Care Home: Manor House Christian Rest Home

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What has improved since the last inspection? Three requirements were made at the previous inspection, relating to care planning and receipt, recording, storage, handling and disposal of medicines. Information obtained during the inspection confirmed that the registered manager has taken action to address and meet these requirements. People living in the home can be assured that their care needs will be set out in an individual care plan, including resident`s recently admitted to the home. The practice of holding two care plans, one in the manager`s office, and a second file in the staff room has ceased, one care plan is now being used, which is held in the staff office to ensure staff have access to current and up to date information about people using the service at all times. The registered manager has improved the safety for the storage of medication in the home. A new medication trolley and a Controlled Drug (CD) cabinet are now in use. The practice of sharing medication between residents has stopped, this was confirmed when carrying out a check of the contents of the medication trolley. Concerns about medication have been made at the last two inspections, issues were identified at this inspection about the inaccuracy and poor recording in the controlled drugs register. In line with the Care Commission (CQC) guidelines, these errors would normally evoke our enforcement pathway, however in view of the fact the manager has made considerable effort to address the requirements from the previous inspections they were asked to investigate these issues and report their findings to us (CQC) by the following day of the inspection. The manager`s investigation concluded there had been a mistake in recording in the CD register, although the amount of medication was correct. To ensure records are maintained correctly the manager has told us they will implement weekly audits, a review of medication policies and inform staff through meetings and training. What the care home could do better: Key inspection report CARE HOMES FOR OLDER PEOPLE Manor House Christian Rest Home Bacton Stowmarket Suffolk IP14 4LJ Lead Inspector Deborah Kerr Unannounced Inspection 29th April 2009 10:00 DS0000024441.V375208.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor House Christian Rest Home Address Bacton Stowmarket Suffolk IP14 4LJ 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) 01449 781447 01449 781447 info@manorhousebacton.co.uk Manor House Christian Trust Mrs Miranda Jane Jolly Mrs Miranda Jolly Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st May 2008 Brief Description of the Service: Manor House Christian Rest Home is a large 16th Century building situated in the centre of the village of Bacton, close to local amenities. It is surrounded by approximately three acres of grounds that include an orchard to the rear of the property. There is a large farm to one side of the home and a General Practitioners (GP) surgery to the other side. The building is privately owned and leased by the Manor House Christian Trust for the purpose of providing residential accommodation for older people, within a Christian community. The Trust are somewhat restricted as to any adaptations they can make to the property as it is a listed building and formal negotiation is required before any permission will be given to make any changes. The Trust are responsible for the upkeep and maintenance of the property. The home offers accommodation and care for up to sixteen older people. On the day of the inspection there were twelve people in residence with four vacancies. The majority of residents are practicing Christians, however, local people who do not follow the Christian faith would not be precluded from living at the home. The current range of fees, as at the site visit were said to be £355 .00 per week (Suffolk County Placement Fee) to £475.00 per week (Private Fee). Hairdressing, chiropody, newspapers and toiletries are at extra cost. Manor House Christian Rest Home DS0000024441.V375208.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 stars. This means the people who use this service experience good quality outcomes. This was a key inspection, which focused on the core standards relating to older people. The inspection was unannounced on a weekday, which lasted eight hours. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained in the Annual Quality Assurance Assessment (AQAA) issued by the Care Quality Commission (CQC). This document gives the provider the opportunity to inform CQC about their service and how well they are performing. We also assessed the outcomes for the people living in the home against the Key Lines Of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with six people living in the home, one relative and two staff. The manager was present during the inspection and fully contributed to the inspection process. What the service does well: People living in the home told us, they are able to do what they want to do, when they want to and are free to come and go as they please. They also told us that they are supported by an excellent group of staff and are provided with good food. Comments included, “the home is very clean well looked after, I have nothing to grumble about. At night time if I ring for carers they come promptly I do not have to wait, I can have a cup tea at night if I want, they are a lovely team of staff” and “I can’t find anything wrong, I have my own room, the food is wonderful, the staff are very good, I get on well with all of them. Another person told us, I am very happy here, I am able to follow my own daily routine and do as I want, including when I get up and have my meals. We are treated very well here, they couldn’t do more”. One person told us, “being at Manor House was like living in a 5 star hotel and that everything is beautiful, everything is perfect. Another individual commented, “it is wonderful here, I love it I am able to ‘live my life’ I am not restricted and do exactly what I want and can go out when I want with family and friends. The spirit of the carers is good, they do their job extremely well they are my friends rather than carers”. This was also reiterated by a married couple who stressed that the care staff are very good and look after peoples’ personal care needs, very well. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: To protect the health safety and welfare of people living and working in the home, a falls co -ordinator or similar professional should be consulted to obtain advice and / or training for the further prevention of falls. This particularly relates to individuals that are identified as having repeated falls. Additionally the trustees must, following consultation with the fire authority ensure by means of fire drills and practices at suitable intervals staff and people living in the home are aware of the procedures to be followed in case of fire. Information about the home should to be updated to reflect the change of organisation from Commission for Social Care Inspection (CSCI) to the Care Quality Commission (CQC) and change of contact details. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 7 If senior staff are to undertake needs assessments of new people moving into the home they should be provided with training to ensure they are competent to undertake the assessments and to ensure the home are able to meet that individuals specific needs. People using this service told us, “the environment is a little outdated in décor, however it is kept clean and tidy” and “the décor and furniture is alright, but the dining room is a bit cramped”. Generally the home is well maintained however it was noted in bedroom three that a large crack has appeared down the back of the wall and across the ceiling that requires some attention and the curtains were hanging off the curtain rail. The passenger lift is of an old fashioned nature and consideration should be given to replacing this at some point in the future, with a more secure type of lift. 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. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 8 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 Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 6, People using the 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 may use this service are provided with information and the opportunity to visit the home to help them choose if this service will meet their needs. EVIDENCE: The statement of purpose was not reviewed on this occasion. The Resident’s Handbook (Service Users Guide) provides information about the services provided, the facilities and also includes the complaints procedure. The handbook will need to be amended to reflect the change of organisation from Commission for Social Care Inspection (CSCI) to the Care Quality Commission (CQC) and change of contact details. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 10 As part of the inspection process the records and care pathways of three people living in the home were tracked to ascertain how well the home is meeting their individual needs. A requirement made at the last inspection related to the practice of holding two care plans, one in the manager’s office, and a second file in the staff room. Problems had occurred where information had not been copied or transferred over to the care plan held in the staff office. Only one care plan is now being used, which is held in the staff office to ensure staff have access to current and up to date information about people using the service at all times. All three people being tracked had a detailed pre admission assessment completed, which covered all areas of the individual’s health, personal and social care needs. Additionally where people had been referred through social services a copy of the social workers assessment had been obtained held on file and used to complete the individuals care support plan. People spoken with confirmed they had been provided with information and the opportunity to visit the home before deciding if was the right place for them. One person commented, “the manager visited me in my own home to do an assessment of my needs before I moved into Manor House and I also was able to visit the home and have a look around”. They also confirmed they had stayed for a weeks respite to try out the home before moving in on a permanent basis. All people moving into the home are asked to complete a questionnaire and evaluation form about the admission process into the home and the service they are receiving within three months of admission. All three care plans contained completed forms concluding these people were satisfied with the admission process and the service and had made suggestions where they thought areas could improve. Examples included, “I was made very welcome, well treated and staff listened to me and understood about how I felt moving into a new place” and “my accommodation was well prepared for me when I arrived”. Evaluation forms concluded, “all staff are very kind and helpful” and “the staff are understanding and kind” and I am happy with the extra care I get”. Feedback about the environment suggested there could be some improvement, such as “the décor and furniture is alright, but the dining room is a bit cramped” and “the environment is a little outdated”. Each of the files seen contained a copy of the individual’s terms and conditions of residence at Manor House setting out their fees, the roles and responsibilities of the provider and their rights and obligations whilst living in the home. These are reviewed annually and are in the process of review at present. Additionally, people referred and funded by the Local Authority had copies of the Individual Placement Contract (IPC) of the contract between the home and Social Services. These confirmed the amount of the individual’s contribution. The home does not provide intermediate care. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11, People using the 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 receive health and personal care, based on their individual needs. They can be assured that issues will be dealt with promptly to ensure they are they are protected by the homes policies and procedures for dealing with medicines, however more needs to done to minimise the risk of people sustaining injuries from falls. EVIDENCE: Three peoples care pathways and care plans were tracked as part of the inspection. Care plans had photographs in place of individual residents to identify and personalise the care plan document, with the exception of one person who had recently moved into the home. The plans are well laid out and setting out the actions required by care staff to ensure that peoples’ health, personal and social care needs are met. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 12 Two of the three pre admission assessments and care plans examined showed these had been completed providing a detailed account of the individuals needs, however some information for the most recent person to be admitted to the home had not been recorded. A record of the individual’s medication, physical well being and weight on admission had not been completed. Additionally, the falls section had been marked as not applicable, however their moving and handling assessment states the individual has a history of falls, three in the last six months. Incident and accident forms identified the individual had had a further two falls in March 09. This was discussed with the regsitered manager who confirmed these documents had been completed by a senior member of staff and it was agreed that if this to be part of their role training to undertake assessments should be provided. Supporting risk assessments are in place where people are deemed at risk. These include daily activities, such as moving and handling, bathing, showering, washing, dressing, using toilet facilities, eating and drinking, medication and falls. Moving and handling assessments show people have been provided with equipment to aid mobility and maintain independence, however where people are identified at risk of falls, the assessments have not been fully completed to reflect the individuals current risks, where there is an increased risk of falls. Neither do these take into account the medical factors, for example conditions such as Parkinsons disease. Incident and accident records for the three people tracked during the inspection reflected that in six months one individual had five falls, another had three falls and the third person had seven falls throughout 2008. The homes policy and procedures for managing falls states each resident must have risk assess completed, which includes how falls are to be managed and where they are identified at risk the manager should work in collaboration with relevant local health professionals and local fall prevention strategies and procedures. People in the home are able to access health care services. Peoples nutritional needs are closely monitored with regular weights checks being undertaken. The home has a positive relationship with the local General Practitioner’s (GP) and district nurses who make regular visits to the home. Dates and details and outcomes of appointments had been clearly recorded in peoples care plans. Care plans contained ‘Residents information sheets for transfers or in case of an emergency’. These provide important information about the individual in case, for example they are admitted to hospital in an emergency. Whilst this is good practice these need to be reviewed on a regular basis to ensure information is correct. The transfer sheet for one individual had several changes made to their medication, some were dated where the changes had been made others were not and this could lead to confusion about the individuals current medication. Daily records are well written and provide a good overview of how each individual has spent their day, they also document the care provided and give Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 13 an indication of the individuals health and well being. Staff spoken with were able to give a verbal account of the needs and preferences of individual residents. Conversation with people living in the home and a relative confirmed that staff treat the residents with dignity and respect at all times and the care provided is excellent. The interactions between residents, relatives and staff were observed to be friendly and appropriate. Time was spent with registered manager to follow up on requirements made at the previous inspection in May 2008. The Medication policy has been reviewed to reflect new practice of storing and administering medication, however the policy needs to be amended to reflect arrangements with regard to a change of dispensing chemist. Previous concerns were raised about medication being transported from a locked cupboard in the medication room via a plastic box around the home. This presented a risk that the box could be left unattended and therefore not fully secure. Additionally, controlled drugs were being held in a wooden cupboard in the medication room and were being transported around the home with other blister packed medication in the plastic box. A new medication trolley and a Controlled Drug cabinet have been purchased and are now in use. Daily recordings of the fridge temperature used for storing medication are being record and showed that temperatures are within recommended levels. A previous requirement was made for medicines prescribed for individual’s living in the home to remain the property of that individual and not used as stock medication. The practice of sharing medication between residents has stopped, this was confirmed when carrying out a check of the contents of the medication trolley. Residents prescribed liquid medicines, such as Lactulose, Gaviscon Advance and Peptac Liquid have their own bottle, which was clearly labelled. The home uses the Monitored Dosage System (MDS). Photographs of residents had been attached to the Medication Administration Records (MAR) charts folder to avoid mistakes with the person’s identity. The practice of administering medication is being generally well managed. The MAR charts inspected were found to be completed correctly, where changes in medication had been on the MAR charts, these were clearly marked when the changes were made and who had made them. Staff had made good use of the codes and reverse of the MAR chart to reflect if medication had not been administered and the reason why. However a check of the Controlled Drugs (CD) register highlighted errors in recording. The home currently has one person prescribed controlled drugs. The amount of medication held did not correspond with the amount entered in the CD register. The CD register stated that the individual should have 51 Oxycontin 5mg tablets in stock. The manager and the inspector counted the stock twice, which confirmed there were 52 tablets in stock. The MAR charts were examined for the same period and showed that on the 24/04/2009 the Oxycontin 5mg tablets had not been signed for to reflect if the medication had been administered to the individual, Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 14 however the staff and a witness had signed the CD register on this date to reflect the tablet was administered. Therefore it was unclear if the individual received their medication. A check of the daily log did not indicate that the individual showed any ill effects from not receiving this medication. The individual is prescribed Oxycontin 5mg tablets twice daily. On the 24th April 2009 the stock held following administration of the individuals morning medication was recorded as 62 tablets remaining. An incorrect entry following the second dose reflected there were 62 tablets, which should have been 61, this consequently made the figures incorrect until the 26th April 2009 where a check was made. The member of staff had gone back and changed the numbers without signing and dating and making a written explanation of the changes. Concerns about medication have been made at the last two inspections, in line with the Care Commission (CQC) guidelines, these errors would normally evoke our enforcement pathway, however in view of the fact the manager has made considerable effort to address the requirements from the previous inspections they were asked to investigate these issues and report their findings to us (CQC) by the following day of the inspection. Following the managers investigation they have found a mistake regarding the total of tablets was on the previous page in the CD register. There was a miscalculation of the amount of tablets, therefore the amount in the packet of 52 tablets on the day of the inspection was correct. To ensure records are maintained correctly the manager has told us they intend to do a daily count and a weekly audit. They have also informed us that they are to discuss this issue at staff meetings, review the medication policies and procedures and investigate more detailed training for staff with the responsibility for administering medication. This will be reviewed at the next inspection. The home fully respects the rights of people and supports them through the risk assessment process to retain and manage their own medication. A risk assessment and disclaimer had been signed and dated by one person to retain responsibility for own medication despite advice by their General Practitioner (GP). They have been provided with a lockable cabinet within their room to keep their medication. The policies and procedures file contained a detailed policy on death and dying which takes into account the end of life care provided by the home. The care plans contained information about who to contact and terminal arrangements however these could be further expanded to take into account peoples wishes of how they wish to be supported at the end stages of their life, to remain in the home, if this is what they choose. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, People using the 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 using this service are provided with activities that meet their expectations and which meets their social and recreational interests. EVIDENCE: Care plans viewed contained individual’s life histories, providing a good profile of the person. These provided information of the individuals past, focusing on significant and important events in their life, what matters to them and why. This information provides vital links to the persons past, which has formed their identity, and forms the basis of communication and provides staff with an understanding of the individual. During our visit we spoke with six people living in the home and a visiting relative. People told us, they were happy living in the home they are able to do what they want to do, are free to come and go as they please, are supported by an excellent group of staff and are provided with good food. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 16 People commented, “the home is very clean well looked after, I have nothing to grumble about. At night time if I ring for carers they come promptly I do not have to wait, I can have a cup tea at night if I want, they are a lovely team of staff” and “I can’t find anything wrong, I have my own room, the food is wonderful, the staff are very good, I get on well with all of them. Another person told us, I am very happy here, I am able to follow my own daily routine and do as I want, including when I get up and have my meals. We are treated very well here, they couldn’t do more”. One person told us, “being at Manor House was like living in a 5 star hotel and that everything is beautiful, everything is perfect. The carers and cooks are really good. I like spending my time sitting in the garden, in lovely surroundings and doing my knitting and reading the newspapers. I also like to keep myself busy and do some small household tasks like laying the tables for meals and giving out soft drinks to other residents”. Another individual commented, “it is wonderful here, I love it I am able to ‘live my life’ I am not restricted and do exactly what I want and can go out when I want with family and friends. The spirit of the carers is good, they do their job extremely well they are my friends rather than carers”. This was also reiterated by another married couple who stressed that the care staff are very good and look after peoples personal care needs, very well. A relative commented we are very happy with the home, we were able to visit the home unannounced to look around, the staff were very nice and helpful, open and friendly. My relative appears to have settled well, they are eating well and the care staff are excellent, very caring, we have no complaints. Daily activities offered are recorded in an activities folder and reflect who took part and their level of engagement. Activities include, games such as hoopla and skittles, reminiscence, musical entertainment brought into the home, word games such as eye spy and alphabet, with a theme such as naming plants flowers and trees. Discussion about topical issues and days gone by and armchair exercises. A hairdresser visits the home regularly for people to have their hair done if they choose. Residents were observed moving freely around home and garden making the most of the nice weather. People spoken with confirmed they are able to spend their time as they wish and do take part in some of the activities or choose to spend time in their room or communal lounges watching television or listen to the radio. People also said that they know each other’s families well and spend a lot of time talking with one another. Each day of the week people are able to take part in devotion services with different guest speakers. One resident confirmed they also go to a local Gospel church every week. Time was spent talking with the cook, they are one of three that work on rota basis. Two weekly menus are in place, which are changed monthly to coincide with seasons and festivities, such as Christmas. The menus provide people with a choice of main meal daily. Additionally, the cook and people spoken with Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 17 confirmed that if they do not want either of the choices provided, alternatives are always available. This was confirmed observing the lunchtime meal. Hot and cold drinks were seen being served during the day. Food stocks were plentiful with an appropriate range of fresh, frozen and dried food available. The cooks are aware if people require a special diet. They confirmed they have received training about supporting people with special needs and diets, however this is not required at present as there is no one residing in the home that has eating or swallowing difficulties, only two people who are diabetic. Feedback about the food was in the main positive, comments included “food is very good” and “I have a choice of breakfast, consisting of a full cooked if I wish, mostly I choose to have boiled eggs and cereal”. However a comment was made that food can at times be a bit bland, it is healthy food but just not interesting, but stated I realise it is difficult to cater for everyone’s tastes. People confirmed they could have food brought into the home, such as fish and chips and that they are able to purchase items from a local shop. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18, People using the 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 and their relatives have access to a robust and effective complaints procedure and are protected from abuse. EVIDENCE: The policies and procedures for dealing with complaints, whistle blowing and safeguarding the people living in the home were examined. These will need to be amended to reflect the change in details of the Care Quality Commission (CQC). The manager was also advised of the updated policy and operational guidance available on the Adult Safeguarding Board website, which will need to be reflected in their own policies and procedures. The policy detailing the arrangements for the management of residents’ money and valuables was seen. This had been updated June 2008 as advised at the previous inspection to include the arrangements for safeguarding peoples financial interests and ensure that secure facilities are provided for the storage of any money, looked after on their behalf. Records of two people tracked as part of the inspection showed a clear audit trail of all financial transactions. Monies held for each person were checked against the balance sheets and were found to be accurate. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 19 People using the service and their relatives confirmed they were aware of the complaints procedures and were clear they would talk to the manager if they had any concerns and were confident that there concerns would be dealt with. Residents and relatives told us “the manager, the deputy and care staff are very approachable and I feel able to discuss any concerns openly with them”. The homes’ record of complaints identified that there have been no formal complaints made about this service. The records showed that between August 2004 and December 2007, twenty-three residents had raised minor concerns, which had been dealt with immediately by the manager and feedback provided to the individual(s) concerned and the action taken as a result. Staff files show that all staff have received Safeguarding Of Vulnerable Adults (SOVA) training and that the service has robust recruitment procedures in place. Staff files seen confirmed all staff are subject to Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks, prior to commencing employment. Staff spoken with were clear about their role and their duty of care to raise any concerns they may have about other members of staff conduct and in reporting of incidents of poor practice and suspected situations of abuse. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25, 26, People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Manor House continues to provide people who live there with a safe, well maintained and homely environment. EVIDENCE: Manor House is situated in the centre of the village of Bacton, close to local amenities. It is surrounded by approximately three acres of grounds that include an orchard to the rear of the property and a pretty garden to the front. There is a large farm to one side of the home and a General Practitioners (GP) surgery to the other side. The home is welcoming, nicely decorated and is well maintained, providing safe and comfortable accommodation. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 21 Communal rooms are spacious and well furnished with domestic style furniture, lighting, carpets and curtains. The small lounge has recently been decorated. Information provided in the AQAA and verified at the inspection confirmed new benches and parasols, bird tables and tubs of flowers have been purchased for the garden and a large television for the main lounge. Personal objects seen in the lounges provided a homely feel, ornaments and photographs of family members were placed on side tables so that people could see them. People told us, “the home is nice, the staff keep it very clean” and “the environment is a little outdated in décor, however it is kept clean and tidy”. One resident told us, “I have my own room upstairs, but I need staff to help me to use the stair lift, this is not an issue as the staff are always willing to help me if I ask, I am happy sitting in the lounge but would like to spend time in my own room and would prefer a room on the ground floor as soon as one becomes available. The home has twelve single and two shared bedrooms. These are on the ground and first floor. Each room has its own washing facility with one single room having full en suite facilities. There are two assisted baths, one on each floor. The downstairs bathroom has recently been decorated. New flooring and bath panels have been fitted. There are a number of communal toilets situated around the home. A previous concern was raised about toilet doors as they operate on a swing door basis. This could mean that if the door is not locked properly, it is possible for the door to open outwards whilst the cubicle is occupied. No problems were observed during the inspection. However, it was noted that the home has a staff toilet, which is kept locked, the manager could not give an explanation for this. Toilets throughout the home should be of an acceptable standard to be used by residents and staff without the need for separate facilities. Bedrooms are suitable for the needs of their occupants, with appropriate furniture and fittings. These were nicely decorated with peoples’ personal effects to reflect their individual personalities, hobbies and interests. However it was noted in bedroom three that a large crack has appeared down the back of the wall and across the ceiling that requires some attention and the curtains were hanging off the curtain rail. To ensure the safety of people living in the home, all radiators are guarded with purpose built radiator cover, which minimises the risk of people falling against them and sustaining burns. The home is generally equipped with aids and equipment to promote mobility and maximise people’s independence, including seat raisers, grab rails and other aids, which are available in corridors, bathrooms, and toilets and where required, in residents own rooms. All equipment is being regularly serviced as per the manufacturers recommendations and confirmed from the records inspected. Call systems were provided throughout all individual and communal rooms. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 22 The laundry facilities are clean and tidy with appropriate equipment to launder soiled linen, clothing and bedding. Systems were in place to minimise risk of infection via the use of red bags for any soiled laundry soiled. Appropriate protective equipment, such as aprons and gloves and hand washing facilities of liquid soap and paper towels are provided in all en-suite and toilet facilities, where staff may be required to provide assistance with personal care. The home has a passenger and stair lift for access to the first floor. Consideration should be given to replacing the passenger lift at some point in the future, with a more secure type of lift. Although the lift is being regularly serviced and is in good working order, the lift descends into open space in main entrance hall. The lift is stowed up on first floor the area below is marked out with yellow and black warning tape and it has a cut out sensor if it comes into contact with anything on descent. The inspector was advised Environmental Health inspectors have not raised concerns about the lift. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30, People using the 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 using this service are supported by a staff team that are trained, skilled and in sufficient numbers to meet their needs. EVIDENCE: The home is staffed twenty fours a day seven days a week. Examination of the duty roster reflects the normal staffing ratio is three staff in the mornings between 8am and 2pm, two staff between the hours of 2- 10pm and two night staff from 10pm to 8am. In addition to the care staff a cook, kitchen assistant and a domestic are employed each day. There was evidence from the staff rota, discussion with residents, relatives and staff that staffing levels are well maintained and from observation these appeared to meet residents needs. Information provided in the AQAA and verified at the inspection confirmed the home has a good team of dedicated staff with a low staff turnover. Feedback from people using the service and relatives were extremely positive about the competence and the attitude of the staff. Staff spoken with told us “Manor House is a lovely place to work, there is a good atmosphere and the team work well together and are flexible in covering each other’s sickness and holidays”. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 24 Staff confirmed they had been recruited fairly and that they received good training and support to ensure they have the skills and knowledge to do their jobs and to meet the different needs of the people living in the home. Most recent training has included safeguarding adults, mental capacity act, first aid, moving and handling, health and safety, food hygiene, fire safety, communication and report writing and medication. More specific training to meet the needs of the people using the service has included dementia awareness and stair lift operation. Information provided in the AQAA states the home has a high percentage of staff who have achieved a National Vocational Qualification (NVQ). The home employs a total of eighteen care staff twelve of whom have achieved NVQ level 2 and / or above. These figures reflect 50 of staff hold a recognised qualification, which meets the National Minimum Standard (NMS). The AQAA states the home has a robust recruitment process in place to select the right candidate. Examination of three staff files confirmed this, all relevant documents and recruitment checks, required by regulations, to determine the fitness of the worker had been obtained prior to them commencing employment. The AQAA states all new employees complete their induction training within the first six weeks of their employment. Staff spoken with confirmed they had received a very good induction, which included an orientation tour of the home. Certificates held on the staff files confirmed staff had attended a threeday, Skills for Care Induction at West Suffolk College. The induction meets the requirements of the Common Induction Standards and is verified by Suffolk Care Training Partnership. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38, People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect and is run in the best interests of the people living there by a competent and qualified manager. EVIDENCE: Manor House is a registered charity and is operated by seven trustees who bear the legal responsibility for the running and welfare of the home. The registered manager and a team of staff undertake the day-to-day operation of the home. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 26 The registered manager has worked at the home since 2000. They have obtained the Registered Mangers Award (RMA) and is currently undertaking the A1 Assessors Award. They continue to update their knowledge and has recently attended a two day Depravation of Liberty Safeguards (DOLS) training course with the deputy manager and three senior staff. Discussion with staff, people living in the home and a relative provided positive feedback about the manager and deputy. They told us, the manager’s are good, they are easy to talk to and approachable” and “the manager, deputy and staff have worked with us and are very approachable to accommodate my relative’s needs. To ensure the home is run in peoples’ the best interests, an annual quality monitoring system is in place, which seek the views of residents, relatives and staff. However the most recent quality audit of the home, had been completed in 2007. The manager explained they are in the process of updating the questionnaire to make them more user friendly and will distribute these in July this year. The home continually seeks the views of people moving into the home and after three months residence. They are asked to complete a questionnaire and evaluation form about the admission process and their satisfaction with the service they are receiving. Additionally, staff confirmed they have regular meetings to ensure they are kept informed about changes within the service. A range of policies and procedures were examined during the inspection. These included an infection control manual for Care homes 2008-2010 specifically produced for Manor House, the complaints and safeguarding policies and procedures, falls, managing residents monies and valuables and death and dying. The Policy on managing residents monies and valuables was reviewed on 20/06/08 to reflect the arrangements for holding residents’ money. Small amounts of money are held in the manager’s office. They and the assistant manager hold the keys. Records and receipts are kept of all transactions. People who choose to look after their own money have lockable cabinets in their rooms. The manager advised one person chooses to hold their own money in their purse in their handbag. Although there has not been any issues arisen at present from this arrangement the manager was advised to complete a risk assessment to minimise the risk of other people living or working in the home accessing their money. Food safety monitoring processes are in place, however these are not being kept in one place, the different monitoring forms are spread about the kitchen. The home has obtained a copy of the Safer Food, Better Business pack. A discussion took place with the cook and the manager about the benefits of using the pack to ensure all documentation is completed and easily accessible. The home has recently had an Environmental Health inspection. The report reflects the three recommendations were made to ensure the door on the hot holding cupboard is fixed to ensure it reaches a temperature of 63 degrees or above and for the seal on a chest freezer to be renewed. Evidence was seen at the inspection that action had been taken to address these recommendations. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 27 Staff files confirmed that regular supervision takes place. The documentation reflects that these sessions include discussion about achievements since last the last meeting, any problems, strengths and weaknesses are discussed, the individuals approach to job and areas of development and training needs. The home takes steps to safeguard the health, safety and welfare of people living and working in the home. Risk assessments are carried out for all safe working practices with significant findings recorded and the action taken to minimise risks occurring. The most recent Electrical Safety certificates, including Portable Appliance Testing (PAT) were seen and records showed that all equipment is regularly checked and serviced. The home does not have any appliances requiring a supply of gas, therefore there are no gas safety certificates. Certificates confirmed the passenger and stair lift have been serviced in line with the Lifting Operations and Lifting Equipment Regulations (LOLER). The fire logbook showed that the fire alarm, emergency lighting and fire fighting equipment is regularly serviced. Emergency lighting and the fire alarm system are tested weekly. However there was no record of regular fire drills taking place, although staff have received training. The manager advised that the trustees do not advocate regular fire drills as this upsets the routine of the home. This is a requirement of the Care Home Regulations 2001 that adequate arrangements are made to ensure by means of fire drills and practices at suitable intervals staff and people living in the home are aware of the procedures to be followed in case of fire. Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 28 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 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 X 3 3 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 3 3 X 3 3 3 2 Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 29 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. 1. Standard OP38 Regulation 23 (4) (e) Requirement Following consultation with the fire authority the registered providers must ensure by means of fire drills and practices at suitable intervals staff and people living in the home are aware of the procedures to be followed in case of fire. This will protect the health safety and welfare of people living and working in the home. Timescale for action 11/06/09 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 OP1 Good Practice Recommendations Information about the home should to be updated to reflect the change of organisation from Commission for Social Care Inspection (CSCI) to the Care Quality Commission (CQC) and change of contact details. DS0000024441.V375208.R01.S.doc Version 5.2 Page 30 Manor House Christian Rest Home 2. OP7 Senior staff should be provided with training to ensure they are competent to undertake needs assessments of new service users being admitted to the home. The passenger lift is of an old fashioned nature and consideration should be given to replacing this at some point in the future, with a more secure type of lift. 3. OP22 Manor House Christian Rest Home DS0000024441.V375208.R01.S.doc Version 5.2 Page 31 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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