Care Home: Manor Park

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What the care home does well People tell us that they are happy in the home and well cared for by the staff. “Committed” and “caring” were words used to describe the manager and staff working there. They tell us they enjoy the food provided and “nothing is too much trouble” said one person. Staff have a good understanding of how to meet individuals’ physical and healthcare needs and they encourage people to maintain contact with relatives and friends. The home provides a warm, comfortable and homely environment for people to live in and they are treated with respect and their privacy is maintained. People tell us they are listened to and any issues or concerns are dealt with by staff and a manager who is approachable with adult protection procedures in place to ensure people are protected from harm. The home‘s recruitment practices are robust ensuring safeguarded from potential harm by staff caring for them. residents areManor ParkDS0000025632.V377730.R01.S.docVersion 5.2 What has improved since the last inspection? Since the last inspection the medication practices have improved so that the procedures are now more robust and people’s health needs met. More training has taken place so that staff have more skills and training to ensure people are safe and their needs met. The manager has developed a matrix to ensure there is an up to date record of training. A few requirements relating to the environment have also been met with some redecoration of individual rooms and hallway, the hot water failure remedied and the canopy to the front of the premises removed. What the care home could do better: The provision of information should be reviewed to ensure people have information in a format that is more suitable to their needs. The new system of assessment and care planning is currently being implemented and there are a few areas that need to be addressed to ensure they reflect fully peoples’ health, personal, social and physical needs. The manager and Provider are also reminded of the need to install a controlled drugs cupboard that meets the regulations. They need to ensure that people are provided with a more stimulating environment by providing more interaction, entertainment and activities. The systems in place for monitoring the care and supervising staff must also be improved to ensure a consistent standard of care is provided. The way in which peoples’ finances are managed must also be reviewed so that personal monies are safeguarded. They must also ensure that new staff are provided with core training in a more timely manner to ensure they are safe and competent to care and support people. Key inspection report CARE HOMES FOR OLDER PEOPLE Manor Park 55 Manor Park Lewisham London SE13 5RA Lead Inspector Wendy Owen Key Unannounced Inspection 4th September 2009 10:00 DS0000025632.V377730.R01.S.do c Version 5.3 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 Park DS0000025632.V377730.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 Park DS0000025632.V377730.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor Park Address 55 Manor Park Lewisham London SE13 5RA 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 852 2407 0208 297 9963 M & A Care Limited Mrs Sheila Ruby R Naik Care Home 13 Category(ies) of Dementia (4), Mental disorder, excluding registration, with number learning disability or dementia (1), Old age, not of places falling within any other category (13), Physical disability (1) Manor Park DS0000025632.V377730.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 13 persons of whom up to 13 may be elderly, up to 4 may have dementia, up to 3 may be elderly with a physical disability, up to 1 may have mental health problems and be over 55 years, up to 1 may have a physical disability and be over 55 years 4th September 2008 Date of last inspection Brief Description of the Service: Manor Park is a care home providing personal care and accommodation for thirteen people. It is owned by M&A Care Limited. The responsible person has two other partners in the company. The home is located near to public transport facilities at Hither Green and is less than ten minutes walk along a level road to a parade of shops. The home was opened in 1996 and consists of a large detached property set back from the road. There are three storeys and a basement used for staff facilities and some services for the home. There are nine single bedrooms and two sharing rooms. None of the rooms have en-suite facilities. There is a stair lift up one flight of stairs but there is another small flight of stairs to provide access to the first floor and another flight to the two rooms on the top floor. These rooms are no longer in use as it was recognised that they were difficult to access. There is an extensive garden to the rear of the building. Additional charges are made in respect to activities, hairdresser, transport if provided and other sundries such as toiletries and newspapers. Prospective service users and relatives are given information about the service on an initial visit to the home. It states in the service user guide that copies of CSCI inspection reports are available on request. At the time of the inspection the home was not fully occupied with eight residents living at the home. Manor Park DS0000025632.V377730.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 1 star. This means the people who use this service experience adequate outcomes. This was an unannounced inspection that took place over one and a half days. The registered manager was present when the inspection took place and was involved in the inspection process. The inspection included a tour of the home, looking at records, discussions with people living there, relatives, staff and the manager. We also had a conversation with the Provider. We could not consider the Annual Quality Assurance Assessment (AQAA) as we had not sent it out in time for them to complete it before the inspection visit took place. What the service does well: People tell us that they are happy in the home and well cared for by the staff. “Committed” and “caring” were words used to describe the manager and staff working there. They tell us they enjoy the food provided and “nothing is too much trouble” said one person. Staff have a good understanding of how to meet individuals’ physical and healthcare needs and they encourage people to maintain contact with relatives and friends. The home provides a warm, comfortable and homely environment for people to live in and they are treated with respect and their privacy is maintained. People tell us they are listened to and any issues or concerns are dealt with by staff and a manager who is approachable with adult protection procedures in place to ensure people are protected from harm. The home‘s recruitment practices are robust ensuring safeguarded from potential harm by staff caring for them. residents are Manor Park DS0000025632.V377730.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Manor Park DS0000025632.V377730.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 Park DS0000025632.V377730.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 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. Prospective residents and relatives have access to the information they need to make an informed decision about the home. Residents’ needs had been assessed prior to them moving into the home enabling staff to ensure appropriate care and support is provided. EVIDENCE: Each person has a copy of the Service User’s Guide which has been placed in individual rooms and in the entrance of the home. These documents are available to both residents and relatives. The information continues to be produced in written format. We commented on this at the last inspection indicating that, for many, it is difficult to read. It Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 9 would therefore be more useful to be developed in larger print, pictorial or other formats suitable to those living there to ensure people are able to understand them. We spoke to one person who was recently admitted. They told us they had visited the home with their family and that the manager had visited her whilst in hospital to ask about her care needs. They also told us that when she first came to the home she was made very welcome and was given information about the home and what to expect. She felt that the home “could do no more” in this aspect of her care. We viewed the personal files of two newly admitted residents and found that each person had been visited by the manager and their needs assessed so that they had the information they needed to make a decision on whether they were able to provide the appropriate care to them. Standard 6 is not applicable. Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 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 tell us they experience a good quality of care and the care they receive is good. However, a lack of key written information means that peoples’ needs may be left unmet. Health needs are met through access to appropriate healthcare professionals and sound medication practices. People living in the home are treated with respect and dignity and feel valued. EVIDENCE: Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 11 We spoke to three people living in the home and two relatives about the care provided. All of them expressed great satisfaction about the care being provided. One relative gave us this comment: “the home is quite run down but the quality of care, the commitment of staff, the quality of staff and the care given is second to none.” They went on to tell us that their relative’s “quality of life has improved” since moving into the home. Another relative told us that their parent would not be in the home if it the care wasn’t good. The care is “excellent” and the staff are “very nice people.” People living in the home told us they were happy with the care they received and the main comment was about the caring staff. The personal files of three residents were inspected. The way in which the information about peoples’ care needs are written has changed since the last inspection. The format now includes daily living assessments, followed by the care plan about how their needs are to be met. This system is currently being implemented so that there are still areas to be addressed. Those individual records viewed had an assessment of need in place. The assessment of need, if identifying a need, should then be transferred to a care plan entry that determines how staff are to ensure these needs are met. We found that there was some good information on the assessment which was person-centred and covered a number of areas. However, there were a number of gaps in the care planning and assessment relating to clear identified needs. A care plan would help support staff in ensuring the needs of the individual were being met. It was also evident that a number of assessed needs did not have a corresponding care plan entry, where one was required. For example, a person’s mental health needs had not been addressed nor had their nutritional/dietary needs. On another file the person’s diabetes had been identified but not the action to address their healthcare in respect of this. For instance, regular blood sugar checks, nail care and no care plan information to show how their other health needs are being met such as asthma, enlarged prostate or depression. There was also a lack of information under general medication. The manager told us that these are still a “work in progress” and that there are still areas to be addressed. There were good records in place about the way in which people accessed healthcare professionals, and at an early stage in their stay. In other areas there was sufficient detail about individual preferences on personal care and daily routines. We suggest care plans make it very clear about preferences for bathing or showering and how often. Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 12 Staff encourage individuals to be independent and to take responsibility whenever they can, for their own personal hygiene. When we spoke to three people they told us that they have the assistance and support they need in meeting their personal care needs and that whilst the written information is lacking this is not reflected in the care received. We noted that the evidence relating to attending to personal care needs was quite mixed. Whilst some people enjoyed regular baths or showers others appeared to have, less than adequate arrangements, in place. This aspect of their care or the way in which is recorded should be reviewed. There were some details on social care needs and the home had completed life review forms with residents and relatives to gather more information about residents’ interests, hobbies and other information relating to this area. We would also strongly recommend that the care plan detail how individuals’ monies are managed and responsibilities for this. This ensures individuals’ monies are protected and risk of financial abuse minimised. The care plans had been signed either by the resident themselves or a relative, on their behalf and shows some involvement in the delivery of care to meet the person’s needs. The last inspection required all residents to have a falls risk assessment completed and reviewed. We noted that this requirement had been met, although these should be developed as soon as possible after admission. There was evidence of some risk assessments, such as nutritional screening and moving and handling but this was variable. We also recommended at the last inspection that a pressure sore risk assessment is developed although this has not yet been addressed. We noted records relating to individuals’ weights which showed no issues regarding this aspect of their care. Where residents were assisted with toileting it was observed that their privacy was always maintained and discussions with people living there confirmed this. They told us about staff knocking on their door before entering and that personal care took place in private. It is, however, clear from observations, responses in surveys and discussions with people living there that they enjoy care which meets their individual needs and which is provided in a relaxed and homely environment. Interactions between care staff and residents were respectful and caring ensuring people felt relaxed and comfortable. Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 13 As part of the inspection we inspected the medication practices in the home and looked at other evidence such as pharmacy audits to make judgements about whether this aspect of their care was safe. Medication is stored in a lockable medication trolley which is then kept within a locked store cupboard. The keys are held by the senior on duty. We looked at all the individuals’ medication records and made checks against the medication in stock. We found the practices to be of a good standard and areas that required improvement at the last inspection had improved. Some areas found to be improved at this inspection, included liaising with the GP to change some administrations where people are not taking the medication regularly to PRN. Only one of the medication records did not show the date of receipt in the home. The training matrix recorded a number of staff receiving medication training with five staff currently studying a distance learning course with a college. We would also advise the manager to complete assessments relating to residents ability to self medicate as recommended at the last inspection. This will show they have considered the person’s independence in this aspect of their care. The manager audits medication and records the findings, as does Lewisham PCT. The last report showed there to be a good standard of practice with a few minor areas of improvement required. This includes recording GP specific instructions/directions for administration of “as required” medication and how to write PRN medication. Whilst there are currently no controlled drugs (CDs) prescribed the manager was made aware of the need to provide appropriate storage for this medication. Currently the arrangements are to store medication in a locked cupboard attached to a wall within the locked store cupboard. However, there are specific requirements for this and the manager must be prepared for this storage to be in place as any residents could be prescribed such medication this by the GP. Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 14 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities and interactions are limited therefore reducing stimulation and restriction in improving the individual’s overall well-being. People are encouraged to keep in touch with their friends and family. People enjoy homely food that is nutritious, healthy and varied. EVIDENCE: The last inspection commented on the improvement that had been made in provision of activities. However, it appears that this improvement has not been sustained. Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 15 We were told by the majority of people spoken to that the provision of activities and stimulation could be improved. There is no dedicated staff involved in this area and whilst we were told that afternoon staff provide some activities, this does not appear to be working as well as it should be. People still tell us they need stimulation and interaction on a day to day basis as well as the occasional entertainment of external activity. During our visit over one and a half days we found little activity or stimulation apart from the last afternoon some residents enjoyed a manicure. People can attend a church service provided by a minister visiting the home and they also enjoy the services of the hairdresser who visits regularly. There is clear evidence from residents and relatives that staff encourage and support residents to maintain relationships with family and friends and that these visitors are welcomed by staff. One resident told us about their regular visits from a number of friends and being able to enjoy their company in the privacy of her room. We noted that the care plans showed details of the routines people preferred such as retiring at night and we observed individuals walking freely around the home or spending time in their rooms when they wished to. Personal possessions have been brought in to make people’s rooms more homely and bring some familiarity. There is a four -week rolling menu that offers a good variety of meals that are well balanced and nutritious. The cook asks the residents each day what they would like from the choices on offer. However, one resident told us that there were no choices but were happy with the food provided. We observed the lunch-time meal taking place and spoke to people during the meal. Those spoken to enjoyed their meal and those others observed appeared to be enjoying their as most of the plates were left empty. Drinks were offered throughout and people were assisted to eat their meal. We would suggest, however, that due to the frailty of some of the residents and the support required the manager look at the staffing available during this time. We spoke to a resident who was admitted to the home the previous day and they told us, when asked about the food, that they had “a lovely lunch yesterday”. A relative told us how much their family members’ health had improved since moving in and that they had put on much needed weight. Light snacks and refreshments are also available and in the evening, biscuits, sandwiches and hot drinks are also available. Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 16 Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 17 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. Peoples’ concerns are listened and responded to in order to improve the care for those living there. Measures have been taken by the home to ensure residents are protected from abuse. EVIDENCE: A copy of the complaints procedure was seen located in the entrance hall of the home along with the Service Users’ Guide. It is not immediately visible to visitors, staff and people using the service, so a more prominent location would make it more accessible. It would also be beneficial to produce this in larger print for those with visual impairment or provided in other formats for those not able to understand the written word. It is simply written and includes all the necessary information about the stages and timescales within which complaints will be dealt with. Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 18 Any complaint made is recorded in the home’s complaints log. However, no complaints have been made since the last inspection nor has the Commission received any information that raises concerns. We spoke to two people who live in the home and they told us that they had “no problems” and that they knew who to speak to if they had any concerns. They felt that the staff and the manager were approachable and very helpful. A comprehensive policy and procedure on adult protection is available for staff to provide guidance and information on how they can protect people living in the home. We looked at the training matrix and spoke to staff about their understanding of adult protection. The training matrix which showed 8 out of the 11 staff have received training or guidance in this area in April 2008. They must ensure that all staff have an understanding of their role. We spoke to two members of staff. Both had a basic understanding of adult protection. One member of staff told us about her role in raising such concerns in a previous job and so whilst not being fully aware of the terms had followed procedures. We would expect staff to be aware of the role of other agencies in protecting people living in the home and the discussions we had showed this was not the case. There had not been any adult protection investigations carried out in relation to the home since the last inspection. We have commented in the management and organisation standards on the way people’s personal finances are managed. Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 19 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): 19,20,21,23,24,25 & 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a homely environment that is clean and generally comfortable and adequately furnished. EVIDENCE: Manor Park provides a homely and comfortable environment for residents. There are still some areas that need to be improved such as the redecoration of the bathroom where the new suite has been fitted. Until the decoration has been completed it is not fit for use and limits the number of bathrooms in use. Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 20 However, there are a sufficient number of bathrooms located throughout the home. Some bedrooms have been redecorated with new flooring placed in one of the ground floor bedrooms. External access has been completed but there is a lack of finishing touches to this, as well as the patio area still being uneven. We also noted that the canopy at the front entrance that needed some repair has been removed. We would expect, under the Disability Discrimination Act, there to be some work to be undertaken to ensure access to the front entrance. Inside the home there is a chair lift to the first floor, with five stairs to the second floor that is currently not in use due to access issues. There is currently no signage to inform people of the location. Communal space within the home is sufficient with a large, bright and spacious lounge and a separate dining area. Furnishings are comfortable and domestic in character. The rear garden is large and generally well maintained and can be accessed via French doors from the dining room. There is an area with decking and also a sheltered area where residents can sit away from the sun. This is the area where the patio is quite uneven. The home has a sufficient number of toilets and washing facilities for residents even with the out of use bathroom at the top of the home. The ground floor bathroom, shower room, wc is the most used especially as this is the only wc on the ground floor and a number of people spend their day time in the lounge. The water supply has now been restored to this bathroom. People’s bedrooms were generally of a good size, although one person felt their room was too small and was looking forward to moving to a larger room. People spoken to told us they were comfortable in their rooms and had the furnishings they required. They also had the opportunity to bring in their own possessions. The home was clean and hygienic and free from any offensive odours. Visitors are expected to use the anti bacterial hand-wash as they enter the home to minimise risks of infection. The kitchen which had been newly refurbished since the last inspection and on touring it we found it to be of a good standard. We also noted that they had a three star rating of good from the Environmental Health Officer. Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 21 As we toured around the home we found fire doors in place with “dorguards” to ensure they closed in the event of a fire. However, some of the doors throughout the home are held open by other objects such as a bottle of water, and whilst these doors are protected by fire doors it would be beneficial to fit “dorguards” to these for ease of access for residents. Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient numbers of staff with the skills and competency to care for people living in the home. However, there is a need to review the involvement of the manager in the care staff roster. Recruitment practices are robust and protect people from the employment of unsuitable staff. There is adequate training for staff, although a lack of timely training for new staff in core areas means that there are risks to people’s safety and well-being. EVIDENCE: On the first day of the inspection we found the manager on duty with one member of care staff and cook/domestic. We viewed the home’s rota and found that this was quite usual with the manager working care shifts regularly. We commented on this at the last Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 23 inspection and make further comments in the management and administration outcome group. There are always two care staff that work during the day and early evening with one care worker sleeping in and one who does a waking night. We spoke to five people living in the home all of whom told us that the care staff are “lovely” “caring” “very good” “so sweet” “very gentle”. The interaction between staff and residents was respectful and caring and they appeared to understand their needs very well. Discussions with staff showed there to be a good spirit of team working and supporting colleagues and this reflects in the way care is provided. Currently, all but three staff, have achieved NVQ 2 or above, and two of these are registered to undertake the award. Since the last inspection the home has recruited one member of care staff who started employment in May 2009. The recruitment records of this member of staff was checked and we found the necessary checks had been completed and documents and information required by Regulations held by the home. Discussions with this member of staff confirmed the recruitment practices. We looked at the staff training matrix which had been developed since the last inspection, viewed training records and talked to staff about the training they had received including the induction training for new staff. The training matrix and discussions with staff show core training now takes place. However, we are still concerned about the delay in training new staff, particularly in this instance where the staff member has not received the training in previous employment. Whilst they had a basic knowledge of fire, accident and adult protection procedures the lack of formal training in these areas places vulnerable people at risk to their health, safety and well-being. It is positive to note that they have taken on board comments made at the last inspection that medication training is provided by an accredited trainer with a number of staff registered with a college providing distance learning. There was evidence that the new care staff was in the process of completing the induction work booklet that is used by the home and meets with Skills for Care specifications. Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 24 Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 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): 32,33,35,36 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an experienced manager in place to ensure the safety of those living there and the quality of care is monitored through various systems but the lack of regularity means the service may not be as consistent as it should be. The way in which peoples’ finances are managed must be reviewed to ensure they are safeguarded. EVIDENCE: Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 26 The registered manager has relevant experience to be able to run the home effectively but does not yet have the qualification required by the Commission. At the last inspection she told us that she was is in the process of completing the Registered Manager’s Award (RMA). However, this has not been followed through, although she is currently undertaking a foundation degree in care management. She may wish to check that this will provide her with the desired qualification required by the Commission to manage a care home. The previous staffing outcome group comments on the manager working as part of the staff team for two shifts per week. She then works the remainder of the week on management duties as well one hour after her shift ends. Whilst the home does not have a high number of service users, management duties remain the same for all homes. Trying to work as a carer does give the manager an insight into what happens in the home but it also places her in a difficult situation where complaints may be made against her and also restricts the time spent on management duties such as monitoring. We found that there were issues trying to keep pace with changes and keeping up to date with the monitoring required to ensure the service is consistent as well as safe. There are systems in place to ensure procedures are being implemented and to monitor the quality of care provided. Care planning, finances, health and safety and medication audits are taking place, although these are not as up to date as they should be. For example the last audit on care plans was during April 2009; medication May 2009; health and safety May 2009 and the audit of the kitchen in August 2008. We commented at the last inspection that this may restrict the capacity to continually improve the care and provide a good or even excellent service. The Provider told us they felt the management time was adequate and that they would ensure the operational manager would support her more. However, the manager is the person registered to manage and it is clear they want to undertake more management duties but the allocated time restricts this. We looked at the monthly monitoring visit reports and found that these were now taking place more regularly than previously although consistency is still an issue. We also commented that the lack of a computer with internet access restricts the manager’s ability to keep up to date with practice and to deal with information and communication efficiently and effectively to move the service to a higher level. She continues to be reliant on the Provider for this information. For example an AQAA could have been downloaded and completed rather than rely on the Provider to do so. These resources are needed to be motivated and self-directed Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 27 There is evidence of staff supervision taking place with the manager supervising all staff. Some of this is group supervision covering a particular topic and would be seen as training rather than supervision. Some of the individual supervision for care staff is not as regular as it should be. Records viewed showed staff having formal supervision approximately four times a year on average rather than every six weeks as the standards state. The supervision form is used to discuss a list of issues and is not ideal for a two-way discussion. The manager should consider changing this to reflect the principle behind supervision. We would also expect there to be some record of formal supervision for the new staff member who started working in the home in May 2009 and for ancillary members of staff. There were no records either in the supervision file or the individual’s personal file. Staff spoken to all felt the manager was “hands on” and very supportive of staff and whilst formal supervision may not be in place for all regularly the staff are managed informally. It is the striking of the balance of being “hands on” to monitoring objectively that is needed. The home manages the personal allowance for all residents living at the home and there are procedures in place to ensure these are effectively managed. Each resident has a book in which all transactions are recorded and receipts are also kept. Fortnightly audits of residents’ finances are carried out. However, we noted that the Provider is co-signatory on two individuals’ accounts. The way this money is managed needs to be much clearer to ensure there are safeguards in place for ensuring the safety of these. In one account the Local Authority used to pay money directly to the individual and now pays the monies into the Provider’s account, who then gives the manager some spending money each month. In the second case the manager spends money from petty cash and requests the money from the Provider. It is not clear where the Provider gets money from, how much and how this is audited. This must be made clearer. Care plans must show how such monies are managed including who has Power of Attorney, acts as a guarantor etc and show in the home clear records for the receipt of the person’s monies and records of expenditure relating to their “accounts”. We viewed the records of the monthly health and safety checks and sampled maintenance records. There were up to date maintenance certificates in place for gas, portable electrical appliances, hoist and fire alarms and equipment ensuring the health, safety and welfare of residents. Fire alarm call points had been tested weekly and regular fire drills had been carried out. Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 28 There was adequate insurance in place and the certificate of registration was on also on display. Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 29 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 2 x 3 3 3 n/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 X 2 2 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 x 2 2 x 3 Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 30 Are there any outstanding requirements from the last inspection? yes 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 2 Standard OP1 OP12 Regulation 4&5 16 Timescale for action They must provide information in 01/01/10 formats that are more suitable to the people living there. The provision of activities and 01/01/10 stimulation must be improved to improve the overall wellbeing of the individual. The way in which personal 01/12/09 finances are managed must be made clear with the systems in place for auditing of these made available to ensure there is transparency and peoples’ monies protected. Training must be provided for 01/12/09 new staff to ensure they are safe and competent to care for the individual. Supervision must take place 01/12/09 more regularly and include ancillary staff. The systems in place for 01/12/09 monitoring and auditing the quality of care must be more consistent. A controlled drugs cupboard 01/03/10 must be installed that meets the regulations Requirement 3 OP35 17 4 OP30 18 5 6 OP36 OP33 18 24 7 OP9 13 Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 31 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 OP16 Good Practice Recommendations The complaints policy should be produced in other formats that are suitable for residents, relatives and any other visitors. Individual assessments with new service users should be carried out on whether they can take responsibility for taking their own medication and this is recorded. Risk assessment should be developed in relation to risks of pressure sores and nutrition. Minutes of residents meetings should include the action to be taken and by whom in response to issues raised. We strongly recommend that the home is provided with a computer and internet access. 2. OP9 3. 4. 5. OP8 OP14 OP37 Manor Park DS0000025632.V377730.R01.S.doc Version 5.3 Page 32 Care Quality Commission Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.london@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. 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