Care Home: Manor Rest Home The

Similar services:

• Maple Lodge
• Heathlands
• Aston Court Nursing Home
• Breme
• Ravenhurst
• Bank House
• Inspirations
• Westmead

What the care home does well People have their needs assessed and they are offered visits and a trial stay before making a decision about moving in permanently. The home has a relaxed atmosphere and visitors are made welcome. People can choose how they spend their time and activities are being provided. People enjoy the meals and their choices are considered. People like the staff who support them and some staff have worked in the home for many years. People feel staff support them well with their daily care and health needs and that they are treated as individuals. The service provides support for people with mental health needs who have had difficulty accepting help in the past.Medication is safely managed. People`s concerns are listened to and any safeguarding incidents are appropriately reported and managed. Robust checks are carried out on new staff. The staff team feel well supported and trained. There is a stable management team who are very experienced. What the care home could do better: When someone`s health needs change records should show they have been given a choice about accessing their GP in a timely manner. Keyworkers could be more vigilant in ensuring that people`s bedrooms are fitted out to meet their needs and promote their independence. The service could be provided in a more person centred way that ensures interactions and involvement in daily routines in the home, thus promoting individual`s wellbeing and self confidence. The people who wish to should have regular opportunities to practice their life skills, such as cooking and doing laundry. People should be given regular opportunity to go into the community with support, if this is needed. This could result in them building up their self confidence and life skills. Recruiting male staff should be made a priority because of the potential benefits this could provide to the men living in the home. Senior staff should observe daily life experiences and review how the service can be more person centred and inclusive. Random inspection report Care homes for older people Name: Address: Manor Rest Home The Bullingham Lane Lower Bullingham Hereford Herefordshire HR2 6EP two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jean Littler Date: 1 4 0 6 2 0 1 0 Information about the care home Name of care home: Address: Manor Rest Home The Bullingham Lane Lower Bullingham Hereford Herefordshire HR2 6EP 01432274732 01432761466 thebarnoffice@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Julie Ann Minett Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Sheila May Nauth,Mr Narendra Nauth care home 23 Number of places (if applicable): Under 65 Over 65 0 0 23 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 5 23 0 The maximum number of service users who can be accommodated is: 23 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 23 Dementia (DE) 5 Mental Disorder, excluding learning disability or dementia 23 Care Homes for Older People Page 2 of 12 Date of last inspection Brief description of the care home The Manor Rest Home is situated on the outskirts of Hereford with easy access to local facilities, including public transport to the city centre. Parts of the house are Elizabethan and the building has been adapted and extended for use as a care Home over many years. In recent years the scope of care the Home sets out to provide has been narrowed and currently the Home caters primarily for people over the age of 65 who have needs relating to their mental health. Fees are individually assessed. Care Homes for Older People Page 3 of 12 What we found: We, the Commission, carried out this Random Inspection over six hours. No one in the home knew we were coming. We did not look at all the Key standards but sampled some records and looked at a snap shot of what was happening in the home that day. The last full Key inspection was carried out in September 2007. During the inspection we did the following things:- We looked at some of the most important records, such as, those about peoples care, medication and staff recruitment. We looked around the home and one person showed us his bedroom. We spent time in one of the lounges observing the afternoon routine and how people were spending their time. We spoke to some of the people about their lives and the support and care they receive. We spoke to staff and the manager about how the home is managed. Eight people living in the home and five health professionals returned surveys to us. Their views were positive about all aspects of the home. The manager, Julie Minnett, had sent information about the service to us before the visit in the Annual Quality Assurance Assessment. This told us what she thinks the service does well and what future plans there are. The manager explained in the AQAA that a detailed needs assessment is carried out before a place is offered to an interested person. She said trial visits are always offered so the person can see if they want to move in. There is up to date information about the service that is given to each new person and their representatives. People were obviously relaxed in the home and were deciding where to spend their time. Some were watching the world cup football, others used the smoking area regularly and some went into town or to appointments. Staff told us that activities are not usually planned in advance and that they see who is at home and decide what to do during their shift. They said they find some people hard to motivate, particularly the heavy smokers. There were no activities planned for that afternoon, however, a manicure session was held while it was quiet before the evening meal. Some of the women enjoyed this and it gave them quality time with staff. The manager reported in the AQAA that she intends to employ an activities worker and offer a wider variety of social opportunities to people in the home. The post had recently been advertised. She said currently visiting entertainers are arranged, some people go out to pubs and shops, and quiz, games and pampering sessions are held. Christian services are held at special times in the year. A summer BBQ was held and a Christmas fancy dress and coffee morning. Surveys returned to us indicated that people were satisfied with the activities provided. Staff told us that there is an open door policy in the home and some people go out into Hereford without staff support. Others are only able to go on short local walks Care Homes for Older People Page 4 of 12 unaccompanied. The location of the home means there is no local shop in easy walking distance. The recruitment of an activities worker is positive as it should enable the people who need support to access the community more often. Regular community access is vital for people who wish to maintain social links and life skills such as using public transport and shopping. The manager said in the AQAA that four meals a day are provided and that peoples meal preferences are established and added to the menu where possible. Feedback from people in the home indicated they were satisfied with the meals. A visitor expressed surprise that strawberries had not been offered yet, but the person she was visiting said he was not bothered about this and he liked the food. The meals observed seemed to be relaxed and sociable. The home was clean and there are a variety of seating areas for people to choose from. The AQAA showed that there was a programme of redecoration and replacement of equipment and carpets. For example some bathrooms had been refurbished and one now has an electric bath hoist. New carpets are due to be fitted in some communal areas. One man showed us his bedroom. This was large and arranged so he had a sleeping area and an area to relax. He said he was comfortable and that his privacy was respected. Some observations for potential improvements for him were noticed. His window was small but the lighting in his room was not bright enough to compensate for this. He had no mirror by his sink so he was having to wet shave away from the sink using in his wardrobe mirror. There was no direct light in this area. The deputy is his keyworker so these areas should be explored when they next meet. While observing the daily interactions we saw that staff carried out numerous tasks to run the home while people living in the home seemed to be, for the most part, passive recipients. Some people are elderly and frail and for them this may be appropriate. However, many people are younger and they are receiving a service because of their mental health needs. Being actively engaged and taking responsibility for daily tasks may raise their self esteem. Examples seen included; staff waiting on one man, who missed lunch because he was out shopping. The staff were very kind but did not get him involved in getting the food, his cutlery, sauces or a drink. He appeared physically able to be involved. He told us he was grateful and staff were very kind, but he does not have any opportunity to prepare food and is losing these skills. The kitchen is locked when staff have finished preparing meals so there is no direct access to hot drinks. The manager confirmed that no one is allowed to prepare food in the kitchen because of the risks and infection control concerns. Risk assessments should be personalised and take into account the potential benefits to people, their wishes around risk taking and the need to safeguard people from unreasonable dangers. A review of risk taking practices is recommended and consideration given to how people can be supported to live as normal a life as possible and maintain their skills. Some routines seem based on well established shift routines rather then on staff responding to peoples needs and promoting their involvement. For example, a woman said she wanted a cup of tea at 1.30pm. A worker reminded her that tea break was at 2pm. This person had not taken part in any activity after lunch and seemed to only have the next set activity to mark her day such as the medication trolley or the tuck shop trolley. She would have no doubt benefited from a few minutes of staff time to help her Care Homes for Older People Page 5 of 12 make her own cup of tea. Tea and coffee breaks were served from a catering trolley in large heavy pots. Staff did not encourage anyone to pour their own drinks or even add their own milk or sugar. The pleasant dining room could be used as a cafe, with people being supported to pour their own drinks and socialise. These routines should be reviewed and the service developed to be as personalised and therapeutic as possible. The medication management system was in order and clear records were being kept. The balance of the controlled drugs was correct. Some people are supported to administer their own creams but no one is assessed as being able to hold their own tablets in their bedroom. Peoples right to refuse their medication is respected. If this becomes routine the persons GP or consultant is informed. Feedback from health professionals, including three GPs was very positive. Comments included; The home is run well, the staff know people and their needs well; An excellent residential home. The management team are very professional, caring and competent. They deal with a variety of different situations. There is good communication with the mental health team. The culture is one of care and acceptance of peoples uniqueness and mental health needs and behaviours; The Manor is held in the highest regard. The care given to residents that can be very difficult is extremely good; I have a very challenging person living at the home and I find the service very supportive towards the person. The manager said peoples keyworkers update their care plans each month. They also summarise significant events whenever they are on shift. The records for one man were sampled. His plan had not been reviewed since March 10. The health section was not up to date with details of recent contact with health professionals. The manager said this was a performance issue with his keyworker that she had addressed. This persons care records showed that since he had been in the home he had been seen by health professionals including his psychiatrist and GP on several occasions as health needs arose. He had been seen by a chiropodist in March 10 and he had an eye test in Aug 09, indicating that routine check ups are being appropriately planned. He had complex needs and the daily notes indicated staff were providing him with a lot of time to support his person care need. He had been unwell recently and was admitted into a psychiatric hospital on the day of the inspection. He had seen his psychiatrist when he became ill and she had arranged for his hospital admission, however, there had then been a weeks delay for a bed to become free. It was our view that the mans GP should have been informed and requested to visit during this time. The manager was sure she had made the right decisions in the mans best interest. In future, records should show more clearly how people have been consulted about their health needs and wishes regarding treatment and better reflect the requirements of the Mental Capacity Act. It is positive that people are being consulted regarding their wishes about the end of their life. The manager said staff have been provided with training in palliative care to a level 3 standard. The manager told us that no physical restraint is being us. Support is accessed from the Community Mental Health Teams when necessary. When psychiatric appointments were delayed the manager advocated for people in the home by making a complaint on their behalf. Most staff are trained to respond to challenging behaviours. The manager said this training needs updating for some staff but this has been arranged. Care Homes for Older People Page 6 of 12 In the AQAA the home told us that they have received only one complaint in the last 12 months. The record showed the manager had taken this seriously and had resolved the issue promptly to the satisfaction of the person living in the home. We have not received any complaints about the service in the last year. A large print version of the complaints procedure is on display and people meet their keyworkers each month so they can raise any concerns in private. The manager has reported one situation to the Council Safeguarding team when she became concerned about the level of family pressures being placed on one person. Staff have been trained about how to safeguard people. The worker spoke to confirmed this and felt strongly that abuse would not be tolerated by the staff or management team. One new workers recruitment file was sampled and this showed that the required checks had been completed before the person started. The manager told us a robust induction is worked through with each new worker over their first six months. Feedback from staff confirmed that they felt well trained for their role. There have not been any changes to the management of the home since the last inspection. The manager was aware of recent and pending changes to legislation that affects the service. She has continued to communicate well with us and has made appropriate notifications about events that could or have affected the health, safety and/or welfare of people living in the home. The manager said she and the deputy often work providing direct care to people in the home. She feels this provides them with very clear information about the service people receive. Feedback on the service is requested directly in surveys and through keyworker sessions. These strategies are positive. Direct feedback can be affected if people have low self esteem and low expectations about the services they receive. It is now becoming recognised within the profession, that quiet observation over 1-2 hour periods, of how people using the service experience daily life, can help managers make positive changes to the quality of the service they provide. It is recommended that this type of review is added to the current Quality Assurance processes. What the care home does well: People have their needs assessed and they are offered visits and a trial stay before making a decision about moving in permanently. The home has a relaxed atmosphere and visitors are made welcome. People can choose how they spend their time and activities are being provided. People enjoy the meals and their choices are considered. People like the staff who support them and some staff have worked in the home for many years. People feel staff support them well with their daily care and health needs and that they are treated as individuals. The service provides support for people with mental health needs who have had difficulty accepting help in the past. Care Homes for Older People Page 7 of 12 Medication is safely managed. Peoples concerns are listened to and any safeguarding incidents are appropriately reported and managed. Robust checks are carried out on new staff. The staff team feel well supported and trained. There is a stable management team who are very experienced. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 Keep clear health records to demonstrate that decsions are being made in peoples best interest, in consultaion with them, and with regard to the Mental Capacity Act. The management team should review the risk taking practices and ensure there is a balance between safeguarding people and enabling them to live ordinary lives and take decisions (when they have mental capacity to do so) for their own level of risk taking. Review each persons bedroom facilities and ensure these meet their personalised requirements and promote their independence. Enable people to be offered regular access to the community with support if they need this to help maintain life skills and self confidence. Recruit male staff so men in the home have access to male support with personal care and other potential benefits such as a Mans Group. Senior staff should observe daily life experiences and review how the service can be more person centred and Page 10 of 12 2 14 3 24 4 27 5 28 6 33 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations inclusive. Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 12 of 12 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!