for two months and in that time he has started to review all aspects of his responsibilities with the registered providers. The residents said to me that he looks after them well and is very responsive to their needs. He communicates a clear sense of direction and leadership which residents and staff are able to relate to. There is formal quality assurance procedure in place. The latest exercise was carried out with a positive response from the residents. Comments such as “good atmosphere with everyone feeling better” “Carpets require more frequent hovering” “More garden tables” “Glad people can contribute to the running of the home” We met the registered provider who regularly visits the home to talk with the residents and support the manager and staff. The residents said that Mrs Anson was a nice lady and very approachable. One of the registered providers who is Mr Anson is an accountant and he ensures 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. The home has sufficient insurance cover in place with a certificate displayed in the office. The family of residents manage their financial affairs. Collation and storage of records was found to be inefficient and disorganised. Management should present the resident and staff files more professionally with files indexed and ordered. Inspectors do not make suggestions about how registered persons manage their business. We do however make good practice recommendations based on standards, regulations and knowledge of good practice. Residents have the right to access their own file held on them at any time. All residents’ files should be maintained in an ordered manner, which is accessible, by them. The providers have made a substantial investment in improvements to the fabric of the building . The improvements include the updating of the electrical system. Improvements are going to be made to the home’s fire alarm and emergency lighting systems to make them safer. The manager should review the home’s fire safety risk assessment. The home’s fire safety records, including alarm and equipment test were up to date and in sufficient detail. The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 26 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 2 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 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 3 18 2 2 2 2 2 2 2 2 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 2 2 2 The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? First 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 OP3 Regulation Requirement Timescale for action 28/02/08 2 OP7 3 OP9 4 OP22 5 OP27 14(1)(a-c) The registered person must ensure that a comprehensive assessment of need must be completed for all prospective residents. 15(1) The registered person must provide care plans with sufficient information about the residents needs to inform, guide and direct staff. Resident files must be professionally maintained for the quick retrieval of information. 13(2) The registered person must write a drug error policy and procedure and ensure that all staff have up to date training in medication. 23(2) (b) The registered person must make good the roof and ceilings in some of the residents bedrooms. 18 (1)(a) The registered person must review staffing levels and skill mix need so that they meet the assessed and recorded needs of the residents by day and by night. 19 The registered person must
DS0000070049.V347970.R01.S.doc 28/02/08 28/02/08 28/02/08 28/02/08 6 OP29 28/02/08
Version 5.2 Page 28 The Old Manor House provide evidence that staff are recruited on the basis of fair, safe and effective recruitment policies and practices and are suitable to be employed in a care setting and to provide proof of identification. There is a lack of evidence that staff are trained and competent to do their jobs. 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 OP15 Good Practice Recommendations The registered person should list an alternative for every meal so that residents are able to exercise a greater degree of choice. Individual records of food provided to them should be maintained so that their nutritional needs can be monitored The registered person should provide training for all staff on Adult protection and update the policies and procedures to reflect the action to be taken should an allegation of abuse be made. The registered person should implement Skills for Care induction training for all new staff. The registered person should present resident files in a more ordered and professional manner. The registered person should review and bring up to date the home’s fire safety risk assessment. 2 OP18 3 4 5 OP30 OP37 OP38 The Old Manor House DS0000070049.V347970.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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
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