Care Home: Guisborough Manor

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What the care home does well Guisborough Manor provides a homely and friendly place for people to live. All furnishings and decor are of a high standard. Staff spoken to clearly enjoyed working at the home. They know the people who use the service well and are committed to providing the best care that they can. The staff work together as a team and are well supported by the manager. Good interaction was observed between the staff and people living at the home. What has improved since the last inspection? There is a cinema surround sound available in a lounge on the ground floor and the first floor. People enjoy relaxing and watching a movie. There are more activities available and shops, such as the old fashioned sweet shop and a fashion shop visit regularly and there is also weekly pet therapy, regular outings and entertainment. The manager writes a monthly newsletter and includes people`s birthdays, introduces any new staff and outlines all forthcomimg events. Some people who live in the home like to comment about the newsletter, its layout and print. The manager has encouraged them have more input, but at the moment they are happy as they are. What the care home could do better: Care plans should be in place only where a need has been identified. Some of the care plans could be developed further to be more person centred. More information is needed in the daily reports to show how people are spending their days. Key inspection report Care homes for older people Name: Address: Guisborough Manor Woodhouse Triangle Middlesbrough Road Guisborough Redcar & Cleveland TS14 6QU     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: Valerie Daly     Date: 1 3 0 5 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 23 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 23 Information about the care home Name of care home: Address: Guisborough Manor Woodhouse Triangle Middlesbrough Road Guisborough Redcar & Cleveland TS14 6QU 01915652294 01915652303 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): St Martins Care Ltd Name of registered manager (if applicable) Sharon Elizabeth Hammond Type of registration: Number of places registered: care home 63 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of users who can be accommodated is 63 The registered person may provide the following category of service only: Care Home only - Code PC To service users of the folowing gender: Either Whos primary care needs on admission to the home are within the followng categories: Old age not falling within any other category - Code OP, maximum number of places, 63 Dementia - Code DE, maximum number of places, 63 Date of last inspection Brief description of the care home Guisborough Manor is a new purpose built home located on the outskirts of Guisborough. It is registered to accomodate sixty three people who or have dementia or require help with personal care only. Currently the people who require personal care Care Homes for Older People Page 4 of 23 Over 65 0 63 63 0 2 4 0 7 2 0 0 9 Brief description of the care home live on the ground floor and people with dementia on the first floor. The first floor is accessed by a passenger lift. All of the rooms are single and have en suite toilet and washbasin facilities. There are ample assisted baths and showers available. There are various communal lounge and dining areas located throughout the home. Car parking facilities are available. There are numerous shops, pubs, restaurants and churches in the nearby town centre. The weekly fees are from £477.32 to £512.54 Care Homes for Older People Page 5 of 23 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 service is two star. This means people who use this service experience good quality outcomes. This Key Inspection was to check that the home meets the standards that the Care Quality Commission say are the most important for the people who use the service, and that it does what the Care Standards regulations say it must. The inspection was conducted by a regulatory inspector in two inspection days. During the inspection a number of records were looked at, including records of people who use the service, along with staff recruitment and training records and maintenance. There was also discussion with the manager, care staff and people who live at Guisborough Manor. Care Homes for Older People Page 6 of 23 The manager had completed the Annual Quality Assurance Assessment (AQAA), the services self-assessment of how well they think they are meeting the standards. We have reviewed our practice when making requirements to improve national consistency. Some regulations from previous reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 23 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 23 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 23 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 there needs assessed prior to admission, ensuring their needs can be met. Evidence: The care files of four people who live in the home were examined. Two had recently been admitted to the home and two had lived there for some time. There was a range of assessments in place. People are only admitted after a full assessment of need has been carried out by an appropriately trained person. This is to make sure that the home can meet the needs of the people who go to live there. A survey from a relative said that they had received sufficient information about the home to enable them to make a decision about whether or not their family member would like to live there. The home does not provide intermediate care therefore assessment of standard 6 is Care Homes for Older People Page 10 of 23 Evidence: not required. Care Homes for Older People Page 11 of 23 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. Care plans and risk assessments are in place and evaluated regularly. Medication procedures are robust. Evidence: The files of four people who use the service were examined. All care files contained an assessment of need, there was a range of care plans and risk assessments in place, where required. The care plans gave care staff the information needed to support and meet the care needs of the person. There was a personal pen picture which gave information about where the person was born, their childhood, family, jobs. hobbies. Each person had a base risk assessment in place regarding their ability to go out alone. Another persons pen picture gave information about what activities the person liked to do in the home, food preferences, when they liked to get up and go to bed and if they preferred a male or female member of staff to assist with personal hygiene tasks. Care Homes for Older People Page 12 of 23 Evidence: A number of care plans contained good information, such as, in personal hygiene, one person had a phobia about washing and could stay in the same clothes for days. They had poor dexterity and could not hold a toothbrush properly. There were some care plans in place where a need had not been identified, for example one person had a plan for medication, stating senior staff to ensure there is adequate supply of medication. The evaluation each month stated all medication remains the same. However this person was not taking any medication. Some of the care plans could be developed further to be more person centered. One person had a care plan for mobility. Their chart showed they had suffered two falls. However the falls had not been documented on the care plan and the risk assessment had not been changed to reflect the persons current needs. Evaluations of care were being carried out monthly however in general they need more information. Daily records were written by codes, for example A is for personal hygiene, B for eating and drinking, F for continence. The codes are to prompt carers to ensure all areas are mentioned. However they are taken literally. In the lounges people were observed to be nicely dressed, some people were having a wander around and others were sitting comfortably in armchairs. A group of people were spoken to. They thought the home was good and felt able to comment on anything if they werent happy. They enjoyed the meetings and said they got on well with the staff. Visitors were seen to be coming and going, talking with staff and also with their family members. Policies and procedures were in place for the ordering, receipt, storage, disposal and administration of medication. Staffs who administer medication had undertaken training in the safe handling of medication and were competent. Staff are observed by management administering medication for competency every three months. Since the previous inspection prn medication is now kept individually in boxes in the medication trolley. There are daily checks of controlled drugs carried out and a full medication audit every week. Care Homes for Older People Page 13 of 23 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 who use this service have choices in their daily lives as much as is possible. Good contact is maintained between the people who live in the home, relatives and friends. A varied diet is provided. Evidence: The home employs an Activity Co ordinator who organises a range of activities for people in the home. Each person has their own individual client profile, which gives information about where they were born, their family, occupation and significant events in their lives. An old fashioned sweet shop visits every 2 weeks, which is popular. There is also pet therapy weekly, regular fashion parties and entertainment at least every 5 weeks. The activity co-ordinator takes small groups of people out, sometimes to a cafe in a local garden centre, a car ride across the moors, a meal in a pub. There are also visits between the 2 sister homes and bingo or quizzes take place. Games such as giant scrabble, who wants to be a millionaire and indoor bowls are popular and families join in. Care Homes for Older People Page 14 of 23 Evidence: Following every activity session a detailed account is made about who attended, their willingness, memory, participation and responsiveness. Since the previous inspection management had purchased a cinema surround sound system for both the units. Fund raising events take place and when it is for a charity the organisation doubles the amount raised. In an upstairs lounge a bar has been built by a member of staffs relative. People in the home can enjoy a drink whilst watching a film. There are regular meetings for people held and activities and outings are discussed. The manager writes a monthly newsletter and includes peoples birthdays, introduces any new staff and all forthcomimg events. Some people like to have their say about the news letter, its layout and print. The manager has suggested they have more input, but at the moment they are happy as they are. The menu had recently had changes made following one of the peoples meetings. There is a wide range of choices of food. For lunch on the day of the inspection, there was either chicken casserole or corned beef hash on the main menu. People also had alternatives to choose from, salads, soup, jacket potatoes, sandwiches. A group of people spoken during the inspection said they thought the food was lovely and plenty of it. Surveys received from people also commented on the food, saying there was always lots to choose from. The dining tables were set very nicely and there was also an extra area upstairs for people to sit in to eat. Care Homes for Older People Page 15 of 23 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 who use the service are able to express their concerns and have access to a robust effective complaints procedure, are protected from abuse, and have their rights protected. Evidence: The home has a complaints policy and procedure in place. There had not been any complaints made to the home since the previous inspection. People spoken to during the inspection said they would always talk to staff or the manager if they had any problems. The home has a whistle blowing policy and procedure in place. There was evidence in the staff training information that staff had received training in Safeguarding People. During interviews with staff they confirmed they had received training and were able to discuss the procedure to follow in the case of suspected abuse. Care Homes for Older People Page 16 of 23 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 physical design and layout of the home enables people who use the service to live in a safe well-maintained and comfortable environment. Evidence: A tour of the home took place. The high standard of decoration and furnishings has been maintained. The home is light and airy with a variety of areas for people to sit and relax in. There are choices of rooms with a television, with music or just a quiet place. Bedrooms are personalised with items of furniture or pictures, ornaments, televisions. People spoken to said they had brought in what they wanted to fit into their rooms. The home was very clean and odour free. Care Homes for Older People Page 17 of 23 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. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. Evidence: A staff rota was available, which showed there was a skill mix of staff on duty, with a senior on each shift on both units. The home has a policy and procedure for the recruitment of staff. Three staff files were examined. Each file contained the required information, references and CRB check were in place. People had included their history of employment history however in two of the files it showed the year(s) in which they were employed from and to and did not include the months. This potentially shows a gap in employment. The home has a training plan in place, which showed training was up to date. Recent training included, dementia awareness, continence, mental health, fire safety and evacuation, infection control, nutrition and the protection of vulnerable adults. At the time of the inspection there were thirty three cares employed and three domestic staff. twenty nine members of staff had completed NVQ level 2 or above. This is very good practice. Care Homes for Older People Page 18 of 23 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. Staff work as a team. People who use the service are protected by the health and safety policies and procedures. Evidence: The manager is competent and experienced to run the home. She has a deputy manager and senior staff to support her. There are regular meetings held for people who use the service and staff and these are minuted. One person suggested having smaller water jugs as others can be too heavy, same were purchased. there is also a new menu suggestion box and new ideas are encouraged. The home has a quality assurance system in place. However questionnaires are not sent out to relatives and staff help people in the home to complete them if needed. Responses from the questionnaires are fed into an Annual Review, which gives a summary of the outcomes. Care Homes for Older People Page 19 of 23 Evidence: The area manager completes a regulation 26 visit every month and a report is completed. A range of documentation is looked at along with an inspection of the premises, discussions with staff and people who use the service. A number of health and safety documents were examined and they were found to be in good order and up to date. The home has a formal supervision system in place. There was evidence to show that staff received supervision regularly. A computer and printer in the home would assist the managment team. Care Homes for Older People Page 20 of 23 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 21 of 23 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 7 Care plans should be in place only where a need has been identified. Some of the care plans could be developed further to be more person centred. More information is needed in the daily reports to show how people are spending their days. People should include months of employment from and to as well as year(s). The quality assurance system should be developed further to include relatives of the people who live in the home. 2 3 29 32 Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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