Care Home: Flixton Manor

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What the care home does well Detailed assessments were undertaken before people came to live at the home. This makes sure that the staff know everything they need to know about what care the person needs and can reassure them that their needs can be met. Each person had a care plan that had been reviewed regularly to ensure it was accurate and up to date. This means that staff had information that told them what each person`s abilities were and what care they needed. An activities organiser was employed at the home who was very enthusiastic and committed to finding innovative ways to increase peoples` mental and social stimulation. The home was clean and fresh smelling. People said they liked living at the home, that routines were flexible and the food was good. Comments included, "I feel very comfortable and well looked after and that they care about me", "The place is very nice and the food is first class", "I enjoy looking at late programmes on the TV", "It`s a good home" and "I am content. It is a good home and I have made some friends". One visitor commented, "I am very satisfied with the care my aunt receives, the staff are very good". Since the last inspection the home has been subject to a safeguarding investigation, following allegations of abusive practices made by an anonymous person. The manager demonstrated, by her cooperation with the safeguarding investigation, that she understood safeguarding procedures and was committed to ensuring that the safety and wellbeing of people living at the home. Some recommendations were made as a result of the investigation to improve certain areas such as documentation, but it was also acknowledged that there were lots of good working practices within the home, that people living at the home were able to express themselves and spoke highly of the care they received. What has improved since the last inspection? At the last key inspection we made two requirements which had both been met at this inspection. The manager had registered with us after demonstrating that she had the knowledge and competence to effectively manage the home. Care plans were more detailed although some could still contain further information. However, generally they explained for staff what care they needed to deliver. In the AQAA it was reported that 66% of staff had successfully completed National Vocational Qualifications (NVQ). This was an increase from the last inspection. The NVQ is a qualification that is obtained following training in providing personal care and helps to ensure that staff have a good basic knowledge of the care they need to provide and the reasons such care is needed. . What the care home could do better: Medicines were generally managed safely but we did see that prescribed creams for some people were actually in other peoples` rooms. The manager should review the procedures for handling creams and ointments to make sure they are stored safely and given to the right people. Although care plans had improved staff did not always complete monitoring charts accurately; this is essential in order to be of any use when staff review the care that is given and how effective it is. The majority of people we spoke to said they were happy and content living at the home but several did appear unkempt, with crumpled clothing and long, dirty finger nails. In addition, although some peoples` rooms were personalised with ornaments, photographs and mementos, other rooms were quite sparse and bare and some rooms had maintenance issues such as wall clocks that showed the wrong time and call bells that were broken. Development of the key worker system would enable staff to help people on a more individual basis with issues such as personalising their rooms, maintaining their hygiene and keeping their personal toiletries safely. Although many people said they liked the food provide at the home, we saw that people requiring a soft diet were given meals that looked unappetising, with all the components of the meal mixed together. Separating out the meat/fish and vegetables would allow people to taste each part of the meal and would provide greater enjoyment and interest. The home was clean but untidy in parts. This was a risk to some people living at the home as their bedrooms were near areas where large pieces of equipment were stored haphazardly. Also the majority of bathrooms and toilets had no liquid soap or paper towels. These need to be provided so staff can maintain good hand hygiene and prevent the spread of infection. The manager described difficulties in accessing appropriate training but was aware of the importance of continuing to provide training for all staff and was working on this. People told us the owner of the home was there regularly and the manager said she was well supported. The owner should keep a formal record of some of his visits to show how he is monitoring the running of the home. Key inspection report Care homes for older people Name: Address: Flixton Manor 2-8 Delamere Road Flixton Manchester M41 5QL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Fiona Bryan     Date: 2 3 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Flixton Manor 2-8 Delamere Road Flixton Manchester M41 5QL 01617467175 01617485583 flixtonmanor@msn.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Jan Al Safar Name of registered manager (if applicable) Mrs Christine Simcock Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: All service users will fall within the category of old age (60 ). Staffing levels as specified in the Section 25 (3) Notice dated 28th September 2001, shall be maintained. Up to three service users who require personal care may be included within the maximum occupancy. Date of last inspection Brief description of the care home Flixton Manor is a care home providing nursing care and accommodation for 32 older people. The home had been converted into one residence from two semi-detached houses. Further additions have taken place to enlarge the communal areas and an extension to provide bedroom accommodation. There was a large conservatory at the front elevation of the home that leads into the lounge and dining areas. Access to the home is from the drive and garden. At the end of the drive there is provision for Care Homes for Older People Page 4 of 29 Over 65 32 0 Brief description of the care home parking. There are concrete steps and a ramp for wheelchair access to the entrance door. The home is situated on the main road between Flixton and Urmston. There was easy access to public transport, local shops and parks. It is convenient for the motorway system. The current scale of charges at the home range from £414-£618 per week. Costs in addition to the fees are hairdressing; chiropody per visit, newspapers and toiletries, which are charged on an individual, needs basis. Fees can be discussed with the manager. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection, which included a visit to the home took place on Tuesday 23rd February 2010. The staff at the home did not know that this visit was going to take place. All the key standards were assessed at the site visit and information was taken from various sources, which included observing care practices and talking with people that live at the home, visitors, the manager and other members of the staff team. Key standards refers to those standards we feel are particularly important in ensuring the health, safety, welfare and quality of life of people living at the home. The care and services provided to two people were looked at in detail, looking at their experience of the home from their admission to the present day. We also looked at how other people received care in respect of specific health and personal care needs they had. Care Homes for Older People Page 6 of 29 A selection of staff and care records was examined, including medication records, training records and staff duty rotas. An expert by experience assisted the inspector for part of the inspection. The phrase expert by experience is used to describe people whose knowledge about social care services comes directly from using social care services. This person talked to people living at the home about their quality of life. She completed a report after the inspection; some of her written comments are included in this report. We also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. The manager completed the form well and showed that she was able to identify the areas where the service could be developed. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 29 Medicines were generally managed safely but we did see that prescribed creams for some people were actually in other peoples rooms. The manager should review the procedures for handling creams and ointments to make sure they are stored safely and given to the right people. Although care plans had improved staff did not always complete monitoring charts accurately; this is essential in order to be of any use when staff review the care that is given and how effective it is. The majority of people we spoke to said they were happy and content living at the home but several did appear unkempt, with crumpled clothing and long, dirty finger nails. In addition, although some peoples rooms were personalised with ornaments, photographs and mementos, other rooms were quite sparse and bare and some rooms had maintenance issues such as wall clocks that showed the wrong time and call bells that were broken. Development of the key worker system would enable staff to help people on a more individual basis with issues such as personalising their rooms, maintaining their hygiene and keeping their personal toiletries safely. Although many people said they liked the food provide at the home, we saw that people requiring a soft diet were given meals that looked unappetising, with all the components of the meal mixed together. Separating out the meat/fish and vegetables would allow people to taste each part of the meal and would provide greater enjoyment and interest. The home was clean but untidy in parts. This was a risk to some people living at the home as their bedrooms were near areas where large pieces of equipment were stored haphazardly. Also the majority of bathrooms and toilets had no liquid soap or paper towels. These need to be provided so staff can maintain good hand hygiene and prevent the spread of infection. The manager described difficulties in accessing appropriate training but was aware of the importance of continuing to provide training for all staff and was working on this. People told us the owner of the home was there regularly and the manager said she was well supported. The owner should keep a formal record of some of his visits to show how he is monitoring the running of the home. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before they move into Flixton Manor so they know their needs can be met. Evidence: We looked at the care of two people in detail and also looked at how staff managed the care of several other people in relation to specific conditions and health care needs. A review of the pre-admission assessments showed these were detailed, person centred and fully assessed each persons needs. There were copies of inter agency care plans in place and the information gained from the assessments was used to develop a plan of care following admission. It was reported that there were plans to replace all paper copies of care plans and assessments with electronic records, stored on the homes computer. Staff were in the Care Homes for Older People Page 11 of 29 Evidence: process of inputting all the records so at the time of the inspection 2 different systems were in place although the IT one was not yet fully operative. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were met in a way they preferred. Evidence: We looked at the care of 2 people in detail. Each person had care plans and risk assessments that had been regularly reviewed and updated. Care plans were generally detailed and told staff what support they needed to give. Some care plans could be improved by additional information, for example the care plans for people being nursed on pressure relieving mattresses should include information about the type of mattress being used and how it should be set, so staff can check to make sure it is working effectively. Also the care plan for one person with mental health needs could include more information about what causes their agitation, how this presents and what mechanisms staff can use to help the person calm down. Staff need to take care when they complete risk assessments that they are done accurately because sometimes staff had not included certain factors, such as the age of the person, which may have affected the overall risk score. Care Homes for Older People Page 13 of 29 Evidence: The amount of involvement people who lived at the home had in creating their care plans was unclear and the move towards holding all care records electronically may also make it more difficult for people to easily see their care plans and talk to staff about them. This was discussed with the manager as she needs to look at how access to care records can be promoted if people wish it. Daily records for people were often only written at night and therefore did not give any information as to the care that had been provided during the day. It would be good practice for an entry to be made during the day to show what staff have done and provide the evidence on which to base the monthly review of care. The care plans for some people showed that they needed to be turned regularly to reduce the risk of pressure ulcers. Where this is identified staff should record what care they have given on monitoring charts. We saw that sometimes the charts were not completed accurately and on 2 occasions during the previous week they had not been completed overnight at all. Closer examination also showed that where entries were made they did not always specify if the person had been turned so it appeared that they had been left in the same position for long periods of time. During the course of the inspection we observed several people who were being care for in bed, and we did see that staff were generally attending to them regularly so we were of the opinion that this was a recording issue and that people were getting the care they needed in practice. People in the main looked clean and well cared for. Some people did have long, dirty finger nails and one person told the expert by experience that staff did not help her to clean her teeth. We discussed with the manager how she might improve this. People confirmed that staff were quick to seek medical attention if they were unwell and told us they had been visited by opticians, podiatrists and dieticians. Records were kept of these visits. Medicines were generally managed safely. However, we did find that skin creams in several peoples rooms were actually prescribed for other people. All medicines must only be administered to the person they are prescribed for. Also staff had handwritten on the Medicine Administration Record, the instructions for the administration of an enteral feed. Where staff handwrite instructions it is recommended that the entry is checked and countersigned by a second member of staff to reduce the risk of errors. We did receive some varied comments about staff and how they related to people living at the home. Some people said they were very happy living at the home; one Care Homes for Older People Page 14 of 29 Evidence: person said, I feel very comfortable and well looked after and I feel that they (staff) care about me. However, some people told the expert by experience that staff were sometimes rough and impatient and the manager should talk with staff about the importance of their attitude and conduct during supervision. One visitor said, I am very satisfied with the care my aunt receives, the staff are very good. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had choice and support to meet their expectations and preferences regarding their daily lifestyle. Evidence: Since the last inspection a new activities organiser had been appointed. During our visit we observed the activities organiser undertaking a number of leisure pursuits with people, including knitting and winding wool, bingo and a word game. Different people joined in with different activities according to their abilities and preferences and whilst the activities were going on people were chatting and the activities organiser was encouraging conversation. The activities organiser told us she worked three full days a week and really enjoyed her work. She was very enthusiastic and had clearly thought a lot about her role and how she could best use the time she spent at the home. She had an in depth knowledge of each person living at the home and was creative with ideas to provide social enjoyment and mental stimulation. She had introduced a Points of Pleasure initiative whereby each person was asked to think about 5 things that were important to them and she was using this information Care Homes for Older People Page 16 of 29 Evidence: to try to individualise activities for them, for example one person enjoyed boxing and she was sourcing DVDs of old fights. It was also planned to get some individual Ipods and download specific music on to them so people could listen to their own choice, for example one person liked military music and another enjoyed big band sounds so they would have Ipods with this music on. The activities organiser said she was flexible in arranging events and was led by people living at the home; if she had arranged an activity that did not suit people on a particular day she would save it for another day and try something else. People told us staff promoted choice for them, such as discussing what clothes they wanted to wear and how they wanted to spend their day. People also said they liked the food provided at the home and there was a small choice offered at each mealtime. The menu for the day was written on a board in the dining room but no weekly menu was displayed so people could see what the meals were a few days ahead. We saw the chef asking people during the morning what they wanted for tea and breakfast the next morning. The choice for tea was sandwiches or pizza, although no one chose the pizza and most people did not seem to be sure what it was. The suitability of this was discussed with the manager who agreed to look at the menus. At lunch time several people needed a soft diet. The presentation of soft diets could be improved as all the components of the meal were mixed together. Separating out each component would improve the taste for people because they would be able to identify vegetables, meat or fish etc rather than each mouthful tasting the same. The expert by experience saw that many people stayed in the lounge and ate their meal from individual tables. Staff did not clear magazines and papers away from the tables before placing cutlery haphazardly, which made it awkward for for some people to eat their meal. One person had adapted crockery in order to promote their independence in eating their meal; however the expert by experience saw that they still struggled a lot and would have benefited from additional help. Staff need to ensure they are aware and alert to the needs of people on a day to day basis and adjust the help they offer accordingly. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home were protected by the complaints and safeguarding procedures, which were understood by staff. Evidence: The homes complaints procedure was displayed in the reception area and people told us that if they had any concerns they would speak to the manager. People said they were confident the manager would deal with any complaints properly. The manager kept a record of complaints. One complaint had been made since the last inspection, which the manager had responded to promptly. The benefits of recording minor complaints and concerns that are dealt with immediately was discussed; this provides a valuable tool for quality assurance and would enable the manager to analyse complaints and check that similar minor issues were not repeated without being learned from and used to improve the service. Since the last inspection a safeguarding investigation has taken place at the home following allegations of poor care, which were made anonymously. Every person funded by Trafford Local Authority was reviewed and officers involved in this work acknowledged the positive and professional manner shown by the management team at the home. Some recommendations were made as a result of the reviews, to improve certain areas such as documentation, but it was also acknowledged that there were lots of good working practices within the home, that people living at the home Care Homes for Older People Page 18 of 29 Evidence: were able to express themselves and spoke highly of the care they received. We were satisfied that the manager had demonstrated, by her cooperation with the safeguarding investigation, that she understood safeguarding procedures and was committed to ensuring that the safety and wellbeing of people living at the home. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean and warm but lack of attention to detail meant that some areas were untidy and infection control measures were limited. Evidence: On the day of the visit the home was clean and fresh smelling. It was reported that an extension to the home was planned and the work would start in March 2010. This would provide another 6 bedrooms, and some additional bathrooms and communal rooms. It would be beneficial if it also provided some additional storage space as some parts of the home were quite untidy, especially parts of the basement, where 4 people have bedrooms. Although we acknowledged that there was limited storage space, cluttered areas should be cleared and old equipment disposed of. We saw a number of peoples bedrooms and these varied in size and shape. Some rooms were nicely personalised, with small items of furniture, ornaments, photographs and pictures. Other rooms looked more sparse and bare and the manager said some people did not have many visitors to help them personalise their rooms. We noticed that toiletries belonging to individual people were left in some bathrooms and there were maintenance issues in a number of bedrooms for example wall clocks Care Homes for Older People Page 20 of 29 Evidence: showing the wrong time and nurse call bells that were not placed within easy reach or were not working. The expert by experience spoke with one person who said she had been left unattended for some time and she had been unable to call for help as she could not reach the call bell which was on the floor. Developing the key worker system may enable staff to help individual people to decorate their room to their tastes and would also help ensure that attention to detail was maintained. Paper towels were not available in a number of bathrooms and were also not provided in peoples bedrooms. Although residents will want to use their own towels, staff should have paper towels available to prevent cross infection and promote good hand hygiene. Liquid soap should also be provided in all staff hand washing areas. Cutlery was stored in a container in the quiet room. As some people living at the home have dementia it is recommended that cutlery is kept more securely as this could present a risk to people. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements, recruitment and training ensure that people are cared for and supported safely. Evidence: Staffing levels at the home have remained unchanged since the last inspection. During the day 6 staff were on duty to provide care to 26 people. In general staff and people living at the home told us these numbers were sufficient to provide the care required for everyone. On the day of the inspection there was only one nurse on duty when there would normally be two. The reasons for this were explained and did not appear to be impacting on the care delivery. Two staff files were looked at and these provided evidence that the correct checks were made before staff started working at the home to ensure they were suitable to work in a care setting. The manager said she did have difficulty accessing training for staff. The home is a member of the Trafford training consortium but frequently the manager has found that courses are booked up when she tries to enrol staff on them. It was reported that some training was delivered by external trainers and a training matrix was being developed with the aim of highlighting when refresher training was due. Care Homes for Older People Page 22 of 29 Evidence: In the AQAA the manager reported that 66 of care staff had successfully completed NVQ training. This was an increase from the last inspection. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Flixton Manor is being run in the best interests of people who live there and their welfare is promoted and protected. Evidence: Since the last inspection the manager has registered with us after demonstrating that she has the knowledge and ability to manage the home. An experienced nurse continues to lead on the clinical needs of people as the manager is not a nurse. People living at the home said the manager was approachable and that she did listen to suggestions and any comments made. The manager has tried various methods to obtain feedback about how the home was running including holding resident meetings and asking one person to be the resident liaison and speak to people living at the home informally and feedback any comments or concerns. A quality assurance survey was conducted in 2009. The manager recognised that because staff had helped people complete the surveys they may not be completed Care Homes for Older People Page 24 of 29 Evidence: objectively and had been looking at getting an advocate from Help The Aged to help with the next survey. Surveys had also been distributed to relatives. Responses were analysed and were mostly positive; where issues were identified steps had been taken to address them. The manager carried out monthly audits (checks) on a range of areas, for example hygiene, care planning, fire safety and activities to look at how staff were working. The management of the home appeared organised and well run but some aspects could be improved by the development of a key worker system. Allocating staff as key workers and devising a description for this role would enable staff to help people on a more individual basis with issues such as personalising their rooms, maintaining their hygiene in respect of nails, keeping their personal toiletries safely and minor equipment maintenance such as the setting of clocks and checking that nurse call bells are working. Keyworkers would also be able to help the activities organiser with the documentation of peoples social needs and how they are met; although it was evident a lot of work was taking place in this area, records were minimal as the activities organiser needed to spend as much time as possible working with people and didnt have time to do the paperwork as well. People told us the owner of the home was seen regularly and was also approachable. No formal record was maintained of any of his visits to the home and it is recommended that once a month a visit is recorded as evidence of the work undertaken by the owner to satisfy himself that the manager and staff are working in accordance with policies and procedures and that people living at the home are happy with the service. The system for managing peoples money was satisfactory at the last inspection so we did not look at in detail at this visit. Records showed that the building and equipment were checked and serviced regularly to ensure the health and safety of staff and people living at the home. We did see that several people in the home were moved by staff in wheelchairs without having footrests in place. This presents a risk to people that their feet will get caught under the wheelchair and should not be continued. Care Homes for Older People Page 25 of 29 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 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, Care Homes 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 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 1 8 Staff should ensure that all factors are considered in risk assessments to make sure they are accurate. Monitoring charts should be completed accurately and daily records should detail what care has been given during the day as well as night, to provide information on which to base reviews of care. Staff should be consistent in offering help with all personal care needs to ensure hygiene needs are met appropriately. 2 9 All medicines should only be administered to the person they were prescribed for. Where staff handwrite instructions for the administration of medicines the entry should be checked and countersigned by a second member of staff to reduce the risk of errors. 3 15 The menu should be reviewed to ensure that it offers meals that are familiar and liked by the client group. Consideration should be given as to how the presentation of meals for those people requiring soft diet can be Care Homes for Older People Page 27 of 29 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 improved. 4 19 Staff should make sure that the home is kept tidy and that they pay attention to detail in individual peoples rooms, storing personal toiletries safely, keeping their wall clocks set at the right time and helping people to make their rooms comfy and personal. Liquid soap and paper towels should be provided in all staff hand washing areas. This will ensure staff have the facilities to maintain good hand hygiene. The manager should continue to access and arrange training in a range of topics to ensure that staff have the knowledge and skills to provide the care required. The owner should keep a record of monthly visits to show that he is monitoring how the home is running. 5 26 6 30 7 33 Care Homes for Older People Page 28 of 29 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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