Inspection on 28/12/06 for The Manor House

This inspection was carried out on 28th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Manor House 07/10/09

The Manor House 25/02/09

The Manor House 30/11/08

The Manor House 20/10/08

The Manor House 15/05/08

The Manor House 11/12/07

The Manor House 06/06/07

The Manor House 15/08/06

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 Uphill Court 62 Uphill Road South Weston Super Mare North Somerset BS23 4TA Lead Inspector Nicola Hill Unannounced key Inspection 28th December 2006 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 Uphill Court DS0000067101.V319527.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. Uphill Court DS0000067101.V319527.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Uphill Court Address 62 Uphill Road South Weston Super Mare North Somerset BS23 4TA 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) 0208 5606691 Shreyas S.A.I.N. Ltd Mrs Jana Harris Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Uphill Court DS0000067101.V319527.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Manager must be a RN on parts 1 or 12 of the NMC register. Staffing notice dated 26 May 1999 applies. May accommodate up to 25 persons aged 65 years and over. That the manager achieve the Registered Manager`s Award within one year of registration. Date of last inspection Brief Description of the Service: Uphill Court is a registered care home with nursing; it is well established in the local community and sited close to local facilities. The fee level for the home is £450 per week for self-funded residential residents, rising to £600 per week for self-funded nursing care residents. Uphill Court DS0000067101.V319527.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection was undertaken with the manager Jana Harris. Talking with the residents and staff at Uphill Court, provided some of the evidence for this report. The inspector also reviewed care files for residents, and administrative records relating to the implementation of health and safety at Uphill Court. At the time of the inspection there were two vacancies at the home. The inspectors spoke with several residents and used the Commission service questionnaires to gather opinions of other service users. The inspector also spoke with staff on duty at the home during the visit. The residents confirmed that the outcomes from the services provided are of a good standard, and staff commented that they enjoyed working at the home. The quality of the services provided by the home have been judged as being of a good standard. What the service does well: What has improved since the last inspection? Uphill Court DS0000067101.V319527.R01.S.doc Version 5.2 Page 6 The improvements made since the last inspection include the introduction of regular supervision for staff; a four-week menu plan which was drawn up following consultation on an individual and group basis with residents; refurbishment and redecoration of bedrooms has taken place as they become vacant. The delegation of authority and responsibility between the owner of the home and the manager has been clarified, and the management of the home is settled and stable. 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. Uphill Court DS0000067101.V319527.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 Uphill Court DS0000067101.V319527.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): 3,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions to the home only take place following a preadmission assessment by qualified staff. EVIDENCE: The statement of purpose has been updated and is in the entrance hall and accessible to visitors and residents. The individual care files for residents indicated that a pre-admission assessment had been undertaken which ensured that the home was able to meet identified need. Residents confirmed being met by the train staff prior to admission, either at home or in hospital. The service questionnaires also confirmed that pre admission information was good. Residents confirmed that contracts were issued which confirmed the services to be provided. Uphill Court DS0000067101.V319527.R01.S.doc Version 5.2 Page 9 The 21 residents at the home at the time of the inspection have average age of 86. The religious preferences of each individual are stated on the admission documentation, these needs are met through the regular multi denominational services held at the home. The ethnicity of the resident group is majority white UK and one white Irish. Uphill Court DS0000067101.V319527.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 adequate. This judgement has been made using available evidence including a visit to this service. Although residents have individual health care plans, communication of change in health care needs could not be evidenced. EVIDENCE: The feedback from the commissioned questionnaires for this section was good with residents identifying that there are sufficient staff that listen to them and take notice of what the residents’ wishes are. Residents confirmed verbally to the inspector, that their experiences of receiving personal care from staff was good. The inspector reviewed several of the care files for residents at the home; some of them were new residents and some older residents. The home continues to use various assessment tools to identify levels of dependency and care needs. For some individuals the assessment tools identified a need but there was no care plan in place. However the daily records maintained by nursing staff did not accurately reflect changing health care needs. Some Uphill Court DS0000067101.V319527.R01.S.doc Version 5.2 Page 11 entries stated that an event had occurred but there appeared to be no followup action to support any care need. The trained staff team have verbal handovers, and the manager is confident that the information is exchanged is sufficient and residents are supported with their care needs. However record keeping was an issue that was raised at the last inspection and staff must maintain records which are reflective of the care residents receive. The physical appearance of residents is good and indicate that they are welldressed and well groomed; inspector visited several residents who were in their rooms which were tidy, with clean linen on the beds. There is a good standard of cleanliness at the home and infection control measures in place. Three of residents were receiving treatment for pressure ulcers, and there was clear evidence of wound charts and dressing protocols in place to support healing. The GP visits the home on a regular basis and is supportive with advice for wound care. The care plans for some residents indicated that specialist health care provision would be advisable and the manager was able to demonstrate liaison and referral to specialist health care services such as the mental health team, community physiotherapy etc. The system for recording and administration of medication was found to be in good order; the home use a unit dose of system (Pharmacy Plus). The inspector checked medication which was not included in the blister packs, generally the stock control was good except for when required paracetamol which obviously had been used for several residents from one residents box. The manager will raise this with the trained staff as it is an indication of complacency and inattention when dispensing medication. The inspector and manager also discussed that the stocks of paracetamol should be spot checked and this could be delegated to the home owner who is a pharmacist. All the controlled drugs with recorded correctly and had accurate stock levels. The Uphill Court DS0000067101.V319527.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. The home encourages residents to be actively involved in the day-to-day running of the home. The home takes resident feedback seriously and makes changes were possible. The home operates a key worker system which enables closer resident staff relationships. EVIDENCE: Since the last inspection the manager and owner have continued to be proactive in seeking the preferred lifestyle choices of the residents. To celebrate Christmas the home organised numerous events, both in the home and in the community, and gave residents and families the opportunities to attend. The residents who spoke with the inspector confirmed the activities programme that had been planned and were able to identify which they attended and which ones they enjoyed the most. To support the development of the activities programme at home the staff responsible for organising sessions had attended training. Through the holiday period activities were on a one-to-one session, however the staff now have ideas and equipment in place to plan small focused group sessions. The key workers also take residents out and about whenever possible. Uphill Court DS0000067101.V319527.R01.S.doc Version 5.2 Page 13 The staff situation in the kitchen has stabilised and staff have received an update on food hygiene awareness. Residents were able to confirm that they were consulted by the manager and owner when the four-week menu plan was produced. However the quality and presentation of the meals remains variable and received the least positive comments directly from service users and from the service questionnaire. This was discussed in depth with the manager who proposed giving the menu to residents on a weekly basis to allow them to make their own choices in advance, and also identify any meals which are unpopular. The manager is also keen that kitchen staff receive further training to enhance quality of the meals. Uphill Court DS0000067101.V319527.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 good. This judgement has been made using available evidence including a visit to this service. Residents understand how to make complaints and what they can expect to happen when a complaint is made. EVIDENCE: Uphill Court has a rigorous complaints procedure; three complaints have been received in the last 12 months, and have been resolved by the manager. The resident questionnaire clearly demonstrated that residents were confident they knew who to approach if they wish to make a complaint. There have been no adult protection issues at this home. Uphill Court DS0000067101.V319527.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 adequate. This judgement has been made using available evidence including a visit to this service. The service provides a homely environment; it has a rolling programme to improve the decoration, fixtures and fittings. The home is generally clean and tidy and there is hygiene equipment available for effective infection control. EVIDENCE: Since the last inspection there has been ongoing refurbishment and repair to various areas around the home. The building is old and has lacked investment and therefore the improvements made so far have not significantly impacted on the environment. However the manager was advised to produce a programme of intended work so that residents, staff and visitors know what is planned and that there is going to be investment in the home. The manager and inspector discussed the heating in the dining room, currently it is too cold to use, and fixed wall mounted heating such as electric heaters Uphill Court DS0000067101.V319527.R01.S.doc Version 5.2 Page 16 will be purchased. The inspector also advised that the hoist needed to be cleaned, and have new rubber handles. The home is generally clean and tidy and there are no unpleasant odours. Uphill Court DS0000067101.V319527.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 good. This judgement has been made using available evidence including a visit to this service. Residents have confidence in the staff to care for them. EVIDENCE: At the time of the inspection there were 21 residents at the home, with varying levels of dependency. The staff rota indicated that there were three care staff on duty between 8 a.m. and 8 p.m. supported by the trained nurse; two staff cover the night-time hours one of which a trained nurse. The staff work to a planned rota which is adjusted according to the level of support needed by the residents, for example, if more residents were admitted to the home than the number of care staff on duty would need to increase. The comments from the service user questionnaire about the quality of staff were very favourable and the key worker system allows staff and residents to develop good relationships. The staff at the home undertake basic induction training and are supported to attend additional service specific training such as catheter care, dementia care etc. Four of the current care staff team have NVQ2 or above, two care staff are working towards NVQ 3, and one is currently working towards NVQ 2. The manager has a training plan for the coming year which incorporates in-house training and attendants on external courses such as the training sessions available from North Somerset PCT and Weston College. Uphill Court DS0000067101.V319527.R01.S.doc Version 5.2 Page 18 New staff records were reviewed and the recruitment process could be seen to be fully implemented; supervision for staff has been introduced to the home and currently is working well. Uphill Court DS0000067101.V319527.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, 32, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has sound policies and procedures which the manager effectively reviews in line with current practice. management processes ensure that they receive feedback on their work. EVIDENCE: The manager and new owner of the home have developed a sound working relationship with clear lines of accountability and responsibility. The manager will provide the day-to-day leadership in the home and oversee the standards of care of the residents supported by the owner who visits on a weekly basis and undertakes regulation 26 responsibilities. The management of the home Uphill Court DS0000067101.V319527.R01.S.doc Version 5.2 Page 20 have worked together and support each other when necessary i.e. for staff disciplinary issues. The manager and owner attend regular staff meetings and are available to staff and residents. The manager continues with the quality assurance systems to ensure that regular feedback is received and that any issues that are raised are acted on. The supervision of staff has been fully implemented and the manager was able to show evidence of this, verbal evidence from the staff team supported this. The issue of the day-to-day supervision of the work of the care assistants in the home was discussed with the manager; the trained nurses must be confident enough to act as team leaders and direct the day-to-day routine at the home. The manager is confident that the nurses have the skills to do this and will be holding a meeting specifically to remind them of their responsibilities in overseeing the care that is being given, and recording it effectively. The recent environmental health report received at the home highlighted some deficiencies in the implementation of food hygiene. The requirements recommendations clearly indicate that the cooks do not have a good understanding of food hygiene and therefore are unable to implement this at the home. This is despite of both cooks receiving in-house food hygiene refresher training. The issues raised by the environmental health officer were very minor and easily resolved. It will be a requirement that both cooks and other staff who are responsible for food preparation attend an externally assessed Foundation Certificate in Food Hygiene, recognised by the Chartered Institute of Environmental Health. The staff team attended fire training from Tom King in November 2006 but have yet to receive a certificate for this training; the fire safety risk assessment was also being formulated by this trainer and has not yet been received, the manager will follow this up. The accident records were reviewed and 11 accidents recorded since August 2006, the majority of these were minor falls. Uphill Court DS0000067101.V319527.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 X X 3 X X 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 2 X X X X X X 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 4 3 X 3 X 3 Uphill Court DS0000067101.V319527.R01.S.doc Version 5.2 Page 22 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 14(2) Requirement Timescale for action 28/12/06 2. OP38 13(3)(4) 3. OP30 18(1)© The registered person shall ensure that the assessment of the service users needs is (a) kept under review; and (b) revised at any time when it is necessary to do so having regard to any change of circumstances. The registered nurses must ensure that the document fully any change in health care needs of the residents and if necessary produce a plan of care to meet presenting need. The registered person shall make 28/02/07 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. The registered person shall ensure that (c) unnecessary risks to the health or safety of service users are identified and as far as possible, eliminated. The employees responsible for the preparation of food must attend an externally operated Food hygiene course. The registered person shall, 28/02/07 having regard to the size of the DS0000067101.V319527.R01.S.doc Version 5.2 Uphill Court Page 23 care home, the statement of purpose and the number and needs of service users (c) ensure that persons employed by the registered person to work at the care home receive (i) training appropriate to the work they are to perform; and (ii) suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. Persons responsible for cooking meals must be trained to do so. 4. OP20 23(2)(0) The registered person shall 16/04/07 having regard to the number and needs of the service users ensure that external grounds which are suitable for, and safe for use by, service users are provided and appropriately maintained. Outdoor space should be made accessible to the residents. The registered person shall 16/04/07 having regard to the number and needs of the service users ensure that (b) the premises to be used as the care home are all sound construction and kept in a good state of repair externally and internally. A programme of maintenance and renewal of the fabric of the building is planned and implemented. 5. OP19 23(2)(b) Uphill Court DS0000067101.V319527.R01.S.doc Version 5.2 Page 24 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 OP36 Good Practice Recommendations The trained nurses must act as team leaders and direct the day-to-day routine at the home taking responsibility to oversee the care that is being given. Uphill Court DS0000067101.V319527.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Somerset Records Management Unit 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 Uphill Court DS0000067101.V319527.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!