Care Home: Manchester House

What the care home does well The home has worked well with infection control and have followed advice and support to manage the infectious outbreak. The manager reported that a nurse has been identified and is attending appropriate training to work with infection control professionals and audit the home more effectively. What the care home could do better: We made a strong recommendation on the visit that the care plans of the people infected at the time of the visit should be updated to include all necessary care interventions and that these continue to be reviewed. Care plans should be continually updated to ensure consistent communication and monitoring of care. We would require that the manager and provider review the weekend domestic staff cover as the current provision is inadequate and does not ensure consistent standards of cleanliness. The carpet on the dementia care unit did have an offensive odour and the staff explained that there is a lot of food spillage at meal times and this is difficult to clean. We would require that new carpet / appropriate flooring is put down and that this should meet the needs of the people on the unit with respect to ease of cleaning. We would require that the manager completes an audit of all staff [including domestic staff] to ensure that they have completed training in infection control and food hygiene [where necessary] and that records are updated to reflect good standards. This will ensure that all staff are confident and have the necessary competence to care for people with these care needs. The home must inform The Care Quality Commission [CQC] of any outbreak of infectious disease. This fulfills the homes legal requirements and ensures all authorities are notified. We would strongly recommend that the home continue to develop the audit tool discussed so that standards in infection control can continue to be improved. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Manchester House 83 Albert Road Southport Merseyside PR9 9LN two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Michael Perry Date: 0 3 0 4 2 0 0 9 Information about the care home Name of care home: Address: Manchester House 83 Albert Road Southport Merseyside PR9 9LN 01704534920 01704501053 elaine.whitehead@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Chromolyte Limited care home 65 Number of places (if applicable): Under 65 Over 65 0 34 0 dementia old age, not falling within any other category physical disability Conditions of registration: 18 0 13 The registered person may provide the following category of service only: The registered person may provide the following category of service only: Care home with nursing - Code 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 - Code OP (maximum number of places: 34) Dementia - over 65 years of age Code DE (maximum number of places 18) Physical disability Code PD (maximum number of places 13) The maximum number of service users who can be accommodated is: 65 Date of last inspection Brief description of the care home Manchester House is registered to provide nursing care for up to 48 elderly people and 13 younger adults with physical disability. The older persons care includes a registered Care Homes for Older People Page 2 of 10 Brief description of the care home unit for people with dementia. Chromolyte Ltd owns the Home privately and the Responsible Individual is Mr A. M. Zachariah. The Registered Manager is Breda Hickey RGN. Manchester House is large converted building situated close to Hesketh Park and within easy reach of Southport town centre. The accommodation consists of the Bedford Unit which is an elderly dementia care unit situated on the ground floor on one level. It includes its own separate day space and access to two out door areas. The remainder of the home is for the general elderly and younger physically disabled service users [Albert and Victoria units] and is over 2 floors with level access via lifts. There are 3 large day space areas for this group. The current fees are #365 to #569 Care Homes for Older People Page 3 of 10 What we found: We [Care Quality Commission] visited the home unannounced following some concerns raised by the Public Health Department regarding the management of a recent infectious outbreak in the home. The specific concerns were around the lack of knowledge amongst managers, lack of adequate cleaning and lack of appropriate and timely notification of the outbreak. During the visit we spoke to the manager and senior staff on duty as well as care staff. We looked at the care records for people who were still assessed as infected and looked at how they are being managed. We also visited the various units in the home and observed the care. Training records were looked at as well as current policies and procedures available. Following the site visit we spoke with a senior nurse working in infection control who has been visiting the home during the outbreak. At the time of the visit we found the home had worked with the infection control nurses and existing care practices were satisfactory and the infection was being managed. There were managment issues that need to be addressed however. We looked at four outcome areas. Health and Personal Care We reviewed the two people in the home who were currently infected and had diarrhea and vomiting. Care records detailed the daily care over the current period. The manager and care staff spoken with had followed the advice of the infection control nurse and both people were being cared for appropriately following current good practice guidelines. Staff spoken with could explain the daily care and were able to show that equipment such as hand washing facilities and appropriate laundry bags were in place. The care plans for both people did not specify current care needs nor the care interventions currently being carried out. It is important that the care plan is updated so that staff can have a consistent reference for care practice which is regularly reviewed. Residents may be put at risk if care practice is not effectively communicated from shift to shift. Environment When we spoke to the environmental health nurse there were concerns expressed around the cleanliness of the home when they had first visited at the commencement of the outbreak. For example the carpet on the dementia care unit was not clean. There was also a concern that at the start of the outbreak, which was at the beginning of a weekend, there were inadequate domestic staff to clean the home. This meant that people in the home may be put at risk from further spread. These concerns were highlighted in the context of the home having experienced previous infectious outbreaks of a similar nature. Care Homes for Older People Page 4 of 10 We spoke to the manager who confirmed that some areas had been identified as not clean. The carpet in the dementia care unit is now under review to be replaced. We confirmed that currently the domestic cover for weekdays is five staff but during the weekend this is reduced to one. The manager has reviewed this in the light of the current concerns and has increased the numbers at weekend to two. Given the size of the home we remain concerned that the current increase is not enough given the homes assessment that five domestic staff are needed during the week and the findings of the environmental health nurses when they originally visited that overall cleaning standards are not always maintained. We toured the home during the visit and found standards of hygiene to be satisfactory. The dementia care unit was seen and cleaning staff where on duty. The units laundry facility was clean and equipped. The carpet on the unit did have an offensive odour and the staff explained that there is a lot of food spillage at meal times and this is difficult to clean. We would require that new carpet / appropriate flooring is put down and that this should meet the needs of the people on the unit with respect to ease of cleaning. Staffing One of the concerns about the staff response to the outbreak was that not all staff have the necessary competencies and knowledge around infection control and how to manage this. We spoke with the manager and looked at records for staff training. One nurse has diploma in infection control but this was some years ago. The manager reported that staff training around infection control was up to date but staff records did not support this as they had not been updated. We saw evidence of a workshop attended by 11 staff held in the home in December 2008. Other evidence was from the induction file of one fairy new staff member who had covered infection control as part of the introduction training to the home. The manager reported that all staff have completed training in food hygiene but again the records were not up to date to support this. We would require that the manager audit all staff to ensure they have had updates in infection control and food hygiene and ensure records reflect this. The staff rotas for the period covering the outbreak of the infection show that numbers of care staff had been maintained despite some staff being off sick. The manager had made use of agency staff cover when needed. We have made comments around the sufficiency of domestic staff cover at weekends in the home and this needs to be reviewed to ensure that consistent standards of cleanliness are met. Management and Administration We looked at the policies and procedures available in the home and found that these were up to date and provided good reference material. The homes infection control policy had been reviewed by the manager 18 months ago. The home also had relevant good practice reference material. Care Homes for Older People Page 5 of 10 The manager showed an understanding of the reporting process and was able to give an outline of how the infectious outbreak had developed. This had efectivly occurred on the dementia care unit over one day. The outbreak was reported the next morning to Public Health. The home have identified a key nurse who will work with infection control using an audit tool designed to monitor standards in the home around the management of infection. This shows the home are trying to work proactivley in the best interests of people living in the home. It is a requirement that the Care Quality Commission are informed of such outbreaks. This is legal requirement and on this occasion was not carried out. The manager must ensure that all staff are aware of this reporting process. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 10 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 16 A new carpet / appropriate 15/05/2009 flooring must be put down in the demetia care unit main lunge / dining area. This should meet the needs of the people on the unit with respect to ease of cleaning. The current flooring is not clean and does not meet the needs of the people on the unit. 2 27 18 The manager and provider must review the weekend domestic staff and provide sufficient nmbers of staff to ensure cleanliness is maintained. The current provision is inadequate and does not ensure consistent standards of cleanliness. 15/05/2009 3 30 18 The manager must complete 15/05/2009 an audit of all staff [including domestic staff] to ensure that they have completed training in infection control and food hygiene [where Page 8 of 10 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action necessary] and that records are updated to reflect good standards. This will ensure that all staff are confident and have the necessary competence to care for people with these care needs. 4 38 37 The manager or provider 30/04/2009 must notify the Care Quality Commission of any infectious outbreak in the home. This is ensure that legal requirments are met and the home is being correctly monitored. 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 We made a strong recommendation on the visit that the care plans of the people infected at the time of the visit should be updated to include all necessary care interventions and that these continue to be reviewed. Care plans should be continually updated to ensure consistent communication and monitoring of care. We would strongly recommend that the home continue to develop the audit tool discussed so that standards in infection control can continue to be improved. 2 38 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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