Care Home: Manor (The)

Similar services:

• Henry Nihill House
• Birchwood
• The Infirmary
• Orchard House Nursing Home
• St Josephs Rest Home
• Red Court Nursing Home
• Spinney (The)
• Queen Elizabeth House

What the care home does well The service has increased the number of residents living in the home since the last inspection, some of whom have a diagnosis of dementia, and the registered manager and her staff are working hard to meet residents` differing needs and preferences, which residents and their relatives appreciate. The home has increased the numbers of staff available to meet residents` needs and the provider organisation is demonstrating a commitment to staff training and development as part of this process. During 2007 the building was closed for significant refurbishment and provides a comfortable, safe and homely place for people to live in. What has improved since the last inspection? At the last inspection seven requirements were made and I was pleased to see that all of these had been complied with. The requirements were in the following areas: preadmission assessment information including the religious, social and cultural needs of people; care planning; same gender care provision; providing meals that meet people`s cultural and religious needs; staffing levels; staff training and for the provider organisation to ensure that the registered manager had sufficient resources to carry out her delegated tasks. What the care home could do better: At this inspection six requirements are made in the following areas: timely referrals to the district nursing service; more individualised activities; a further improvement to the home`s procedures on keeping people safe; facilities to assist people keep their personal possessions safe and two areas relating to health and safety. A good practice recommendation is also made regarding further staff training to help people living at the home make as many decisions for themselves as they are capable of. The registered provider, the registered manager and the staff team may wish to refer to the Commission`s Key Lines of Regulatory Assessment (KLORA), to consider how they may further enhance the overall quality of care in the home. CARE HOMES FOR OLDER PEOPLE Manor (The) 110-112 Hainault Road Leytonstone London E11 1EH Lead Inspector Peter Illes Unannounced Inspection 15th April 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor (The) Address 110-112 Hainault Road Leytonstone London E11 1EH 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) 020 8539 2011 manager.manor@aermid.com www.aermid.com Aermid Health Care Limited Norma Guadalupe Dimaiwat Care Home 17 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (17) of places Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 - Code OP 2. Dementia, over 65 years of age - Code DE(E) The maximum number of service users who can be accommodated is: 17 3rd December 2007 Date of last inspection Brief Description of the Service: The Manor is a care home registered to provide care, support and accommodation for 17 older people, who may also have a diagnosis of dementia. The home is owned and operated by Aermid Health Care Limited, which provides a range of care services nationally. The premises consists of two converted adjoining residential houses. Accommodation is provided on two floors that are connected by both stairs and a lift. The accommodation consists of 17 single rooms, 7 with en suite facilities. The home also has a range of adapted shower, bath and toilet facilities on both floors. The main communal areas are a large lounge/ dining room and a smaller quiet lounge. The rear garden has a large grassed area, with a patio and garden furniture. The home is situated in Leytonstone with good transport links to local shops and facilities. A stated aim of the home is to provide people that live there with a secure, relaxed and homely environment in which their care, well-being and comfort is of prime importance. The provider organisation must make information about the service, including CSCI inspection reports, available to people living at the home and other stakeholders. The current weekly charge starts from £550, depending on the assessed needs of the person. Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Since the last inspection the Commission has agreed a variation to the home’s conditions of registration that involved reducing the number of people the home can accommodate from nineteen to seventeen and to increase the number of people who may have a diagnosis of dementia from six to seventeen. This unannounced key inspection took approximately six and a half hours with the registered manager being available throughout. There were fourteen people accommodated at the time and three vacancies. The inspection activity included: meeting and speaking with the majority of people living in the home, four of them independently; detailed discussion with the registered manager; independent discussion with three care staff; independent discussion with the home’s chef; discussion with an operations manager and a human resource (HR) manager that both visited the home during the inspection; independent discussion with a district nurse who visited the home during the inspection; independent discussion with a relative that visited the home during the inspection; a brief discussion with officers from the London Fire Brigade who visited the home during the inspection and independent discussion by telephone with an operational manager from the L.B. of Waltham Forest older people’s services. Further information was obtained from: an Annual Quality Assurance Assessment (AQAA), submitted by the home to the Commission in March 2008; a tour of the premises and documentation kept at the home. What the service does well: The service has increased the number of residents living in the home since the last inspection, some of whom have a diagnosis of dementia, and the registered manager and her staff are working hard to meet residents’ differing needs and preferences, which residents and their relatives appreciate. The home has increased the numbers of staff available to meet residents’ needs and the provider organisation is demonstrating a commitment to staff training and development as part of this process. During 2007 the building was closed for significant refurbishment and provides a comfortable, safe and homely place for people to live in. Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Manor (The) DS0000042130.V361690.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 (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has up to date information about the services it provides so that people can know what to expect from the home. The needs of people seeking to live at the home are assessed and, once admitted, their needs are reviewed to help staff in continuing to meet their current needs. EVIDENCE: On the 4th April 2008 the Commission agreed a minor variation to the home’s conditions of registration that the registered provider had applied for. This involved reducing the number of people the home can accommodate from 19 people to 17 and to increase the number of people who may have a diagnosis of dementia from 6 to 17. The home had a satisfactory statement of purpose and service user guide that were seen. The registered manager is in the process of amending both documents to include the recent changes in Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 9 registration. Both documents gave both people living in the home and those considering doing so clear information about the services provided. At the last inspection the home was only accommodating two people following a closure period for refurbishment. At this inspection the home was accommodating fourteen people, five of whom had been admitted to the home in the previous week. The last five people that had been admitted was due to the planned closure of a nearby L.B. of Waltham Forest local authority registered residential home. An operational manager from L.B. of Waltham Forest older people’s services, who had been involved in the transfer arrangements was spoken to independently by telephone and stated that in her opinion the move had gone well. She also stated that two of the five people were quite close and wanted to move together, she went on to say that the home had made sure that the two people had rooms close together to assist them feel more comfortable during the moving in process. At the last inspection a requirement was made that the registered persons must ensure that during the initial pre-admission assessment the religious, social and cultural needs of the residents are clearly identified. Evidence was seen that this requirement is being complied with. The files of five people were inspected, three relating to people that had recently transferred from the local authority home and two others for people that had been admitted from the community since the last inspection. All five files contained a range of external assessment information that had been made available to the home prior to the person’s admission, including specialist medical assessments where appropriate. The files also contained information from pre-admission assessments undertaken by the registered manager prior to the individual moving into the home. The assessment information was seen to include information about the person’s religious, social and cultural needs. A relative of a sixth resident, who had been admitted from the community since the last inspection, visited the home during the inspection and was spoken to independently. The relative indicated that they had been involved in the initial assessment process and had been asked to sign the documentation to confirm they agreed with the information. The relative also stated that they had been invited to, and had attended, a review meeting at the home six weeks after the person had been admitted to discuss how the person was settling in. The relative stated that to date they were satisfied with the care provided by the home and was pleased that more people had been admitted recently to provide more company for their person. The home does not provide intermediate care. Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from having their needs and preferences properly recorded on their care plans, which include guidance to staff on how to meet these. People are generally well supported regarding their health care needs with access to a range of healthcare professionals although planning for this for new residents needs to be more consistent. Satisfactory medication policies and procedures are in place to safeguard people living in the home. People are treated with respect and dignity by staff, which they and their relatives appreciate. EVIDENCE: At the last inspection a requirement was made that the registered persons must ensure that care plans are more specific with regard to the recording of the religious and cultural needs of the individual. At this inspection the care plans of five residents were inspected. The requirement was being complied with including care plans specifying, where appropriate, people’s needs in Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 11 these areas including food preferences, support needed with culturally appropriate personal care and some guidance for staff on how to communicate with residents for whom English was not their first language. Evidence was seen that relatives of one person from an ethnic minority background had been involved in a recent review and had signed the records of the meeting. The registered manager stated that the relatives were being very helpful in assisting staff to further understand and meet this person’s cultural needs. The care plans seen were broken down into relevant areas relating to the person’s assessed needs and gave guidance to staff on how to meet these needs. The three files inspected relating to people that had recently transferred from the local authority home also contained a copy of the care plan from that home that was current at the time of transfer. The home reviews and evaluates care plans at least monthly and evidence of this was seen on the plans for people that had lived at the home for some months. Evidence was seen that people living at the home are registered with a G.P. and evidence of appointments with G.P.’s were seen for people that had lived in the home for a number of months. Evidence was also seen that people are supported to attend appointments with relevant healthcare professionals including a dentist, optician, hospital outpatient appointments and the district nursing service. A district nurse visited the home during the inspection and was spoken to independently. The district nurse stated that she was currently visiting the home daily to give insulin injections and that she felt the care of people was generally good and that the staff were helpful when she visited. However, she did state that recently the district nursing service had not been informed in advance of the needs of some of the newer residents. She continued that this had been problematic as she had only become aware of those people’s medical needs when she arrived and found them admitted. A requirement is made that the registered persons must ensure that prompt referrals are made to the district nursing service, including as part of the preadmission assessment process for new residents, where input from this service is required in order to meet residents identified health needs in a timely manner. Evidence was seen on files inspected of up to date risk assessments regarding nutrition, moving and handling, risk of falls, continence and pressure sore prevention and that these were being reviewed on a regular basis. Staff spoken to independently were able to describe people’s needs, including potential risks, and day to day actions they may take to address these. Records were seen to evidence that residents were being weighed on admission and then generally on a monthly basis with fluctuations in weight being monitored and action taken accordingly. Staff spoken to confirmed this. The home has a medication policy that was seen located within the medication cupboard. One resident was able to administer their own medication and records relating to this were seen and were satisfactory. This person was spoken to independently and confirmed that this was their choice and they Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 12 were happy with the arrangements agreed with the home in relation to this. Each person’s file inspected had a medication profile that was up to date and included a photograph of the person. Three people’s medication and medication administration record (MAR) charts were inspected and were accurate and up to date. Records of medication received into the home and medication disposed of were seen and were up to date. Evidence was seen from both the annual quality assurance assessment (AQAA) and staff training records that staff that administer medication had received training to do so. Staff spoken to confirmed this. The regulations regarding the safe storage of controlled drugs in registered care homes have recently changed and new professional guidance to care providers was issued by the Commission in January 2008. This can be found on CSCI Professional, the Commission’s website for care providers. The change in regulation means that now, if a care home stores any controlled drugs they will need to obtain a controlled drugs cupboard, which meets the required specification, in which to store them. The home currently does not have any residents that are prescribed controlled drugs, however it did not have a controlled drug’s cupboard at the time of this inspection. The home will need to fit such a cupboard should any new or existing resident be prescribed controlled drugs in the future. Following the end of the inspection activity the registered manager informed us that a controlled drug cupboard had been ordered. At the last inspection a requirement was made that the registered persons must ensure that residents wishes and feelings are taken into account and clearly recorded in respect of same gender care provision. At the time of the last inspection their were only two people living at the home and staff numbers at the time reflected this which limited options with regard to choice regarding gender of carer, especially at night time. At this inspection the registered manager was working hard to comply with this requirement and there were more staff employed by the home including an appropriate gender mix. People’s preferences regarding how their personal care was delivered was recorded on their care plans and evidence seen that the home was endeavouring to meet these. Staff were observed interacting with residents in a positive, relaxed and friendly way. It was noted that on occasion staff were spending time with individuals, especially in trying to generally reassure some of the newer residents who were still in the process of settling in to their new home. Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from a range of leisure and recreational activities that they enjoy although more work is needed to ensure that people’s differing needs and preferences are being properly addressed in this area. Relatives and other visitors are made welcome at the home, which they and people living there appreciate. People are encouraged to exercise as much choice and control over their lives as they can to maximise their independence. They are also provided with a range of healthy and nutritious meals that they enjoy. EVIDENCE: Residents’ interests are recorded in their care plans and there was evidence of activities provided daily within the home. A group of more able residents were observed enjoying a game of dominoes during the morning of the inspection. A member of staff led a karaoke session in the afternoon, with residents with a range of abilities seen to be enjoy this. The home has recently installed a large plasma screen television and the karaoke was being played through that. The Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 14 registered manager stated that recently children from a local school had visited the home and that residents enjoyed this. A letter of thanks was seen to evidence this. The home also records on residents’ files the activities that individuals take part in each day. Evidence was seen that staff are working hard to identify and support residents regarding their cultural, religious and sexual needs and that equality and diversity is generally promoted by the home. People from different of ethnic minority backgrounds stated that they felt comfortable in the home. However, with the recent increase in the number of residents, further work is now needed to provide a more individualised range of social and recreational activities that meet the differing dependencies, needs and interests of the people now living in the home. Although staff were seen working hard, including interacting with more dependent people, in my judgement those more dependent people would benefit from opportunities for more focussed and personalised stimulation and activity, especially those with a diagnosis of dementia. The registered manager and the operations manager both acknowledged that there was further work to do. They went on to state that active consideration was being given to employing an activities coordinator to work in conjunction with staff in this home and in another of the provider organisation’s homes located nearby to further promote this. Given that most resident vacancies in the home have now been filled, that the home is now registered to accommodate more people with a diagnosis of dementia and that the abilities of the current residents differ significantly from each other, a requirement is made regarding the home providing more varied and personalised activities. The registered persons must ensure that a varied and personalised range of social and leisure activities and opportunities are available for all residents, both inside and outside of the home, in order to meet people’s individual needs and preferences. The majority of the residents have some contact with relatives and friends. The home’s service user guide states that visiting times are kept flexible and that open visiting is encouraged, it goes on to state that residents may entertain visitors in the privacy of their room or in the public areas of the home. Residents and a visiting relative spoken to independently confirmed this. Evidence was also seen from the home’s visitors’ book that numbers of visitors attend the home most days. The relative that was spoken to independently stated that they were always made welcome when they visited the home, was offered a drink and that the staff were polite and friendly. The manager confirmed that the home was not the appointee for any of the residents but did look after personal allowances for most of the residents. The personal allowance system for one resident was sampled. This was satisfactory with an individual and up to date record of money held and spent, the person’s money kept in an individual wallet with the amount corresponding to the record and that all the residents’ individual wallets were kept locked in the office. One more independent resident confirmed that they were able to manage their own finances, however a requirement is made regarding this in the Environment section of this report. During a tour of the building it was Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 15 noted that residents could and did bring their personal possessions to the home and residents spoken to confirmed this. At the last inspection a requirement was made that the registered persons must ensure that the religious and cultural dietary needs of all residents are catered for and reflected in the daily menus. At that time the home had just reopened after a period of refurbishment, had only two residents and the main meal was being prepared by another of the provider organisation’s registered residential homes, situated nearby. The home has recently employed its own cook who was spoken to independently. There is a clear menu in place that the cook and registered manager stated reflected residents’ preferences and there are two options for each main meal. The menu’s seen contained some options to meet the wishes of people from ethnic minority communities e.g. lamb korma with rice. The registered manager and the new cook stated that they were aware of the need to keep the menus under review and continue to develop these, especially given the differing needs and preferences of the people that have recently been admitted to the home. People spoken to stated that they enjoyed the food served by the home and staff were seen to be assisting those residents that needed this in a friendly and relaxed way during lunch on the day. Food was seen to being stored appropriately and a range of satisfactory health and safety records relating to the kitchen were seen. Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has satisfactory procedures for dealing with concerns and complaints and people living at the home felt confident that any issues raised would be properly dealt with by the home. Residents are also protected by the home’s safeguarding adults policy and procedures that the registered manager and staff are familiar with. However, the home needs to ensure it is aware of the local authority’s procedures should a safeguarding issue be identified, in order to maximise protection to both residents and staff. EVIDENCE: The home has a clear complaints procedure that was seen, including in the service user guide and displayed in the entrance hall to the home. There had been no complaints recorded at the home since the last inspection and none had been received by the Commission in that time. People spoken to indicated that if they raised any issues with the staff these were dealt with promptly and to their satisfaction. They also stated that they felt confident that if they had a more serious concern that the registered manager and staff would deal with this appropriately. The home had a detailed safeguarding adults policy that was seen. The registered manager and staff that were spoken to independently were able to Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 17 describe appropriately the actions that would need to be taken if an allegation or disclosure of abuse was made. Records showed that staff had undertaken safeguarding training and those staff spoken to confirmed this. However, the home did not have a copy of the L.B. of Waltham Forest’s Safeguarding Adults policy. Given that the L.B. of Waltham Forest is the local authority that the home would need to inform if a safeguarding issue was identified this policy and procedure is needed in the home. This is to ensure that any referral or notification is made in a timely and appropriate way to the relevant local authority social work team. A requirement is made that the registered person must ensure that a current copy of the L.B. of Waltham Forest’s Safeguarding Adults policy and procedure is available in the home and that the home’s own policy and staff training programme in this area is reviewed to ensure they are consistent with the Borough’s policy. This requirement is made to maximise protection for residents and staff at the home. No safeguarding issues had been recorded by the home or reported to the Commission since the last inspection. Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 & 26. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is well decorated, well furnished, well maintained and that meets their needs. However, an improvement is needed to maximise residents’ ability to keep their private possessions safe. The home was clean and tidy throughout creating a pleasant environment for people accommodated, staff and visitors. EVIDENCE: A tour of the building was undertaken as part of the inspection activity and it was noted that a significant refurbishment of the building had been undertaken in 2007. Accommodation is provided on two floors that are connected by a staircase and a lift. There are seventeen single bedrooms, seven of the bedrooms have en-suite facilities and all have washbasins. The rooms seen Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 19 were well equipped and decorated, had personal call bells and had been personalised according to the wishes of the people living in them. People spoken to during the inspection stated that they were happy with their bedrooms. The home has a new walk-in “wet room” shower/ toilet and an additional accessible toilet on the ground floor and two bathroom/ toilets and a separate toilet on the first floor. The registered manager stated that it was planned to convert one of the first floor bathrooms into a “wet room” within the next twelve months. Appropriate aids and adaptations were in place throughout the building to assist people with limited mobility. The home’s main communal area is situated on the ground floor and consists of a large lounge/ dining area and a second quiet sitting room. The home’s kitchen, laundry and staff facilities are also situated on the ground floor. The home has a large and pleasant landscaped rear garden and a front garden is paved and provides off street parking for the home. The home is well furnished, well decorated and generally well maintained. There are suitable signs and pictures on doors to bedrooms and to other communal areas to assist people to find where they want to go and overall the building meets the needs of people living in it. Residents spoken to stated that they were happy with their bedrooms overall although one, more independent resident when asked, stated that they did not have a lockable space in their room to keep personal possessions secure. It was also noted that this resident did not have a key to their room. A requirement is made that the registered persons must ensure that all residents have a lockable space available to them in their bedrooms to assist keep their possessions safe, unless the reason for not doing so is explained in their care plan, including how this decision was made. The home must also offer residents a key to their bedroom unless the reason for not doing so is explained in their care plan, again, including how this decision was made. This requirement is made to promote the dignity and independence of residents. A good practice recommendation is also made in the Staffing section of this report regarding staff training on the implications of the Mental Capacity Act, including assessing people’s capacity to be able to make informed choices about their daily lives. The home was clean and tidy throughout the inspection and had appropriate laundry facilities that were seen. Records were seen to indicate that staff had received training in infection control and in the use of chemicals or substances that are hazardous to health (COSHH), staff spoken to confirmed that they had received this training. Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A staff team with a range of qualifications and competencies, in sufficient numbers, support people living in the home. However, staff and people living at the home may also benefit from further staff training relating to recent legislation regarding people’s ability to give informed consent. People accommodated are protected by the home’s effective recruitment procedures. EVIDENCE: At the last inspection a requirement was made that the registered persons must ensure that the staffing levels and the organisation of the staff rota takes into account the needs of the people using the service. Staff must be employed in sufficient numbers and mix as are appropriate for the health and welfare of residents. This must include a review of the ancillary tasks currently being undertaken by care staff; and the risks to residents and staff when staff work alone. At the time of the last inspection there were two residents accommodated and only one member of staff on each shift, including the registered manager. Evidence was seen at this inspection that this requirement was being complied with and evidence to demonstrate this is contained below. Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 21 At this inspection an up to date staffing rota was seen. The rota indicated that three care staff were on duty throughout the day and two waking care staff on duty at night. The majority of the registered manager’s hours are in addition to this although she is currently covering an occasional part of a shift where necessary. It was also noted that the registered manager is currently on duty when not on the rota for a significant number of both early and late shifts to monitor care in the home given the recent increase in resident numbers. There is currently no deputy manager although the registered manager stated that the registered provider is currently considering different deputising arrangements. She went on to state that in the meantime a suitably competent and experienced member of staff is identified to lead shifts when she is not on duty and arrangements are in place for that person to obtain management advice if required. The home has recently employed a full time cook and the annual quality assurance assessment stated that it was the registered providers intention to employ designated domestic staff over the next twelve months. The majority of the current residents at the home are mobile and staffing levels were judged to be satisfactory to meet their needs at the time of this inspection. Of the ten care staff currently employed there is an appropriate split between female and male workers to better provide gender sensitive care. Evidence was seen that the registered provider is committed to recruiting qualified staff and providing appropriate training for staff once employed at the home. Of the ten, three care staff have achieved the national vocational qualification (NVQ) level two in care and two are working towards this; two care staff have achieved NVQ level 3 in care and two are working towards this and two care staff are working towards NVQ level 4 in care. The majority of care staff have been appointed since the last inspection, following the closure of the home for refurbishment during 2007. The staff files of three staff appointed since the last inspection were inspected. These were well ordered, clear and showed a commitment to operating a robust recruitment procedure. All three files contained, an enhanced criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check, a clear application form, two references, proof of identity with a photograph and evidence of entitlement to work in the UK where appropriate. At the last inspection a requirement was made that the registered persons must ensure that all staff working in the home receive comprehensive and accredited training in caring for people living with dementia. This will ensure that staff are equipped with the relevant specialist skills and knowledge. At this inspection evidence was seen that this requirement was being complied with. Evidence was seen that staff had received the following training since the last inspection: care of people with dementia, protection of vulnerable adults, fire safety, infection control, safe administration of medication, COSHH and visual awareness. Individual staff training profiles sampled reflected this and staff spoken to independently confirmed that they had attended such training and Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 22 had found it useful, particularly the training regarding the care of people with dementia. In addition evidence was seen on staff files inspected that they had receive an appropriate induction when employed and staff spoken to confirmed this also. The home is now registered to provide care to more people that have a diagnosis of dementia. It was noted during the inspection that staff in the home have not received training on the practical implications of the Mental Capacity Act 2005, which came fully into effect on 1st October 2007. This legislation is particularly relevant for assessing whether people accommodated have the capacity to give consent or make decisions about a range of areas that affect their lives and how this should be evidenced in the documentation kept by the home. An example of this is referred to in the Environment section of this report regarding people having access to keys to lockable spaces in their bedrooms and to their bedroom door. A good practice recommendation is made that registered manager and staff should receive training on the Mental Capacity Act 2005 and how this legislation should be practically implemented in the home for the benefit and protection of both residents and staff. Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from the service being managed by a qualified and experienced registered manager. People accommodated and other stakeholders are consulted regarding the quality of the service the home provides. People’s financial interests are safeguarded while living in the home. Staff receive regular supervision to assist them meet the needs of people accommodated and to assist in their own development. The home has a range of effective health and safety procedures in place to protect people living there, and others that work or visit the home, although two identified areas need some further attention to evidence that this protection is maximised. Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 24 EVIDENCE: The registered manager is also a registered nurse, has achieved the registered managers award (RMA) and was able to demonstrate during the inspection that she has the experience, skills and abilities to manage the home. At the last inspection a requirement was made that the registered provider must ensure that the registered manager is able to discharge her responsibilities fully. The home must be operated and managed in a manner to ensure sufficient care, competence and skill, according to the numbers and needs of residents. This requirement was made by the inspector that undertook the last inspection because: the home had at the time recently reopened from a period of refurbishment, was only accommodating two residents and the staffing levels were minimal and were judged to be inadequate to allow the registered manager to fully discharge her duties effectively at that time. At this inspection this requirement was judged to have been complied with by the registered provider. Evidence is presented throughout this report to indicate that the number of residents has increased, that the home is working hard to meet their needs and preferences and that the numbers of staff employed to do this has been increased as part of this ongoing process. This has given the registered manager the capacity and support to focus on more strategic management issues within the home. Evidence was seen that during February and March 2008 the registered manager had sent out satisfaction questionnaires to residents, relatives and health and social care professionals. These were sampled and showed a range of useful feedback, mostly positive. The registered manager stated that the feedback would be incorporated into aims and objectives for the home for the next twelve months. Feedback from residents, relatives, staff and external health and social care professionals spoken to during the inspection was generally positive. It was noted that in the Annual Quality Assurance Assessment (AQAA) it stated that prior to filling in the document that the nine residents accommodated at that time, and their relatives, were consulted as part of the process and had indicated their overall satisfaction with the care currently being provided. The registered manager stated the home was not an appointee for any of the residents finances although did hold their personal allowances. Records of these were sampled, including checking the cash held for one resident against the record sheet for that money, and the record was seen to be accurate and the cash properly secured. Evidence was seen from staff files inspected and from staff spoken to independently that staff receive formal recorded supervision and staff confirmed that they felt that this was useful. Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 25 During a tour of the home at the start of this inspection it was noted that fire doors in the home were secured open with “doorguards”. These are devices that are fitted to the bottom of the door, hold the door open and are released when the fire alarm sounds by a wireless signal sent by the fire alarm system. It was also noted that two of these doorguards were emitting a warning sound to indicate that the battery in the device was low in power. During the morning of the inspection officers from the London Fire Brigade local fire station called at the home for a routine check of the overall fire protection systems in operation there. At the end of their visit they fed back to the registered manager including stating that they had checked the fire alarm and door closures and that these were working properly but that the batteries must be replaced as a matter of priority in identified doorguards. They also stated that the signage relating to fire exits needed some minor modification. They stated that the fire protection systems, including documentation relating to this, were satisfactory. They went on to say that they would return to the home in due course to check that the identified work had been carried out. The registered manager told me that there had been a short-term difficulty in attending to the doorguard batteries as the normal provider organisation maintenance person was on leave. However, by the end of my inspection activity on the day a maintenance person had attended the home and replaced the batteries in the identified doorguards. A requirement is made that the registered persons must ensure that there is a robust maintenance system put in place to maintain all equipment linked to the home’s fire protection systems in a timely manner and that all recommendations made by the London Fire Brigade are complied with within the deadlines given by that authority. This requirement is made to maximise the safety for all who live in or who visit the home. A range of satisfactory health and safety documentation was seen including: the home’s fire log, which recorded that the latest fire drill had been undertaken in February 2008 and that other fire fighting equipment had been serviced in January 2008; portable appliance certificate, electrical installation certificate and evidence that the home’s water storage system is inspected to minimise the risk of legionella. A current gas safety certificate could not be located during the inspection and a requirement is made regarding this. The registered persons must ensure that there is a current gas safety certificate for the home and that it is kept available for inspection at the home. This requirement is made to maximise the safety for all who live in or who visit the home. No other health and safety issues were identified. Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 X X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 27 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 OP8 Regulation 13(1) Requirement The registered persons must ensure that prompt referrals are made to the district nursing service, including as part of the pre-admission assessment process for new residents, where input from this service is required in order to meet residents identified health needs in a timely manner. The registered persons must ensure that a varied and personalised range of social and leisure activities and opportunities are available for all residents, both inside and outside of the home, in order to meet people’s individual needs and preferences. The registered person must ensure that a current copy of the L.B. of Waltham Forest’s Safeguarding Adults policy and procedure is available in the home and that the home’s own policy and staff training programme in this area is reviewed to ensure they are consistent with the Borough’s policy. This requirement is made DS0000042130.V361690.R01.S.doc Timescale for action 19/05/08 2. OP12 16(2) 30/06/08 3. OP18 13(6) 19/05/08 Manor (The) Version 5.2 Page 28 4. OP24 16(2) 5. OP38 23(4) 6. OP38 13(4) to maximise protection for residents and staff at the home. The registered persons must ensure that all residents have a lockable space available to them in their bedrooms to assist keep their possessions safe, unless the reason for not doing so is explained in their care plan, including how this decision was made. The home must also offer residents a key to their bedroom unless the reason for not doing so is explained in their care plan, again, including how this decision was made. This requirement is made to promote the dignity and independence of residents. The registered persons must ensure that there is a robust maintenance system put in place to maintain all equipment linked to the home’s fire protection systems in a timely manner and that all recommendations made by the London Fire Brigade are complied with within the deadlines given by that authority. This requirement is made to maximise the safety for all who live in or who visit the home. The registered persons must ensure that there is a current gas safety certificate for the home and that it is kept available for inspection at the home. This requirement is made to maximise the safety for all who live in or who visit the home. 19/05/08 19/05/08 19/05/08 Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 29 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 OP30 Good Practice Recommendations A good practice recommendation is made that registered manager and staff should receive training on the Mental Capacity Act 2005 and how this legislation should be practically implemented in the home for the benefit and protection of both residents and staff. Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Manor (The) DS0000042130.V361690.R01.S.doc Version 5.2 Page 31 - 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!