Care Home: Manor House

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What the care home does well Manor House provides a homely, safe environment for the people who live there. Care plans are in place and kept up to date. Peoples health needs are recorded and met by staff. Staff have access to training and support to help them do their job. People said staff are `attentive`, `patient` and `responsive`. People also said that there is a sense of `happiness`. Visitors are made welcome. Birthdays and other important events are celebrated. Staff said it`s a `nice atmosphere` and that people are well looked after. What has improved since the last inspection? The Statement of Purpose has been updated to reflect the services provided, giving people up to date information. We saw regular monitoring of peoples weight, ensuring their health needs are fully met. Records of individuals finances were up to date and the balances correct. Staff recruitment is in line with regulations, with two written references received before employment and gaps in employment explored during the interview process. The fire alarm has been tested almost every week and the lift service record noted `all is working properly`. These issues were raised at the last inspection.The manager said that they now have more hours for staff to provide activities in the home for people who use the service. Six members of staff have completed NVQ to Level 2. CARE HOMES FOR OLDER PEOPLE Manor House London Road Morden Surrey SM4 5QT Lead Inspector Emma Dove Unannounced Inspection 20th May 2008 10:20 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor House Address London Road Morden Surrey SM4 5QT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 648 3571 F/P 0208 648 3571 manorhouse@totalserve.co.uk Mr Dudley Sessford Mrs Helene Sessford Mrs Helene Sessford Care Home 23 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (23) of places Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th April 2007 Brief Description of the Service: Manor House is a registered care home for up to twenty-three elderly people, ten of whom may have dementia. Eighteen people are currently living there. Manor House is a small family run business with one of the owners managing the home. Accommodation is provided over two floors of a detached property. A lounge, conservatory, smoking lounge, dining room, kitchen, laundry room, bathroom, toilets and some bedrooms are on the ground floor. Further bedrooms and bathrooms are on the first floor. All bedrooms have ensuite facilities. A lift serves the ground and first floor. People who use the service have access to a large well kept garden. Manor House is in a residential area of Morden. Parking is to the side of the home. Public transport bus services are very close. Information about the CSCI is available at the home. The current fees are from £520 to £550 per week depending on whether it is a single or double room. Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means people who use this service experience good quality outcomes. This unannounced inspection took place over eight hours on the 20th May 2008. One regulation inspector visited, looked at records, spoke with people who use the service, three visitors, the owner, manager, deputy and four members of staff. Questionnaires were sent to people who use the service and their relatives, placing social workers, health professionals and staff. We received six completed questionnaires, comments from these are included throughout this report. The manager completed an Annual Quality Assurance Assessment, which contained good information that is included in this report. The service has kept us informed of issues relating to the home as required. What the service does well: What has improved since the last inspection? The Statement of Purpose has been updated to reflect the services provided, giving people up to date information. We saw regular monitoring of peoples weight, ensuring their health needs are fully met. Records of individuals finances were up to date and the balances correct. Staff recruitment is in line with regulations, with two written references received before employment and gaps in employment explored during the interview process. The fire alarm has been tested almost every week and the lift service record noted ‘all is working properly’. These issues were raised at the last inspection. Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 6 The manager said that they now have more hours for staff to provide activities in the home for people who use the service. Six members of staff have completed NVQ to Level 2. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 and 6 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home understands the importance of having sufficient information when choosing a care home. A ‘Welcome Pack’ and Statement of Purpose have been developed to help people make the decision to move in. Assessments are completed before admission and during the trial period, to ensure that the home is the best place for an individual. People are invited to visit and spend time at the home to meet other people who live there and staff. Intermediate care is not provided. EVIDENCE: The Statement of Purpose has information about the services provided, the owners and staff. A ‘Welcome Pack’ has been developed for people who are about to move in. This tells them about the routines, meal times, the admission process, bed changing, activities, the key work role, extra charges Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 9 made for hairdressing and escorting people to appointments and other useful information about the home. We saw assessments in peoples case files, both from placing social workers and those completed by the manager or senior staff before a person moved into the home, or shortly after in the case of an emergency admission. The manager said that people are invited to look around and come for a trial period before a final decision is made about whether the home is ‘right’ for them. People who use the service generally said that their relatives had visited and chosen the home for them, although they were happy with the choice. Three relatives said they ‘always’ and one relative said they ‘usually’ had enough information to help them make the decision about their relative moving in. Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Personal support is responsive to individuals needs and preferences. Staff respect peoples privacy and dignity and are sensitive to any changing needs. People have access to healthcare services in the home. Medication is well managed with records signed and almost up to date. EVIDENCE: We saw case files contain assessments which are developed into care plans. Care plans include information about the level of support an individual needs and are reviewed and updated monthly, or more often if required. The manager said that they encourage people to do as much for themselves as possible. Staff confirmed that they support people to manage their own personal care and only offer help when required. People told us that staff offer the ‘right’ help and ‘they know what I need’. Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 11 We saw risk assessments, mobility and general assessments completed with people who use the service, this ensures staff are aware of potential issues and know how to keep individuals safe. People who use the service said they feel safe and staff know how to offer them the best help. Two relatives said the home meets the needs of people who live there. Two members of staff said they are ‘always’ given up to date information about the needs of people who use the service. Three relatives said the home ‘always’ and one relative said ‘usually’ gives the care required and expected. Three relatives said they are ‘always’ and one relative said they are ‘usually’ kept up to date with important issues. Two members of staff said that they are aware of peoples different needs and about the equal opportunities policy. People who use the service are registered with a GP and other health professionals such as chiropodist, dentist and optician visit when required. We saw details of peoples health needs in case files. Staff complete training on working with people with some medical conditions, ensuring they are able to meet individuals needs. We suggest contacting local branches of support groups for people who use the service, which may also provide relevant training for staff. Medication is appropriately stored, labelled, up to date and signed by staff. Staff complete training in the administration of medication and are aware of the reasons people take medications. Two gaps were noted in one person’s medication, staff said this was because the medication was not required. This must be clearly written on the Medication Administration Record Sheet at the time. Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People who use the service can take part in planned in-house activities and go out to local places of interest. People have the opportunity to maintain important family and personal relationships. Staff practices promote individuals rights and choice. The menu is varied and meets peoples cultural, religious and medical needs. EVIDENCE: We saw activities staff arranging art and craft activities for people who use the service. A ‘rummage box’ is available for people to feel different textures and hear different noises. This box could be developed and be more readily available to people in the lounge. People can continue with their own hobbies when they move in. The library has some books for people to read. The manager said that they hope to get the mobile library to provide a wider selection of books, giving people a better choice. Photographs are displayed around the home of outings and events, helping to keep them ‘live’ for people who participated. A photograph album is available Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 13 with more pictures of events and outings, for people who use the service, visitors and staff to talk about. Some people said they have ‘done their share’ and are not keen to be involved in activities or outings. Other people said there is ‘plenty to do’, while other people said ‘ not much to do here’ and ‘I watch the television’. Two people thought that the home helps their relative live the life they choose. We saw visitors made welcome, kept up to date with information about their relative or friend and any news about future events at the home. Mealtimes are well-managed social occasions. People generally sit in the dining room, although they can have meals in the lounge or their rooms if they wish. Staff provide people with appropriate, dignified support if required at meal times. The manager said the menu has been developed over time, taking into account the needs and preferences of the people who use the service and they offer traditional English foods. In the future if someone wanted different meals, this could be arranged. People made positive comments about the food they get. A few negative comments came from people about the difference in food when the cook is away, although this was not a major issue and the food is always ‘edible’. There is a ‘high tea’ twice a week when sandwiches and cake are served in the lounge, people said they particularly enjoy this. Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and easy to understand. Information about how to make a complaint is available to people who use the service and their representatives. People are generally aware of how to make a complaint. There are appropriate policies and procedures for safeguarding adults. Staff complete training in protection. EVIDENCE: The manager said that complaints are taken seriously and responded to quickly, to ensure people are satisfied with the service they receive. We saw the complaints record indicate actions taken and the outcome of complaints. There is a suggestion box in the hallway for people if they prefer to remain anonymous. The home have not received any complaints since the last inspection of the home in April 2007. We have not received any complaints since the last inspection. Three visitors said they have no issues or concerns about the home or the services provided. Two relatives were aware of how to make a complaint. One relative was not aware of the complaints procedure but said they have no concerns. One relative couldn’t remember if they had received information about how to make a complaint, although said they had no issues. Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 15 Two members of staff were aware of how to respond to concerns raised by people who use the service or their representatives. Policies regarding safeguarding are in place, the manager and staff have completed training in the protection of vulnerable adults. The manager said that they could do more training in safeguarding and will liaise with the local authority for this. We saw records of individuals finance, these are up to date, with the balance correct and signed by the manager. Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 and 26 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home has been developed over the years and is generally appropriate to meet the needs of the people who live there. The well maintained, safe environment provides aids and adaptations to meet peoples needs. Bedrooms have been personalised to the individuals taste. The home is well lit, clean and smells fresh. EVIDENCE: People who use the service have access to a lounge, conservatory, library and dining room on the ground floor, with a fully accessible, well-kept garden. Two people said that they enjoy looking out over the garden, seeing the birds and other wildlife and seeing other people sitting outside. Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 17 The manager said there is a redecoration schedule, which includes bedrooms being painted before a new person moves in. The manager said that they plan to replace carpets throughout the home, we saw the schedule for work to be carried out during June 2008. We saw that bedrooms have been personalised and people have brought items of furniture and belongings. One person said how important it was to bring ‘bits from home’ and how that helped them settle. Appropriate cleaning schedules are in place to ensure that bedrooms, communal areas, toilets and bathrooms are cleaned at convenient times for people who use the service. All areas of the home were clean and smelt fresh. Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People have confidence in the staff who care for them. Staffing levels were seen to be sufficient to meet the needs of people who use the service. There is a good staff recruitment procedure with appropriate checks carried out before staff start work. Staff have access to relevant training to help them carry out their job more effectively. EVIDENCE: We saw sufficient staff to meet the needs of people who use the service. The published rota shows three members of staff on duty during the day, with the manager, deputy, cook, domestics, activities staff and maintenance person supporting them to meet peoples needs and keep the home to a good standard of repair and hygiene. Two members of staff said that there is ‘always’ enough staff to meet peoples needs. The staff team have remained fairly stable since the last inspection in April 2007 with three full time and two part time staff leaving. Two relatives said they feel staff ‘always’ and two relatives said staff ‘usually’ have the right skills and experience to work in the home. Comments from people who use the service and relatives included: ‘care staff are excellent’; Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 19 ‘more than satisfied with the care and attention’; ‘they treat all equally’; ‘they are aware of age and disability issues’ and ‘staff are kind, helpful and caring’. The manager said they do all the relevant checks and have all the paperwork in place before new staff start work. We saw that staff files contain an application form, at least two written references, a Protection of Vulnerable Adults (POVA) first check, a Criminal Records Bureau (CRB) check and a copy of the individual’s induction schedule. Staff confirmed that they had been interviewed, that references had been requested and a CRB check completed before they started work. The manager said staff have access to a range of training to help them meet the needs of people who use the service. Two members of staff said that they get training to help them carry out their role. Six members of staff have completed NVQ to Level 2. Two members of staff currently doing NVQ to Level 2 and two members of staff are doing NVQ to Level 3. Staff complete training in safeguarding through the local authority. Two members of staff have completed training in working with people with a visual impairment. The manager and deputy have attended training in dementia care, covering nutrition and medication. This training should be available to all staff to help them meet the needs of people with dementia. Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and experience. The owners and manager drive the service. Clear health and safety policies, procedures and practices are in place to protect people who use the service, staff and visitors. EVIDENCE: The owner and manager have been at the home for over twenty years and have developed the service to provide good quality care to people. The manager said they run the home in the best interests of people who live there. Staff confirmed that the manager is approachable, available and listens to peoples needs and tries to meet them within the confines of the service. The manager and staff said they hold regular ‘residents’ meetings and that they Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 21 plan to type the minutes and make them available to everyone at the home and people who visit. People who use the service have asked for more activities and different foods and the manager said they have listened and plan to offer more activities and outings and keep the menu under review. The manager said that between herself, the deputy and a senior member of staff, all staff now receive regular supervision, although she noted that this could be better recorded. Two members of staff confirmed that they meet with the manager regularly. One member of staff said they did not have regular one to one supervision with a senior member of staff. We saw health and safety records and copies of certificates to be in place and up to date. The electrical supply and portable electrical appliances were tested in April 2008 and the gas safety check was completed in March 2008. The fire alarm has been serviced at regular intervals and staff have tested the system almost every week. Fire drills are held twice a year and every month a senior member of staff runs through the process with staff on duty. Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is suggested that staff be given guidance on the actions to take if they see a gap in the Medication Administration Record Sheets, to ensure peoples health care needs are fully met. Consideration should be given to the provision of a wider range of activities to meet all peoples needs. 2. OP12 Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Manor House DS0000027225.V363851.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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