Care Home: Canford Manor Nursing Home

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What the care home does well There is good consideration by the home and staff about the psychological impact moving into a care home has on people. Effective documentation ensures there is evidence of communication with representatives of people living at the home about their health and welfare. What the care home could do better: The assessment of people before they move into the home needs to be improved to ensure there is sufficient information about a person`s needs to enable the decision be made as to whether the home can meet that person`s needs. Care plans should be person centred, detailing the wishes and preferences of people with regard to areas such as personal care. There should be personalised information in care plans bout meeting needs such as continence and skin integrity to ensure continuity of care for people living at the home. Guidelines need to be in place for the administration of `as required` medications to ensure people only receive these medications when they need them. Medication procedures must ensure that medications administered are signed for and for any medications not administered the reason for this must be recorded. It cannot be assured that people living at the home are protected from harm and injury due to the environment of the home. Several areas of the environment have the potential to pose risks of harm to people living at the home. There needs to be documented evidence that risks associated with the environment of the home have been considered and action taken to reduce the impact of any identified risks. Substances hazardous to health such as cleaning fluids were left accessible to people living at the home. These must be stored in secure areas so they do not pose any risks to people. There needs to be a registered manager at the home. Random inspection report Care homes for older people Name: Address: Canford Manor Nursing Home 38 Manor Way Lee-on-Solent Hampshire PO13 9JH two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Gina Pickering Date: 3 0 0 3 2 0 1 0 Information about the care home Name of care home: Address: Canford Manor Nursing Home 38 Manor Way Lee-on-Solent Hampshire PO13 9JH 02392550437 02380559164 stannes@pegmar.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Christopher Imonikhe,Mrs Kathryn Dawn Imonikhe Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 24 Number of places (if applicable): Under 65 Over 65 24 24 24 old age, not falling within any other category physical disability terminally ill Conditions of registration: 0 5 5 Service users in the PD and TI categories cannot be admitted under the age of 44 years. Date of last inspection Brief description of the care home Canford Manor is a care home providing nursing care for a maximum of 24 older persons. The home is located in a residential area of Lee-on-the-Solent and is close to local amenities, shops and public transport. Accommodation comprises of 24 single Care Homes for Older People Page 2 of 15 Brief description of the care home rooms with en-suite facilities over two floors. A shaft lift is provided to give easy access to the upper floor. There is a large lounge/dining area and a separate small lounge is also available. There is a rear garden, which is accessible to residents and there is car parking at the front of the home. Care Homes for Older People Page 3 of 15 What we found: At this random inspection we looked at the health and personal care for people living at the home, the safety of people in the home environment and the management of the home. We used information from the Annual Quality Assurance Assessment (AQAA) that the home is required to complete. A visit was made to the home on 30 March 2010. During the visit to the home we looked at documentation relating to three people living at the home, had discussions with Mr and Mrs Imonikhe who are the registered providers, three staff members and four people living at the home. We also had a look at various areas of the home and viewed documentation relating to the running of the home. The AQAA told us pre admission assessments are carried out to ensure all the service users needs can be met. We looked at the pre admission assessments for three people, two of which had moved into the home in the previous twelve months. For the person who had moved into the home several years ago information on the assessment form was limited and Mrs Imonikhe told us that the assessment process had moved on since that time. However for the two people who had moved into the home in the last twelve months there was also limited information on the assessment form. For example details about personal care needs consisted of needs assistance but no details about what assistance is needed. For one person there was no detail about skin integrity needs other than a statement to assess. There was no detail about social interests or family involvement for one person. We asked Mrs Imonikhe how a decision was made from this information as to whether the home would be able to meet the needs of the person being assessed. She described the difficulties experienced in completing thorough assessments. This included problems assessing people because themselves and their relatives were in a highly anxious state and difficulties experienced obtaining information about peoples conditions from hospitals. However there were no details in the individuals records to indicate that all had been done that was possible to assess the persons needs. We were told that social services assessments of peoples needs are not obtained for people being admitted to the home under care management processes. In the situation of the home not being able to complete an in depth assessment of a persons needs, details in a social services assessment would assist the service in making the decision as to whether they can meet the individuals needs. Present assessment process cannot ensure that the needs of people can be met when they move into the home. We assessed how the personal and health care of people living at the home is being met. Each person living at the home is required to have a care plan that details the actions to be taken by staff to ensure that persons has his/her health and personal care needs met in way they like. We were told in the AQAA that the home works on a person centred approach and the service user (person living at the home) is encouraged to choose their own pathway of care. We looked at care plans for three people living at the home. Assessments were in place for each person about moving and handling that included any constraints such as limb weakness that would make moving difficult or poor comprehension that would pose the person problems with understanding instructions. Details were recorded about the assistance the persons needs to move in a variety of settings in the home. This included the use of aids such as hoists and walking frames and how many staff members are needed to support that person to move safely. Care Homes for Older People Page 4 of 15 Assessments were in place for each person about the risk of developing pressure ulcers with details about the actions to be taken to reduce these risks. This included the use of pressure relieving equipment such as special mattresses and actions such as two hourly changes of position and assessment of at risk areas of the persons body. For some people it was detailed in their care plans that cream needed to be applied to the vulnerable areas of their body, but there were no details about the type of cream to be used. Assessments were in place for each person about the risk of malnutrition with actions detailed to reduce the effect of any identified risk. There were also details about how to meet any special dietary requirements for health or personal reasons. Monthly weights were recorded on all the people whose records we looked that detailed there were no concerns with their weight. Each person had a plan detailing how their personal care needs were to be met. This included details such as to encourage the person to wash areas of the body they can do themselves, staff to assist with weekly baths and hair washes and gave details of any moving and handling equipment required in providing personal care safely. However there was no detail about what the person was able to do for themselves or their preferred toiletries. Some personal care plans detailed that the person liked cream applied but did not detail what cream was used. Wound care plans provided a detailed description of the wound and details about the dressing and cleansing agents used, the frequency of dressings and progress of the wound. Records detailed wounds were being attended to following the description of care in these plans. There were photographs of the wound, however these photographs were not dated so tracking the progress of the wound with photographs would not be possible. There were details about the involvement of specialist health care practitioners with regard to wound care such as General Practitioners and Tissue Viability Nurses. Individual assessments identified individuals at risk of falling out of their beds. Bed side rails were used to reduce the risks of these identified people of falling out of their bed and harming themselves. For some people whose plans we looked there was a signed consent from the person or their representative for the use of bed side. For one person there was no signed consent, but conversation with this person evidenced he/she understood the reasons for the use of bed sides and agreed to there use. Each person had an assessment that identified whether they were at risk of falling with action to be taken to reduce identified risks detailed. One if these assessments detailed that the areas should be clear of obstacles. When we spoke with this person in his/her bedroom we observed the cable from the call bell was trailing across the floor in front of the door to the bedroom. This was done so the call bell was easily accessible to the person, but the practice of having cables trailing across the floor poses a risk to both the person living at the home and staff members entering the bedroom of tripping and falling. Care plans for the management of continence provided details of assistance and the type of incontinence aid that is used by the person. However details of frequency of assistance were vague such assist to the toilet regularly and check pads. There were no details about what regular meant. This means that there is a risk of different staff interpreting this instruction in varying ways and the person living at the home not receiving consistent Care Homes for Older People Page 5 of 15 care with regard to meeting their continence needs. Each person had care plans for their communication needs and psychological needs. Both of these areas were well thought out with details that included the psychological impact moving into the care home had on the person. Communication care plans detailed any problems the person had with communication whether it was a hearing or visual problem or if they had difficulty in expressing what they wanted to say and good guidance for staff members about how to communicate with the person. For one person it was detailed that because of their mental cognition they were unable to use a nurse call bell to summon assistance from staff members. This persons care plan detailed that regular safety checks were to be undertaken but did not stipulate the time and how often she should be safety checked. We discussed this with Mrs Imonikhe and she told us she will implement a chart for recording when and how often people at risk are checked for their safety. There was a form in each persons care plan file to detail wishes about end of life care. However these forms were not completed. There was no detail about the wishes of people in their final days whether they would want to be admitted to hospital, whether they would want to stay at the care home and how much medical intervention they would want. This means there is a risk that in the final days of a persons life they will not receive the care and support they would wish for. For some people there were details about their funeral arrangements. In each persons file there was a form to indicate the care plan had been reviewed by the home along with the person living at the home and their relatives. Not all of these were signed, though conversation with some people living at the home indicated they understood the need for the care they were receiving and were happy with it. All care plans were signed by staff members to indicate they were reviewed by staff on a monthly basis. The AQAA had told us the home had implemented a record sheet to evidence communication with relatives about changes in the health care of people living at the home. We saw records that evidenced this was happening. Records are kept of all contacts people living at the home have with health care professionals. These indicated that people have their medications reviewed, physiotherapists are involved for people who have changing mobility needs, the Tissue Viability Nurse is involved for people with wound care problems and relevant referrals are made to General Practitioners to ensure peoples health care needs are met. We assessed some of the medication practices at the home. We had a look at the Medication Administration Record (MAR) charts for four people. These charts are hand written by staff members at the home, but there was no signature to identify the person who had transcribed the information onto the charts. It is good practice that if staff members transcribe details on the MAR charts that they sign to indicate their accountability of having transcribed the information correctly. Mrs Imonikhe explained the process she completes for ordering and receiving medications that includes the viewing of peoples prescriptions to ensure the medications they are being administered are the medications prescribed to them by their medical practitioner. She showed us the documentation she uses to check the amounts of medication stock held at the home, thus ensuring there is an audit trail of all medications received into the home, administered to people and destroyed. She also described to us the procedures that are carried out to Care Homes for Older People Page 6 of 15 ensure medications prescribed such as antibiotics are obtained promptly even when prescribed outside normal opening hours of chemists. All medications are administered by the nurses at the home who sign the MAR chart to evidence they have administered the medication to the person named on the chart. For three of the four charts we looked at there were missing signatures, meaning it had not been evidenced that the person had received their medications. There were no reasons documented as to why that medication had not been administered. This means it cannot be assured that all people living at the home are receiving their medications as prescribed to them by their medical practitioner. Some people were prescribed medication to be take as required. This included medication for pain relief, constipation and nausea. There were no indications in care plans or relevant guidelines in the MAR charts detailing when to give the medication or when to ask the the person if they need it and what symptoms to look out for to indicate this medication is needed. One care plan did detail apperients (laxatives) to be given as prescribed. But for this person the apperients was prescribed to be give as required, so there was still no clear guidance as to when this medication should be administered. This means people are being put at risk of either receiving when they do not require them or not receiving them when they do require them. People should live in a home that is clean, homely and posses no risks to them. We had been told in the AQAA that the home is warm, clean and a safe environment with no offensive odours. However during the course of our visit to the home we identified issues with the environment and provision of equipment that had the potential to cause harm to people living there. We had a look around the environment of the home viewing a sample of bedrooms, the communal areas that consisted of a large lounge/diner and a smaller lounge and a variety of bathrooms and toilets. It was observed that many of the radiators did not have guards over them, some of which were in peoples bedrooms. One of the radiators that was not guarded was by the front door. This felt very hot to touch and if somebody fell against it posed a risk to them of receiving a burn. We discussed the practice of not guarding radiators with Mr Imonikhe. He told us all radiators had been risk assessed and only those that posed a risk to people had radiators guards put in place. However when we asked to see relevant risk assessments for the radiators he was unable to show us any assessments for 2009 or 2010. There was no relevant information in peoples care plans to indicate the risk to them of unguarded radiators had been considered. All windows in the home are able to fully open including windows on the first floor. We discussed with Mr Imonikhe the risks this might pose to people living at the home. He told us that as part of the persons care planning process the risk of them jumping or falling out of open windows had been considered and nobody presently living at the home was at risk. However we could not find any information in the care plans that confirmed an assessment had been completed and the practice of having fully opening windows was not putting anybody at risk. We had a look at the bathrooms. There are two bathrooms on each floor. On the ground floor there is a bathroom with an assisted bath and one with a shower. It was noted that the shower had steps up to it. Discussion with staff and the Mr and Mrs Imonikhe indicated that this room is not used by people living at the home because their mobility problems means the shower is not accessible to them. On the first floor there is a bathroom with an assisted bath and a second one with a bath and hoist. The bathroom with hoist had cracked tiles to the side of the bath that looked unsightly and could pose Care Homes for Older People Page 7 of 15 difficulties with thorough cleaning of the room. The bathrooms with assisted baths had a sheet of paper to record the temperatures of bath water, however these had not been completed since 2008. We discussed this with Mr and Mrs Imonikhe who told us that the temperate of water is controlled by preset thermostats on the bath taps ensuring the water is at a safe temperature. Mr Imonikhe confirmed the baths are serviced regularly but was unable to show us a recent service certificate. The most recent he could show us was dated 2005. Mr Imonikhe contacted us the day after our visit to the home to inform us that bath temperatures are recorded on the bath records for each person living at the home. There was toilet roll available in all bathrooms and toilets, but with the exception of one room toilet rolls were not in dispensers or holders, but were instead placed on cisterns at the back of the toilet or balanced on hand rails. Mr Imonikhe contacted us the day after our visit informing us that the reason for toilet rolls not being in dispensers or holders was because the holders had been located on the wall at the back of the toilets which was difficult for people to reach. However many of the toilet rolls we observed were still located at the back of the toilet on the cisterns which would be difficult for people to reach. There is the concern that because toilet rolls were not in an appropriate container/holder there is a risk of cross contamination from toilet rolls coming into contact with dirty surfaces and then being used by a person living at the home. There were no paper towels in any of the bathrooms or toilets. Cloth hand towels were available that were placed over radiators. We discussed the best practice of using disposable paper hand towels to reduce risks of cross infection with Mr Imonikhe. He told us they had run out of supplies of paper hand towels and they were being put in place that day. He also told us that the use of cloth hand towels was acceptable because all staff use gloves when attending to the toileting needs of people living at the home and nobody living at the home accesses the toilet independently. However there was no consideration of cross infections risk posed to people living at the home during washing and drying their own hands. There was dispensing liquid soap in bathrooms and toilets, but there were also bars of soap that would pose risks of cross infection. We did observe disposable gloves and aprons were available to staff members which assist with the prevention of cross infection. We noted in bathrooms there were bottles of shampoo that were not named. If these were being used for communal purposes it is poor practice, exposing people to risk of cross infection from using communal toiletries. As these rooms are accessible to people living at the home there is also the risks posed to them from ingesting such substances. We also saw a can of air freshener in one bathroom, a bottle of disinfectant spray in the sluice that was accessible to all and a container of cleaning fluids left unattended in the corridor outside peoples bedrooms. These would all pose risk of harm to people living at the home if they were to get hold of them. We informed My Imonikhe about the cleaning substances in the corridor, he responded by finding the cleaner to remove the substances to a safe place. The home should have a registered manager in day to day control of running the service in the best interests of people living there. The service has been without a registered manager since January 2007 and has been managed by Mrs Imonikhe who is the registered manager for a second care home owned by Mr and Mrs Imonikhe. Correspondence from Mr Imonikhe received in December 2009 indicated a manager had been appointed and was going to commence the process of submitting an application to Care Homes for Older People Page 8 of 15 CQC for registration as manager of the service. This person was on duty during our visit to the home and was involved as part of the inspection process. She told us she had recently received her check against the Criminal Records Bureau which is the first step to submitting an application to CQC, but had not yet completed an application form. During discussions with Mr and Mrs Imonikhe they confirmed that the application would be submitted soon. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 15 Care Homes for Older People Page 10 of 15 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 11 of 15 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 A full assessment of peoples 01/05/2010 needs must be obtained before the person moves into the home. So before the person moves into the home it can be assured their needs can be met by the home. 2 7 15 Care plans must be 01/05/2010 personalised to detail individual preferences and needs for all aspects of care. This includes, but is not exclusive to, personal care preference, frequency of safety checks and assistance with meeting continence needs. So people living at the home receive the care and support they need in the manner they prefer. 3 9 13 Arrangements must be made 01/05/2010 for the recording, handling, safekeeping, safe administration and disposal of medications received into Page 12 of 15 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action the home. This includes, but is not exclusive to, ensuring medications adminstered are signed for and the reason for any medication not adminstered is documented and ensuring for people prescribed as required medications there are written guidelines about the use and administration of these medications. So peoples health and welfare is protected by good management of medications. 4 19 13 An assessment of the 01/05/2010 environment of the home must be made and documented. Action must be taken to eliminate any identified hazards. So people living at the home are not exposed to risks that could affect their health and welfare. 5 26 13 There must be appropriate 01/05/2010 hand washing facilities and equipment in all areas of the home to eliminate risks of cross infection. So people living at the home are not put at risk of ill health because of poor hand washing and control of infection practices. 6 38 13 All substances hazardous to health must be stored in secure areas and must not 01/05/2010 Care Homes for Older People Page 13 of 15 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action be accessible to people living at the home. So people living at the home are not exposed to substances hazardous to health that have the potential to cause them ill health. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 14 of 15 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 15 of 15 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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