Care Home: Greathed Manor Nursing Home

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What the care home does well The Home operates a structured admission policy with all residents having a full needs assessment in place to establish if the home can meet individual needs. Good care plans are maintained that are reviewed and updated regularly. Privacy and dignity are observed and residents are treated with respect at all times. Catering arrangements are excellent providing residents with a well balanced nutritious and varied diet. Dining facilities are relaxed and enable residents to invite guests for meals by arrangement. Accommodation is of an excellent standard with ample shared and individual space for residents to enjoy. Extensive well maintained gardens provide an additional facility for residents to enjoy. The staff team are competent and provide nursing care and support to residents in a sensitive and professional manner. The organisation is committed to the training and development of the staff. The home is well managed by an experienced manager with the skills and understanding to care for older people. Quality assurance is monitored and feedback acted upon to provide best practice. Resident, relative and staff meetings take place regularly. The health, safety, and welfare if the residents and staff are observed. Risk are identified and assessed, to promote safety, independence, and a safe working practice. What has improved since the last inspection? This was the first key inspection undertaken in this service since the home was registered. What the care home could do better: There are no requirements or recommendations as an outcome of this inspection. Key inspection report Care homes for older people Name: Address: Greathed Manor Nursing Home Greathed Manor Ford Manor Road Dormansland Lingfield Surrey RH7 6PA     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: Mary Williamson     Date: 0 4 0 6 2 0 0 9 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 25 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) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Greathed Manor Nursing Home Greathed Manor Ford Manor Road Dormansland Lingfield Surrey RH7 6PA 01342832577 01753642141 mail@greathed.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Pressbeau Limited Name of registered manager (if applicable) Mrs Linda Jordan Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 23 The registered person may provide the following category/ies of service only: Care home with Nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Physical disability - PD Date of last inspection Brief description of the care home Greathed Manor Nursing Home is a Grade 11 Listed Manor. It is situated in Dormansland on the borders of Surrey, Kent, and Sussex. The home is located within five acres of beautiful landscape gardens providing an idyllic environment for residents to enjoy. The garden pathways are suitable for wheelchair users. Care Homes for Older People Page 4 of 25 Over 65 23 23 0 0 Brief description of the care home The home provides accommodation and nursing care for twenty three residents and when phase two is completed this number will increase to forty. Communal facilities include three large lounges, a library, and a private lounge for receiving guests. Individual accommodation varys from private suites to en-suite bedrooms with shower facilities. These are located over two floors and have lift access. Most bedrooms overlook splendid views of the countryside. Bathrooms have been adapted to meet the mobility needs of some residents. Ample car parking facilities are available in the grounds. The fees charged for this service range from £700 to £1,400 per month. Care Homes for Older People Page 5 of 25 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: The quality rating for this home is TWO STAR. This means that people using this service experience GOOD quality outcomes. This was the homes first key inspection since it was registered and was unannounced. The inspection was undertaken by Mary Williamson over a period of four hours. The Registered Manager represented the home for the duration of the inspection. The home is able to provide accommodation and nursing care for twenty three residents, and this number will increase to forty when phase two has been completed. There were six residents living in the home on the day of the inspection. The manager introduced the inspector to the residents in the home and the staff on duty. She also showed the inspector around the communal areas of the home and some of the residents rooms. Care Homes for Older People Page 6 of 25 Records relating to the care of the residents and the management of the home were examined. These included needs assessments, care plans, medication records, menus, staff training and development files and staff employment records. It was possible to talk with some of the residents and gain feedback regarding their experiences about living in the home. It was also possible to talk with the staff on duty about the training they received and the recruitment procedures they experienced. The home completed an Annual Quality Assurance Assessment (AQAA), that provided us with information we asked for. Some of which has been used in this report. The Care Quality Commission would like to thank the residents, and staff team for their assistance and hospitality during this inspection. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? 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 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 8 of 25 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 9 of 25 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. Prospective residents have access to sufficient information to help them make an informed choice about living in the home. Residents have their needs assessed prior to admission to establish that the home can meet these. Contracts of occupancy outline the terms and conditions as appropriate. Evidence: The home has a statement of purpose and residents guide in place. This is available to all prospective residents and their relatives prior to admission providing them with information they need to make a decision about living in the home. This is also available in large print and an audio CD if required. All prospective residents have a needs assessment undertaken by the manager. This provides the information necessary to establish the suitability of the placement and if the home can meet individual assessed needs. Three needs assessments were seen Care Homes for Older People Page 10 of 25 Evidence: and these are detailed and informative. All residents have a contract of occupancy in place. These outline the accommodation available, the type of care provided, the fees payable, and the method and frequency of the fees. These are signed and dated. Care Homes for Older People Page 11 of 25 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. Individual care plans are well written, outlining the care to be provided and the outcomes to be achieved. Appropriate arrangements are in place to meet the health care needs of residents. The homes medication procedure protects the residents, who are also treated with dignity and respect. Evidence: All residents have an individual care plan in place. These are written with information gathered at the pre admission needs assessment, input from the resident whenever possible, information obtained from relatives and any medical reports available. Three care plans were sampled. These are well written and outline the care to be provided and the outcomes expected. Identified risks have been assessed and included in individual care plans, which are reviewed and regularly. Arrangements are in place to meet the health care needs of the residents. All are registered with a local GP who visits the home regularly. Records of GP visits are included in the care plans. Chiropody is available six weekly or by request. Dental care and visits from the optician are also arranged. Specialist support can be arranged on Care Homes for Older People Page 12 of 25 Evidence: referral by the GP. The home has a medication policy in place and all medication is administered according to this policy, and in line with The Nursing and Midwifery Councils (NMC) Code of Professional Conduct. Medication is supplied by Chemistree in blister pack format. They also undertake medication audits and staff training. The medication recording charts (MAR) were seen. These are well maintained and include a photograph of identification, and known allergies. Medication is stored safely in a central medication storage room located on the ground floor. Privacy and dignity is observed. Staff were seen to interact with residents in a polite and professional manner. Staff were also observed to knock on residents bedroom doors prior to entering, and address them in their preferred title. There are ample facilities throughout the home for residents to have visits in private. Care Homes for Older People Page 13 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activity arrangements continue to be developed to meet the assessed need of the residents. Spiritual and diverse needs are observed and promoted. The systems for autonomy and choice are good enabling residents to exercise choice and control over their lives. The standard of catering is excellent and offers residents a wholesome appetising, and varied diet. Evidence: Activity arrangements are gradually being developed according to individual need and choice. Some activities include art and craft, back in time, and general knowledge quiz. Staff were observed spending quality time with residents on a one to one basis. Residents receive a daily newspaper and some people like to spend time alone in their rooms listening to music or watching television. Family links are maintained and visitors are welcome in the home at any reasonable time. Relatives can arrange to have a meal with residents, and are also invited to participate in home events. Spiritual needs are supported and the manager stated that the home has made Care Homes for Older People Page 14 of 25 Evidence: contact with local clergy and they will visit on request. Menus are planned by the chef with input from the residents. Everyone is offered a choice of food for all three meals. A cooked breakfast is available if required, two main alternatives are offered for lunch, and at least three options are available for the evening meal. Drinks and snacks are served throughout the day and homemade cakes are served with afternoon tea. The chef has a good understanding of the nutritional needs of older people and holds a current certificate in food hygiene. He operates a daily cleaning schedule, and maintains the required food safety records. He stated that he visits all the residents daily for feedback. Residents spoke highly of the food and one said the food is excellent here another said I am always satisfied with what is served. Meals are served in a relaxed and pleasant atmosphere. Sensitive support is provided to residents that require help with feeding. Care Homes for Older People Page 15 of 25 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. The complaints procedure and the safeguarding vulnerable adults procedures in place protect residents living in Greathed Manor. Evidence: The home has a complaints procedure in place. This forms part of the residents information guide and a copy of this is also displayed in the home. Staff spoken to were aware of this procedure and residents felt that any issues or concerns are managed before they get to the formal complaints process. Records confirmed that there has been one complaint from a relative since the home was registered. This is currently been managed effectively using the complaints procedure. There is a safeguarding adult procedure in place. During a group discussion with staff they confirmed that they had received training in this procedure, and would know what to do if they felt an incident of abuse was taking place. The home has a copy of Surreys Multi Agency policies and procedures on Safeguarding Vulnerable Adults in place. The manager has attending training regarding these policies and has cascaded this throughout the staff team. Care Homes for Older People Page 16 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is suitable for its stated purpose. The residents live in a luxurious environment that is maintained to an excellent standard, and meets both their individual and collective needs. The standard of cleanliness is very good and procedures are in place to minimise the spread of infection. Evidence: The home provides a luxurious environment for residents to live. It was possible to view the occupied areas of the home with the manager. Communal facilities include three large lounges, a library, a private lounge for receiving guests, and dining areas. Bedrooms vary in size from private suits, to en- suite rooms with shower facilities. Residents are encouraged to personalise their rooms and can have their personal possessions with them. A resident said that I enjoy the view from my room and another said the facilities are excellent. Additional assisted bathrooms and toilets are available to meet mobility needs of residents. The home is located within five acres of beautiful landscaped gardens and residents Care Homes for Older People Page 17 of 25 Evidence: can view these from all areas of the home. They can also access the gardens via ramps and the pathways are suitable for wheelchair use. The laundry is well equipped and suitable for the needs of the home. There is a laundry assistant in post, who will increase the amount of hours she works as the occupancy levels increase. The home has an infection control policy in place. During discussion with staff they were able to confirm that they had received training around infection awareness. Hand alcohol gel was available throughout the home, and staff were observed to use this. Arrangements are in place for the collection of clinical waste. Care Homes for Older People Page 18 of 25 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 are good ensuring that residents needs are being met. Staff training and development is ongoing providing a competent staff team to care for residents living in the home. The recruitment and vetting of staff is good promoting the safety and welfare of the residents. Evidence: The staff duty rota was seen and the staffing levels discussed with the manager. A qualified nurse is on duty twenty four hours a day. Two care staff are allocated on duty during the day and one at night. The manager explained that this will increase when the occupancy levels change. Ancillary staff numbers will also be reviewed accordingly. Residents spoken to stated that the standard of care was good and that staff were caring and kind. Staff training and development profiles are in place and sampled during the inspection. During discussion with staff they confirmed that they had undertaken induction training over a two week period before the home opened. NVQ training is ongoing with some staff having achieved this award and others undertaking Levels 2, 3, and 4. The home has a recruitment policy in place. A selection of staff employment files were Care Homes for Older People Page 19 of 25 Evidence: seen. These included a written application form, two written references, an employment history, and a CRB (Criminal Records Bureau) disclosure. A system is also in place to check PIN numbers of qualified nurses. Care Homes for Older People Page 20 of 25 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. Sound arrangements are in place for the management of the service ensuring that residents benefit from a well managed home. Quality assurance is monitored ensuring that the home is managed in the best interests of residents. Procedures in place safeguard individuals financial interests. The health, safety and welfare of the residents and the staff are observed and protected. Evidence: The home is well managed by the registered manager who is also a qualified registered nurse. She has several years experience in the provision of care for older people and has worked in the organisation in a senior role since 2003. She has the support of the deputy manager who is also a qualified nurse. They operate an open and inclusive style of management and make themselves available to residents and relatives as much as possible. Staff and residents spoken to felt well supported by the management structure in place and said there was always someone senior on duty for advice and help. Care Homes for Older People Page 21 of 25 Evidence: Systems are in place to monitor quality assurance. Regulation 26 visits are undertaken monthly by the operationals manager and retained in the home for information. Questionnaires are distributed to residents, relatives, staff and other stakeholders and feedback is analysed and acted upon. Audits of medication, reviews of care plans, health and safety audits, and catering surveys take place and form part of the quality assurance process. Resident financial interests are safeguarded. The home manages small amounts of money on behalf of residents to pay for items for example hairdressing, chiropody newspapers and sundries. Records and receipts are retained for all financial transactions. Invoices are sent according to procedure. Formal staff supervision takes place at least every two months. This is recorded and retained on personal files. The health, safety and welfare of the residents and the staff are observed and promoted. All staff confirmed that they had undertaken health and safety training. This is part of induction training. Risk assessments are in place to promote the welfare of residents and staff and to also promote safe working practice. The inspector observed that COSHH (Control of Substances Hazardous to Health) is adhered to. Fire safety is observed and there is a contract in place for the maintenance of fire safety equipment and emergency lighting. The AQAA indicated that all the required safey certificates are in place and renewed and updated as required. The inspector noted that the home maintains records of all accidents and incidents and CQC notified accordingly. Care Homes for Older People Page 22 of 25 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 23 of 25 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 Care Homes for Older People Page 24 of 25 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). 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