Care Home: Manor Hall

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What the care home does well Staff were observed to treat residents with respect, knocking on their doors before entering and ensuring their privacy and dignity was protected when providing personal care. Some of the residents said that the food at the home was very good. There were offered choices and meals were well presented. Residents and visitors said the staff are very nice and offer the care they need. What the care home could do better: Requirements made at the last inspection with regard to care plans and staffing were not met, and additional requirements have been made following this inspection. Random inspection report Care homes for older people Name: Address: Manor Hall Borough Lane Eastbourne East Sussex BN20 8BB one star adequate service 05/01/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Kathy Flynn Date: 3 1 0 8 2 0 1 0 Information about the care home Name of care home: Address: Manor Hall Borough Lane Eastbourne East Sussex BN20 8BB 01323-722665 01323647804 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): South Coast Nursing Homes Limited The registered provider is responsible for running the service care home 44 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 44 0 old age, not falling within any other category physical disability Conditions of registration: 0 44 The maximum number of service users to be accommodated is 44. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability - (PD) Old age, not falling within any category - (OP) Date of last inspection 1 2 0 4 2 0 1 0 Care Homes for Older People Page 2 of 15 Brief description of the care home Manor Hall is situated in a residential area of Eastbourne, close to local amenities and public transport with a public park nearby. A considerable amount of work has been done to convert two buildings into this large care home, while still retaining many of its original features. A stair lift and two shaft lifts are in place to enable residents to access all parts of the home. There are two lounges, one on each side of the building. The larger lounge has a dining area and can be used for activities. To the front of the home is a small patio area accessible through the main lounge. There is also an enclosed patio area between the main building and the rear extension. There is limited parking at the rear of the building. The current rate of fees range from £600 to £950 per week. Care Homes for Older People Page 3 of 15 What we found: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Manor Hall nursing home will be referred to as residents. The unannounced inspection was carried out over six hours on the 31st August 2010 by a compliance manager and a compliance inspector. The inspection was undertaken to review the requirements and recommendations made at the last key inspection and whether these had been met. A number of other standards were looked at during the inspection. The Responsible Individual (RI) Mr Chris Colville has been managing the home since March 2010 and was on duty during the inspection. Initial feedback on the outcome of the inspection was given to the RI and the recently appointed manager. The outcome of this inspection is as follows: Choice of Home - Information The Statement of Purpose and Service Users Guide which provide information about the services offered at the home were examined. These documents contain details of management and staffing and were found to be in need of updating. These documents do not contain any information about how the home meets the needs of people with mental health care needs. Health and Personal Care - Service User Plan Five care plans, for people who have moved into Manor Hall since the last inspection, were examined. These were found to contain the pre admission assessment and details of how the home meets the residents physical needs. Two assessments identified that people with mental health care needs were admitted to the home. There was no clear evidence that the home could meet their specific needs. The care plans include risk assessments for moving and handling, mobility and falls, dietary needs and requirements for pressure relieving equipment. The RI was unable to confirm that the risk assessments are undertaken by staff who have completed the required training to undertake this task. There was evidence that the care plans are reviewed, although only one resident has signed to say that he was involved in developing his care plan. There was no clear evidence that the home meets the psychological and social needs of all the residents. Feedback from residents and visitors, spoken to on the day of inspection, was that the staff were very busy and sometimes residents have to wait a long time for assistance. Staff reported all of their time is taken up with personal care, and they do not have any other time to spend with residents. Each resident has a communication sheet which shows the care and support given to residents on a daily basis. These are completed by the care staff and checked by the nurses. There have been improvements in the detail of the information recorded, since Care Homes for Older People Page 4 of 15 the last inspection. However this is confined to personal care, visits by other health professionals e.g. GPs or whether the residents had visitors. No further information about how the residents spend their time is entered. Standard not met. Health and Personal Care - Medication The clinical rooms, medicine trolleys and storage facilities were assessed. The lunch time medicine round was observed. Some of the medicine administration record (MAR) charts did not have a photograph of the resident concerned. This does not adhere to the homes procedure to use the photograph as part of the checking system to protect residents. There were incomplete records in some the MAR charts, and it was not clear if some residents had been given their medicines. It was not clear who was responsible for administering and recording prescribed topical creams. Before administering some medicines pulse rates should be checked, there was no evidence that this had been done consistently. Residents who have diabetes require regular checks of their blood sugar levels, some of these records were incomplete. Staff are required to sign records for residents who self administer their own medicines. There was little evidence that this takes place. Several breaches to the homes administration of medication policies and procedures were observed. Out of date medicines were found in the fridge in one of the clinical rooms. The form for daily checking of the fridge temperatures was not completed daily. The record stated that the temperature was too high on some days. Sharps boxes were overflowing in both clinical rooms and some needles were not disposed of safely. Policies and procedures are in place for the ordering, storage, administration and disposal of medication. Staff spoken to said that they have attended the training provided by the pharmacy responsible for medicines in the home. The training takes one hour and looks at the pharmacys systems for ordering, storing and disposal of medicines. It does not offer training in administration and record keeping. There have been two safeguarding referrals concerning medication that have been investigated by the local authority. Action plans have been agreed with the home and there will be ongoing monitoring by the local authority. The home has been auditing the administration of medicines and this has highlighted a number of errors that have been made by nurses with regard to ordering, administering and recording medicines. However there is no action plan in place to address these errors. Standard not met. Daily Life and Social Activities - Activities. Activities were not offered to people living in the home on the day of the inspection. There is no activity programme in place. Some residents said that they are bored, staff are very busy and do not have any time to sit and talk to us. While other residents said that they prefer to sit in their rooms quietly or watch TV. Staff said that they have been asked to provide activities, but are unable to do so because they are too busy providing personal care. Standard not met. Daily Life and Social Activities - Meals. Care Homes for Older People Page 5 of 15 Choices are available for each meal. The cook said that the residents can have what they want, and staff said they ask the residents what they would like to eat. Staff assisted residents during lunch. However some residents said that they were not asked what they would like for lunch. One resident said she did not know what she was going to have for lunch or supper until it arrived. Care staff said that residents who eat a liquidised diet are given different food, which may be what is left over from the day before. Standard not met. Environment - Hygiene and Control of Infection. A number of concerns were observed throughout the home. These included dirty hoists, cleaning fluids left unattended on the floor in various rooms, waste bins without lids, first aid boxes with out of date dressings, cupboard floors used for inappropriate storage, and unguarded radiators. The home has two sluices, one on each floor. The one on the ground floor is not fit for purpose. It does not have a door and provides open access. The sluice facility is not sealed. Staff have received infection control training. However on the day of the inspection staff were observed to be wearing gloves and aprons when walking between rooms in the home. Standard not met. The laundry room is used to launder the residents clothing. Linen and towels are sent to an external laundry. The laundry room is very cramped and the RI says that he is planning to refurbish it. During the inspection a number of repairs were observed and these were addressed by the maintenance person. This was only after being pointed out by the inspection team. These included an unguarded radiator, a broken radiator lock and a telephone point hanging off the wall. Staffing - Staff Complement. The RI advised that the staffing levels and skill mix have been reviewed and a number of new staff have been appointed since the last inspection. This was aimed at being less reliant on agency staff. Feedback from the residents was that the staff were very busy. They may have to wait thirty minutes for staff to respond to a call bell, particularly at night. Residents also stated that they may have to go to bed at a time that suits the staff numbers rather than when they would prefer. Standard not met. Staffing - recruitment. Six staff files were examined and found to contain relevant information, including application forms, two references and Criminal Register Bureau checks. Standard met. Staffing - Staff Training. Care Homes for Older People Page 6 of 15 The home has a training programme in place. This includes the mandatory training and specific training e.g. dementia care. Staff stated that attendance is recorded within the home and the training manager at head office informs them when updates are required. All new staff are required to complete the induction programme in line with Skills for Care. Staff reported that they have completed this and are encouraged to work towards National Vocational Qualifications. Standard met. Management and Administration - Day to Day Operations. Manor Hall has not had a registered manager for over one year and the RI has been managing the home since March 2010. A senior nurse at the home was appointed manager just prior to the inspection and is applying to register with the Commission. Feedback from staff was that there have been a lot of changes in management but the working atmosphere at the home had improved since the last inspection. Staff felt that they were able to raise any concerns with the RI. Standard not met. The quality monitoring system currently in place uses annual surveys to residents and relatives to obtain feedback about the care and support offered at the home. The RI stated that he is aware of the concerns regarding the lack of activities. Unannounced monthly visits are a requirement under Regulation 26 as the homes directors are not in day to day charge of the home. The last three reports were examined and these identified issues regarding care plans and medication. However they did not include action plans to address them. Standard met. A staff supervision programme is not in place. Staff spoken to during the inspection said that they have not had supervision, which involves a review of their work, or an appraisal since the last inspection. Standard not met. During the tour of the home a fire door was not secure. This raises issues of the safety of residents and the security of the building. The RI confirmed that the home has an up to date fire certificate. What the care home does well: What they could do better: Requirements made at the last inspection with regard to care plans and staffing were not met, and additional requirements have been made following this inspection. Care Homes for Older People Page 7 of 15 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 8 of 15 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 Care plans to be up to date 16/05/2008 and under regular review, with the involvement of residents and/or relatives, to protect residents. To have records around medicines which accurate, true and completed. So that there is a detailed record of treatment given. 30/04/2010 2 9 13 Care Homes for Older People Page 9 of 15 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 That individual assessments 30/09/2010 and plans of care, treatment and support are based on the needs, choices and preferences of the residents. Care plans are reviewed with the involvement of the residents and their relatives where appropriate. This is to ensure that residents: * understand the care, treatment, support and choices available to them * can express their views, so far as they are able to do so, and are involved in making decisions about their care, treatment and support * have their privacy, dignity and independence respected * have their views and experiences taken into account in the way the service is provided and delivered. That clear procedures for 30/09/2010 medicine handling are in place and followed in practice Page 10 of 15 2 9 13 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 at all times. These procedures, which include ordering, safe storage, preparation, administration, and disposal of medication, are monitored, reviewed and this is clearly documented. This is to ensure that all residents will have the correct medicines, at the correct time administered in a safe and appropriate way. 3 12 16 That the residents welfare is 30/10/2010 maintained and their well being promoted by taking account of all their needs including physical, social and psychological needs and providing access to a range of daytime activities. This is to ensure that residents have appropriate care and support, which meets their needs and enables them to make choices about all aspects of their lives. 4 15 16 That staff identify the 30/09/2010 nutritional needs of each resident and document this in the care plans, to include the following: * preferences and/or the need for a particular diet * where a resident is at risk of poor nutrition, dehydration or has swallowing difficulties * the level of assistance needed to eat and drink * any aids that would help Page 11 of 15 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action independence e.g. plate guards, specially designed cutlery, type of drinking cup/glass. This should be reviewed and recorded as their needs change. Staff involved in food preparation provide a healthy balanced diet. This is to ensure that residents: * have a choice of food * have meals that take account of individual preferences and needs including their religous or cultural requirements * are supported to have adequate nutrition and hydration. 5 26 13 That staff follow the homes 30/09/2010 infection control policies, which are designed to assess the risk of infection, manage any infection risks, keep the environment safe and ensure that the home has appropriate levels of cleaning to protect the health and well being of residents, staff and other people entering the home. This is to ensure that residents, staff and visitors are protected through effective infection control assessment and management procedures. 6 27 9 That there are sufficient numbers of staff with the 30/10/2010 Care Homes for Older People Page 12 of 15 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action right competencies, knowledge, qualifications, skill and experience to meet the physical, social and psychological needs of the residents. This is to ensure that the physical, social and psychological health and welfare needs of residents are identified and met as far as possible. 7 36 18 A programme of staff supervision and appraisal is developed and put in place. This is to ensure that all staff involved in delivering care and treatment are supported through a regular system of appraisal that promotes their development, identifies any training needs and reflects any relevant professional requirements. 8 38 23 That advice is sought from the Fire Service with regard to the access and egress from external fire doors. This is to ensure that residents, staff and visitors are protected against risk of unauthorised entrance to the building or that residents do not leave the home undetected. It is also to ensure that appropriate measures are in place to ensure the security of the premises and that the home Care Homes for Older People Page 13 of 15 30/10/2010 30/09/2010 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 complies with any legal requirements relating for the premises. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 14 of 15 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 15 of 15 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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