Care Home: Mockley Manor

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What the care home does well People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. People living in the home are treated with respect and their dignity maintained, which increases their self-esteem and quality of life. The lifestyle people experience in the home matches their preferences; they are supported to maintain their independence and enduring interests that enhances their quality of life. The home is well maintained providing a safe, homely and clean place to live. The home is managed by a competent person to ensure the service is run in the best interests of people living in the home. The manager`s full times hours are supernumerary, this allows the manager time to monitor and audit the services provided by the home. An administrator has been employed in the home this provides the manager with support to undertake her role and manage the home effectively Comments from residents include, `It`s a good place to live` and `I can`t think of anything that needs to be improved.` What has improved since the last inspection? What the care home could do better: CARE HOMES FOR OLDER PEOPLE Mockley Manor Forde Hall Lane Ullenhall Warwickshire B95 5PS Lead Inspector Yvette Delaney Key Unannounced Inspection 3rd July 2008 10:00 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 Mockley Manor DS0000004322.V367810.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. Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mockley Manor Address Forde Hall Lane Ullenhall Warwickshire B95 5PS 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) 01564 742325 01564 742185 Mockleyadmin@alphacarehomes.com www.alphacarehomes.com Alpha Health Care Limited Mrs Chenga Lhamo Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (52) of places Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th April 2007 Brief Description of the Service: Mockley Manor is a care home providing both nursing and residential care for up to 52 residents. The home is registered to provide care for elderly residents both male and female who are aged 65 years and above. Situated in a small village on the outskirts of Stratford-Upon-Avon and Henley-in-Arden, there is not easy access to local amenities. Access to the home is via a country lane and its location is rural. Accommodation for people who live in the home is divided over two floors. The first floor is used mainly for people who require personal care only and the majority of residents living on the ground floor of the home having nursing care needs. Most bedrooms are single, (5 shared rooms) with views of the surrounding countryside. There are three lounges and three dining rooms available as well as extensive gardens. The buildings are a tasteful combination of old and new build. Parking is available at the front and rear of the home. The current scale of charges for living in this home is set at £370 for residents requiring personal care only and £600 for residents needing nursing care. Other additional charges include the hairdresser, Chiropodist, toiletries, magazines and newspapers. Mockley Manor DS0000004322.V367810.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 home is 2 stars; this means that the home overall provides good outcomes for the people who use the service. This was the first Key unannounced inspection of this year, which examines all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. The unannounced inspection took place between the hours of 10:00 and 22:30 hours. This key inspection visit showed improvement in a number of key areas. It was evident that the manager and other staff had made good progress in ensuring that Mockley Manor Nursing Home is meeting the Care Home Regulations and National Minimum Standards of practice. This report uses information and evidence gathered during the key inspection process, which includes a visit to the home. Information examined and seen includes a Statement of Purpose and Service User Guide written by the home, inspection activity details, a number of case files, records and files maintained in the home and information from other agencies and the general public. Four people who were staying at home were ‘case tracked’. This involves establishing an individuals experience of living in the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on the outcomes for the resident. Tracking peoples care helps us to understand the day-to-day life of people who use the service. What the service does well: People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. People living in the home are treated with respect and their dignity maintained, which increases their self-esteem and quality of life. The lifestyle people experience in the home matches their preferences; they are supported to maintain their independence and enduring interests that enhances their quality of life. The home is well maintained providing a safe, homely and clean place to live. Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 6 The home is managed by a competent person to ensure the service is run in the best interests of people living in the home. The manager’s full times hours are supernumerary, this allows the manager time to monitor and audit the services provided by the home. An administrator has been employed in the home this provides the manager with support to undertake her role and manage the home effectively Comments from residents include, ‘It’s a good place to live’ and ‘I can’t think of anything that needs to be improved.’ What has improved since the last inspection? Individual receipts are available to demonstrate the purpose for which items or services were purchased on behalf of people who live in the home. The contents of residents care files and care plans have improved to identify the specific care needs of individual people living in the home. This will ensure that residents receive care appropriate to their needs. Medication practices have improved in the home and the manager carries out internal audits to ensure that the standard of practice is maintained. This will help to ensure that people living in the home are protected from the risk of harm. The level of training attended and received by staff has improved. This will ensure the safety of people who live in the care home and that staff are trained and competent to meet their care needs. Health and safety issues highlighted following the last inspection have been addressed, these include: • • • • Staff following safe procedures when collecting and disposing of dirty laundry. Locking the doors to the sluice and laundry rooms when these rooms are unattended. Storing chemical products used in the home in a suitable and appropriate lockable storage facility. Staff using hoists and other moving and handling aids safely and appropriately. The improvement in these practices will help to ensure that people who use the services have their health safety and welfare protected. Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 7 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. Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5 (Standard 6 does not apply to this home as people are not admitted for immediate care). Quality in this outcome area is good. Comprehensive information about Mockley Manor is available. People visit the home before making the decision about where to live. People receive a comprehensive assessment of their care needs to ensure they can be met before admission to the home. This will support people to make an informed decision about whether to stay at the home and agree to the terms and conditions set by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide were seen and read at the time of the inspection. Copies of both documents are available to people living in the home. Both documents have been reviewed and updated to provide people who live in the home and potential residents with up to date details on the services provided by the home. Information about the size of rooms available to people who wish to use the service had not been included in the Statement of Purpose. This would give people who are involved in a decision about whether to move into the home additional information as to whether the Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 10 home is suitable to meet their needs. Two relatives of residents spoken with said that they were well informed when making a choice about moving into Mockley Manor Nursing Home. The care file of one resident admitted to the home since our last inspection visit in April 2007 was reviewed through the case tracking process. A copy of the assessment was available on file. The pre-admission information for this resident was examined. Assessments read provided details of the resident’s health and personal care needs. Information available includes mobility, history of falls and their medical history. The availability of this information ensures that the specific care needs of each person are identified and used to complete a plan of care. Residents and relatives confirmed that the Manager had visited them to make an assessment before being offered a place in the home. Information in the AQAA stated that all residents receive a pre-admission visit. The resident confirmed that a member of their family had visited the home before making the decision to use the home, commenting “We chose the bedroom at our visit.” The resident and relative spoken with were aware of the procedures of the Home and had seen and read the Home’s Service User Guide. Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. Care plans show improvement and provide staff with guidance on all aspects of resident’s needs and this should result in appropriate care being given to residents. Medicines are administered safely, which protects residents from risk of harm. People living in the home are treated with respect and their dignity maintained, which increases their self-esteem and quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection, there were 43 elderly male and female people living in the home. We examined the care files for four residents. People living in the home looked well cared for. They were well presented and wore clothes that were suited to the time of year. Residents spoken with were happy to be living in the home. Two residents were spoken with in their individual bedrooms. Through conversation they told us, “There is no place like home and I was concerned about moving in here but I find that I am happy.” “The staff are lovely and treat me with respect.” Sitting with the Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 12 residents in one of the lounges while they played a game of cards it was evident from our observation that the personal care needs of people living in the home are being met. Residents knew the nurses, carers and activity coordinator by their first name and interaction between them was relaxed and positive. Residents were smiling and appeared relaxed and happy. The care files examined were for one resident recently admitted to the home, one resident who has problems with weight loss, a resident with complex needs and a further resident who required minimal assistance. The residents were seen and the interaction between them and staff were observed throughout the day. Since the last inspection, the newly appointed registered manager has taken steps to improve the care planning process within the home, with the support of the nursing staff. Previous inspections had identified that, care plans for people living in the home were not specific in identifying residents care needs and providing appropriate guidance for staff on how to meet the care needs. Although not well organised care files documented detailed information about each person. This should provide staff with up to date information about the needs of people living in the home and the actions they need to take to meet those needs. Examination of the four files showed that the standard of care plan documentation had improved. Talking to the residents, care staff and examination of care files demonstrates that individual needs had been assessed and updated to identify current care needs. However, one care plan related to the meeting the care needs of a resident with a pressure sore, had not been fully completed. This could mean that staff fail to give full and appropriate care therefore resulting in deterioration of the person’s condition and wellbeing. This was an exception when compared with other care plans, which made reference to pressure area care as these were detailed and provided staff with sufficient information to meet the individual needs of residents. The care plan was reviewed and updated at the time of the inspection by the manager. Risk assessment had been reviewed and completed in all care plans examined. These include risks related to pressure areas, falls, mobility and nutrition. This gives staff information they need to provide and meet the specific and current care needs of people living in the home. For example, the person who had developed a pressure sore had been identified as being at high risk of acquiring pressure area damage. A care plan had been written with guidance for staff on how to minimise the risk of a pressure sore occurring. We observed that there was pressure relieving equipment, such as a specialist mattress, in use for this person. This supports this person’s plan of care and decreases the risk of Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 13 deterioration in their health and well being. Staff spoken with were able to explain the residents care needs and what they do to ensure that the person’s needs are met. A further resident had been identified as being at risk of losing weight. Daily written reports show that all efforts had been made to encourage the resident to eat and help them to increase their appetite. A care plan was in place to instruct staff on the nutritional needs of the resident, food likes and dislikes and referral had been made to the GP and dietician for advice and support in managing this person’s care. The resident’s family had also been involved to help support the diet care plan. The care plan required that weekly weight checks and records show that this action had been carried out. The above show that as a result of a complaint received by the home and us a robust process for monitoring, reviewing and documenting the weight of people admitted to the home has been implemented. As part of the action required following the investigation of the complaint by the home extra training had been given to staff on the management of weight gain/loss and disciplinary action had been taken. This should mean that weight loss in people living in the home does not go unidentified and that appropriate care is given in a timely manner. Reviewed practice also gives staff instructions on monitoring the resident’s weight and making an appropriate referral to a professional person if needed. Baseline observations of resident’s blood pressure, pulse, temperature and weight had been recorded on or as soon as possible following their admission. This is good practice and would support staff when monitoring any deterioration or improvement in a persons well being. Written daily reports in care files provided information on people’s day-to-day life in the home and provides details on their health and well being. Entries had been signed, dated and timed by the member of staff making the entries. Comments from family members on whether the home is able to meet the needs of their relatives showed a mix of responses these include: Entries in each of the resident’s health records and comments by people living in the home confirmed that they are supported in getting access to relevant health care professionals when needed. This includes access to GP, Chiropodist, Community Psychiatric Nurse and Optician. One care plan contained clear documentation to show that a resident had received ongoing treatment from a dentist. We examined the management of medicines in the home. Medication practices show that there are good systems in place for the ordering, receipt and storage of medicines. A monitored dosage (‘blister packed’) system is used. Medication is safely stored in locked trolleys, which are kept in a locked clinical Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 14 room. The clinical rooms were tidy and organised. The location for storing medication has changed. The manager for the home said that it is hoped that this will provide a room that is better ventilated and hence a temperature that is suitable for maintaining the stability of stored medicines. Staff are regularly recording the temperature of the medicines fridge this will ensure that those medicines requiring cold storage are kept at recommended temperatures. Only trained nurses are responsible for the administration of medication. A medicines fridge is available in with daily recordings of the temperature, which were within recommended limits. The facility for storing controlled drugs (CD) is limited as the size of the internal cupboard was too small to store all the drugs within the inner cupboard safely. There is one CD cupboard to store CDs for both floors. The contents of the controlled drug cabinet were audited against the controlled drug register with one of the registered nurses. All the controlled drug balances were correct and these were reflected accurately in both the CD register and medicine chart. An audit of the medication prescribed for people involved in case tracking demonstrated that medicines had been accurately administered as prescribed and medicine administration records were accurately maintained. There are currently no residents completely self-administering their own medication and this was through the choice of people currently living in the home. Some residents are supported to handle their own medicines in part if they cannot correctly take all following a risk assessment to ensure they are able to do so safely. The home has a homely remedy policy endorsed by the doctor, which further meets the needs of the residents enabling staff to administer medicines for minor conditions, such as headache, without consultation with the doctor. All of the residents we spoke to said that staff treated them well and that they actively helped them to maintain their privacy and dignity. One resident said “I am getting the best care”. A Hairdresser visits the home weekly which helps residents to maintain their appearance and increase their self-esteem. Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 an 15 Quality in this outcome area is good. The lifestyle people experience in the home matches their preferences; they are supported to maintain their independence and enduring interests that enhances their quality of life. Residents benefit from a nutritious and varied diet. There is insufficient evidence available to confirm that people are offered choices at mealtimes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The approach to activities and events occurring both in and outside the home has improved since the last key inspection. An activities coordinator is employed in the home and works 30 hours per week over five days. This is good practice and means that care staff levels are not depleted. Care files examined showed that information regarding peoples preferences for their daily routine had been documented, such as their likes and dislikes of different foods, the time they like to go to bed and details of their interests and hobbies. On the day of inspection the residents were observed playing a game of cards. The playing cards were available in different sizes and had an attachment on Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 16 the back of the cards which made them easier for residents to hold. The adaptation to the back of the cards had been added by the activity coordinator based on the individual ability of the residents taking part. Fifteen residents were observed to enjoy taking part in the game. Prizes were given to the winners. In the afternoon a game of skittles took place in one of the other lounges on the ground floor. It was evident that the activity coordinator was familiar with the preferences of residents and the type of activities that might engage and stimulate each individual. A record of group and individual activities is maintained in the home. The activity coordinator was also observed to be involved in supporting residents at lunchtime. The activities coordinator has developed a planned programme with residents. A newsletter is produced monthly for residents. However it was not evident that residents are encouraged to contribute to the newsletter. This would allow people to make suggestions and be involved in some decision making about what happens in the home. Observations during the inspection visit showed that good interaction was observed between staff and residents. Residents knew individual staff by name and there were good levels of rapport between residents, relatives and staff. An open visiting policy is practised in the home. This helps to support residents to maintain links with their families and friends. Relatives and friends were seen to visit during the day of inspection. Residents told us that visitors are made welcome and the visitor’s record demonstrated that people can visit when they want to. Conversations with families confirmed that relatives are aware they are able to visit at any reasonable time. We observed the lunch time meal service in one of the ground floor dining rooms, the residents’ were supposed to be served at 12.30 pm; lunch was not served until 1.00 pm. It was noted that this irritated some residents with comments like “Come on, what’s happening.” All residents were seen to enjoy their meal. The meal was served from a heated trolley brought down from the kitchen. Meals were delivered to people who chose to eat in their room. Dining tables were not attractively laid, there were no table cloths or suitable napkins and condiments were not available on the table to offer the residents a choice. The arrangements in the dining room have changed to provide smaller tables seating four people, the smaller groups allows for better socialisation between residents. The mealtime was evidently a social occasion with residents coming together and chatting over their meal. Thirteen people attended this dining room for their meal. Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 17 The day’s choice of meal was Cornish pasty or beef and kidney pie accompanied by boiled potatoes, peas and carrots. Strawberries and cream were offered for dessert. Staff said that residents’ are offered the choice of menu during each morning. When residents were asked by our inspector what was for lunch, comments received were “No”, “I can’t remember”, “They (Staff) did tell me”, “they (Staff) will tell me when they give it (lunch) out”. For people who do not have a preference for either of the day’s choices jacket potatoes with varied toppings or omelettes are offered. The cook told us that an alternative meal could be cooked for residents who made a special request. Residents made positive comments about the food provided in the home. One person told us, ‘the food is lovely’. They make some good dinners’. Menus seen on the walls in both dining rooms on the ground floor were placed to high up on the wall for residents to see. The menus on display on the day of the inspection did not reflect the meal served at lunch time. The cook said that meals were under review and this was being carried out with the involvement of the residents’. Staff told us that six people accommodated on the first floor of the home needed assistance to eat their meals. There were sufficient staff available to offer sensitive and timely assistance. Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from the risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure available is in a booklet format titled ‘How to make a complaint.’ The copy seen is available in large print. The booklet is clearly written, is presented in a question answer format and invites the people who use the service to make a complaint if they are not happy with the service. Residents and relatives spoken with said that they were aware of how to complain and whom to complain to. Comments made include: “The manager always listens, she seems to get things done.” “I can talk to any of the staff.” Discussions with the manager, information in the AQAA and records examined confirmed that five complaints both verbal and formal have been received by the home since the last inspection. Issues raised in the complaints include concerns about missing personal items, problems with eating and resident unable to reach the call bell. Three of these complaints have been resolved to the satisfaction of the complainants and two are still being investigated. Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 19 One of the complaints had also been received by the commission. The areas of concern were related to weight loss and took sometime to bring to a satisfactory conclusion. As mentioned under the health and personal care section of this report, systems have been put in place to monitor and review the weight of residents living in the home. The policy and procedure detailing the action to be taken by staff to ensure the protection of vulnerable adults were examined. The information guides staff on the procedures to follow if they saw or suspected evidence of abuse. Staff were able to confirm that they had attended training related to the protection of vulnerable adults. Two members of staff were able to explain the action they would take if they saw abuse. Both answered appropriately. Training records examined indicates that protection of vulnerable adults training had been received by staff during the home’s internal 2008/09 training programme. There have been no safeguarding incidents referred to the adult protection team for investigation. There was no evidence of abuse, verbal or otherwise seen on the day of inspection. Care and consideration by members of staff towards residents was evident at all times. Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. The standard of the environment presents a homely and safe place for elderly people to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mockley Manor offers accommodation on two floors for up to 52 elderly people. The home offers a service for both men and women. The ground floor accommodates resident who require nursing care and the first floor provides a service for people who need support in meeting their personal needs. Some of the accommodation and facilities in the home were seen while visiting and talking to residents and their families and staff. Residents were observed making use of all the communal spaces. On arrival at the home the reception area was being painted as part of the home’s refurbishment plans. The home is well presented and maintained. The home was clean and there were no unpleasant odours on the day of the Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 21 inspection. Residents spoken with were all generally happy with the cleanliness of the home, especially with reference to their own bedrooms. Several bedrooms, including the people involved in case tracking, were viewed. Rooms were comfortable, cosy and well decorated with en suite facilities. Most of the residents rooms visited showed that they were attractive and homely. Residents took the opportunity to bring in pieces of their own furniture, one resident had brought in their own bed. This was a large bed but the size of the bedroom gave adequate space for other pieces of person’s furniture, which includes an armchair. Residents said that being able to bring in small items of furniture and other furnishings such as pictures and cushions helped to make their bedrooms comfortable. Equipment is available to assist residents and staff in the delivery of personal care, which includes assisted baths, moving and handling equipment including hoists. Pressure relieving equipment such as cushions and various types of mattress are available for people who have an identified need for them. Systems are in place to manage the control of infection. Protective clothing such as plastic gloves and aprons were available and arrangements are in place for the disposal of waste. There is a well-equipped kitchen and on the day of the inspection the Cook was well organised and the kitchen was clean and tidy. There is a good wellorganised food store and two freezers and one fridge. Plated food was covered and opened food containers were sealed and date marked. The cook showed the inspector a white board in the kitchen, which was used to list residents names and any special dietary requirements. This includes finding out the likes and dislikes of residents with poor appetites and as a result were showing signs of weight loss. Records examined related to daily, weekly and monthly cleaning in the kitchen these had been appropriately dated and completed. Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. The number of staff on duty is not sufficient to meet the needs of people living in the home at all times of the day. Residents benefit from being cared for by competent staff and are protected by robust recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager told us that the usual staffing complement for the home is 8am – 2.30pm 2.30pm – 9pm 9pm – 8am 2 registered nurses and 7 care staff 1 registered nurses and 6 care staff 2 registered nurses and 3 or 4 care staff Four weeks of the home’s duty rota between 9th June and 6th July 2008 was examined and demonstrated that the staffing levels set by the home (in the table above) are not always consistently achieved especially on a late shift. Examination of the off duty rota’s for ancillary staff show that the following hours are worked: Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 23 • The kitchen is staffed between 8 am and 4 pm three days per week, 8 am and 8 pm three days per week and 8 am and 6 pm one day per week. There are domestic staff on duty six days of the week between the hours of 8 am and 4 pm three days per week and 8 am and 3 pm three days per week. The laundry is staffed between the hours of 6 am and 2 pm five days per week and 3 pm until 8 pm on Saturday and 2 pm until 8 pm on a Sunday. The home employs a maintenance person for 40 hrs each week, The manager is supernumerary and is supported by a part time administrator. The home employs an activities co-ordinator for 30 hours each week. • • • • • The information above does not reassure us that care staff do not have to spend undue lengths of time undertaking non-caring tasks, especially in the kitchen, domestic and laundry areas. It was evident that a review of the number of care staff on duty had been carried out to increase the number of care staff on duty. This has improved some of the outcomes in meeting the needs of residents. The manager told us that staffing levels are reviewed based on the number of residents in the home. There were occasions when the level of staffing could be questioned. For example when a resident needed the toilet but had to wait because the two members of staff working in that area of the home were busy with another resident. This reinforces the need for staffing levels to be based on the dependency of people living in the home to ensure that their care needs can be met in a timely manner and in a way which maintains their dignity. Staff spoken to did not express any concerns regarding staffing levels. Comments made by relatives and residents about staffing include: “There is not enough staff, especially at mealtimes, I can come in and feed my relative but not everyone can.” “The staff are good, they always help if they can.” Information received from one new member of staff confirmed that they were completing an induction period. Information available about the induction process for the home shows that it is linked to the common induction Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 24 standards developed by the Skills for Care Council. Completion of the induction course links directly to the NVQ qualification. The number of care staff with a National Vocational Qualification (NVQ) level 2 or above in care has increased from 7.5 to 27 . This will further increase to 58 when the ten carers currently doing the training have completed the qualification. Introducing a robust induction period and training programme into the home will help to ensure that there is a high number of qualified staff in the home. This practice will support residents receiving care appropriate to their needs from competent staff and promote the residents wellbeing. A paper record is maintained to show training sessions attended by staff. The records showed that the level of training attended by staff had improved since the last inspection in April 2007. Staff spoken with said that they had attended fire training, moving and handling, cross infection. Training records showed the date and topics covered in the training. A review of three staff files confirmed that recruitment practices for the home are good. Staff files contained evidence of protection of vulnerable adults (PoVA) checks and Criminal Records (CRB) checks. These were completed before staff commenced working in the home. References obtained were appropriate. Records of interviews are maintained to support equal opportunity practices within the home. Robust recruitment practices will support the safety of people living in the home. Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 Quality in this outcome area is good. The home is managed by a competent person to ensure the service is run in the best interests of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager was present at the time of the inspection. We were later joined by the Regional Manager for the home. The manager has recently, been registered by us to be the ‘Registered Manager’ for the home. She previously worked in the home as the deputy manager. The manager is knowledgeable about people in the home this includes residents and their families and staff. She has the necessary experience to run the home is a registered nurse and is working towards the registered manager’s award (NVQ level 4). The Manager is keen to make improvements and since the last Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 26 inspection had taken actions to address all of the requirements made following the last Key Inspection. The manager’s full times hours are supernumerary, this is good practice and allows the manager time to monitor and audit the services provided by the home. A further good practice measure implemented was the appointment of an administrator for the home again this provides the manager with support to undertake her role and manage the home effectively. Resident’s and relatives commented in conversation about the management of the home to say that: “The manager is always approachable”. The home’s Quality Assurance file contained evidence that audits are carried out on the services provided in the home and identifies areas for improvement. Action plans are developed for making improvements and are reviewed to monitor progress against the objectives set. The personal monies of people living in the home are kept securely in separate bags and accurate records of income and expenditure are available. The records of the three residents followed through the case tracking process where asked for. These residents had not deposited any money and therefore there was not a need for records to be maintained. An audit of a randomly selected resident’s personal monies was found to be correct. Staff supervision takes place in the home. Records available show that areas covered include: observation of care practices, nursing procedures, personal care and training. The home informs us of any incident or event that affects the well being of people living in the home. Relatives were able to confirm that they were informed of important issues affecting their family member. Health and safety issues highlighted following the last inspection have been addressed. Through observation it was noted that: • • • • Staff followed safe procedures when collecting and disposing of dirty laundry, aprons and gloves were being used. The doors to the sluice and laundry rooms were locked when these rooms were unattended. Chemical products used in the home were stored in a suitable and appropriate lockable storage facility. Staff using hoists and other moving and handling aids safely and appropriately. Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 27 The improvement in these practices will help to ensure that people who use the services have their health safety and welfare protected. Examination of other health and safety and maintenance checks carried out in the home to ensure equipment in use is safe and in full working order. Electrical equipment used in the home had been tested to ensure us it was safe to use and appropriately wired. Water temperatures checks had been recorded monthly and this assists in the prevention of people accidentally scolding themselves. Maintenance checks were completed on fire systems and equipment. Records related to maintenance and services related to the environment were organised. Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 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 3 3 3 Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 29 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 Standard OP27 Regulation 18 Requirement Staffing levels must be reviewed to ensure that sufficient numbers are on duty at all times. Attention should be given to peak times of activity in the home, which includes: • • Lunchtimes to assist residents with eating their meals. Where two members of staff are required to transfer a resident using appropriate and safe moving and handling techniques. Ensuring that care staff do not have to spend undue lengths of time undertaking non-caring tasks, especially in the kitchen, domestic and laundry areas. Timescale for action 31/08/08 • This will ensure that residents care needs can be met safely at all times. Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations Details of the size of rooms in the home, which are accessible by people who live in the home, should be included in the Statement of Purpose. This would give people who are involved in a decision about whether to move into the home full information as to whether the home is suitable to meet their needs. Care plans developed to show staff the care required by people who have developed pressure sores should be audited to ensure that they consistently contain clear guidance, are appropriate and reflect current care needs at all times. This will ensure that all residents identified with a pressure sore are protected from the risk of harm. The home should encourage people who use the service to contribute to the home’s newsletter. This would allow people to make suggestions and be involved in some decision making about what happens in the home. The storage of medicines in the home should be reviewed to ensure that a suitably sized cupboard is available, which allows the safe and appropriate storage of all medicines identified as ‘Controlled Drugs’. Details of the choice of food available in the home should be in a format that people living in the home can easily read, access and relate to. This will ensure that they are able to make choices about what they eat. Condiments should be available and easily accessible by people who live in the home. This will ensure that residents are able to make their own choice on whether they want to use them. Work should continue on improving and increasing the number of care staff with NVQ level 2 qualifications or equivalent in care. This will ensure the safety of people who live in the home. 2 OP7 3 OP14 4 OP9 5 OP15 6 OP15 7 OP28 Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Mockley Manor DS0000004322.V367810.R01.S.doc Version 5.2 Page 32 - 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. 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