Care Home: Nettleton Manor

What the care home does well Staff are committed to the work they do and people who use services were positive about their relationships with staff who work in the home. For example they said they had "no complaints" and "felt safe". They also commented that they felt well cared for and found their rooms to be comfortable. Staff were observed to treat people in a polite and courteous manner. They receive training to ensure that they have the knowledge and skills to provide appropriate carefor people who use the service. The care needs of people who use the service are being met by the current qualified and care staffing levels. Questionnaires are used with people who use the service and their relatives on a six monthly basis to obtain their views. A comment from the most recent survey was "caring is excellent". What the care home could do better: Risk assessments of the services environment are not sufficiently detailed to ensure that all potential risks have been identified and of the action needed to minimise risks to ensure the safety and welfare of people who use the service. There are many issues both internally and externally which need attention to ensure that people live in a well maintained home, for example unblocking gutters, ensuring the requirements of other agencies in relation to the redecoration of the kitchen are completed and ensuring any furniture and equipment is well maintained. There is insufficient staff time allotted to ensure the building is well maintained. It was noticed that a comment from the most recent questionnaires completed by people who use the service and their relatives was "the outside of the home lets it down because the caring is excellent". There are records in place to show that staff are employed in the home only after a thorough recruitment procedure has been followed. However, to ensure the safety and protection of people who live in the home records must also be available to show that any agency staff working in the home have also undergone a rigorous selection procedure. There are insufficient systems in place to ensure all aspects of the service are audited and monitored well enough to ensure the quality of the service and to ensure the health and safety of people the service supports. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Nettleton Manor Moortown Road Nettleton Caistor Lincs LN7 6HX one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sue Hayward Date: 0 4 1 1 2 0 0 8 Information about the care home Name of care home: Address: Nettleton Manor Moortown Road Nettleton Caistor Lincs LN7 6HX 01472851230 01472852015 nettletonmanor@aolconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Hapee Care Ltd care home 41 Number of places (if applicable): Under 65 Over 65 41 41 0 dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 4 The service users in the category of Physical Disability must be aged 50 years and over. The Home is registered to provide personal care, with nursing, for service users of both sexes whose primary needs fall within the following categories: Old age, not falling within any other category (OP) - 41 Dementia - over 65 years of age (DE(E)) - 41 Physical disability (PD) - 4 The registered manager undertakes training to obtain the Registered Managers Award, and should enroll on the training within three months of registration. The registered manager undertakes a recognised training course in the management of dementia needs within three months of registration. Care Homes for Older People Page 2 of 15 The maximum number of service users to be accommodated is 41. Date of last inspection Brief description of the care home Nettleton Manor is a two-storey, victorian manor house, standing back from the road in four acres of woodland and gardens in the village of Nettleton. There are no shops within walking distance although the home is on a bus route to Caistor and Market Rasen nearby towns, which have a range of facilities and services. The home consists of twenty-one single and ten shared rooms some with en-suite toilets or bathrooms. There have been recent alterations to the property to link the main home to the coach house, which provides eight single rooms with en-suite toilets and wash hand basins, a lounge/dining room and a bathroom. The director has confirmed it is not the intention to increase the number of places registered currently. The main home has two lounges and a dining room. There are three bathrooms in the Manor House and several toilets situated near to residents rooms and communal areas. A passenger lift gives access to the upper floor although some rooms upstairs are only available to people without limited mobility. There is a large garden to the rear of the property and a large car park for visitors. The fees confirmed at the time of the visit range from £348 to £504 weekly. Additional charges are made for hairdressing, medical requisites (other than those on prescription), newspapers, clothing and other personal items. Care Homes for Older People Page 3 of 15 What we found: This service previously had a key inspection which was carried out on 02/04/08. At that time it received a quality rating of a one star or adequate service. This inspection, which was announced the day prior to visiting was what we call a random inspection and was done in response to information we had received which raised concerns that some specific standards may not be met, which may affect the health, safety and welfare of people using the service. We visited the home and looked at the specific standards that we felt related to the concerns raised. These were mainly concerning the environment, staffing and management of the service. We spoke to the manager, two staff members on duty and three service users. We also looked at the care records of two people who use services, a sample of records kept which help to determine whether standards are being met effectively and we also checked areas of the home environment which included the dementia care unit, a sample of bedrooms, the kitchen and lounge areas. We also looked at the history of the service and any correspondence we had had prior to visiting. The main findings of our inspection we have set out below under the standard headings we inspected. Health and Personal care. We had information raising concerns about staff living on the premises and disturbing people who use the service. The manager and staff confirmed there are three staff who currently live on the premises over the dementia care unit and who use the main entrance. Discussion confirmed that staff who reside on the premises are not able to have visitors but no policies or procedures or tenancy agreements were in place to confirm this. We discussed that terms and conditions under which staff reside in the home should be clear to ensure that the privacy and dignity of service users is respected. Daily records were checked of the service user who lives in the dementia care unit as well as those of a service user who lives in the main home. Of the sample of records checked no information had been recorded to indicate that privacy and dignity issues had arisen from staff living over the unit and peoples comments on the day of the visit indicated that their privacy and dignity was respected. Complaints and Protection. Three staff currently live on premises over the dementia care unit. The manager and staff said no staff or contractors were occupying any of the vacant rooms in the dementia care unit but had used rooms in the unit for sleeping over before it was occupied by service users. They also confirmed no staff were using any of the vacant rooms in the main house, those that had, had been found alternative accommodation. No other staff reside in the home currently. The records of the three staff who live on the premises were checked and showed that Care Homes for Older People Page 4 of 15 the recruitment procedure had included completing application forms, obtaining medical declarations and references and evidence of protection of protection of vulnerable adults register (POVA) checks and criminal records bureau (CRB) checks. Comments from service users indicated they felt safe and well cared for by staff. Environment. We received information raising concerns in relation to some maintenance and safety of aspects of the home environment. We checked a sample of bedrooms from the main home and in the the dementia care unit as well as some bathrooms and toilets, lounges and the kitchen and pantry area. Areas seen were generally clean and comfortably furnished and no unpleasant odours were noticed. People said they found their rooms comfortable and warm and that staff would turn the heating down if it became too hot. Areas of the main home such as some skirting boards, door frames and one of the lounges seen were not as well decorated as others. Whilst records demonstrated there had been progress to identify any risks that the environment may pose to people who live in the home and the action needed to minimise them they are not sufficiently up to date or clear enough to ensure as far as possible the health and safety of people who live in the home. For example, bedroom windows in the new unit did not have restricted opening and neither was there a risk assessment in place to show that the potential risk that this may pose to people, particularly if they have needs associated with dementia had been assessed or of any action needed to reduce the risk. Neither were policies and procedures in place to inform staff of the action needed where risks may have been identified. For example, whilst action has been taken to provide an alarm system to bedroom doors in the dementia care unit which enable access to an enclosed area, no policies and procedures were in place to inform staff of the response needed should the alarms go off. It was discussed with the director and manager that the unit cannot be considered fit for purpose until a full risk assessment of the premises has been undertaken and issues and any appropriate actions taken to reduce any potential risks. Whilst it was evident that the company is working towards improving areas of the home others are not well maintained, particularly in the main home. For example, guttering was blocked in places and causing damp to some rooms. Commodes in some rooms seen were had paint flaking off them and being wooden, not of a material that is easy to maintain hygiene standards. The kitchen decor was poor and it was noted that some matters were still outstanding which had been raised after the Environmental Health Officers visit of 12/07/07, one which related to redecorating the kitchen. In the new dementia unit there is a steep ramp in the bathroom which has the potential to pose a slip or trip hazard when wet. Staffing. We received information raising concerns that new employees did not receive induction training when starting work in the home and did not always have appropriately skilled staff on duty to meet the needs of people who live there. Twenty-four people were living in the home at the time of our visit, thirteen who Care Homes for Older People Page 5 of 15 require a degree of nursing care. A qualified nurse, five care staff and an agency nurse was on duty at the time of our visit. The manager was also present and in addition catering, laundry and housekeeping staff were on duty. Rotas checked for the day of the visit and the week previous showed that these were the usual staffing levels for the morning shift. In the afternoon care staffing levels are reduced by one and at night three care staff are employed. Comments from staff and rotas checked confirmed that there is always one qualified nurse on duty. People who use the service told us that staff generally attend to them promptly and staff were of the opinion that staffing levels were sufficient to meet the needs of the current people who use the service. Discussion and rotas checked confirmed that a person is specifically employed for fourteen hours a week work to carry out any maintenance tasks needed. This is insufficient time to provide the maintenance that the home currently needs (see comments made at the environment standards). The manager told us that staffing levels are generally maintained without the use of agency staff as current employees were willing to work additional hours as needed to cover any shortfalls. An agency staff member is employed to provide one to one support for a specific service user who lives in the home. Whilst the records of recruitment of three staff chosen at random and including a recently employed staff member verified that the staff selection process had included taking up references and checks such as criminal records bureau, protection of vulnerable adults and identity checks to ensure a thorough recruitment process, it could not be verified that information had been sought from the agency providing staff to Nettleton Manor to show they had been through similar checks. Records did however show the induction programme that a recently employed staff member had followed and training records were in place to show what training each staff member had participated in. Management. We received information prior to the visit that aspects of the service were not being properly managed. For example concerns were raised in relation to whether or not the registered manager had a criminals record bureau check, whether equipment in the home was properly checked and serviced and whether alterations to the home had been carried out properly. The manager has been through a satisfactory process to become registered and part of this process includes a criminal records bureau check. We checked the risk assessments that were in place in relation to the environment as this had previously been raised as an issues at the time of the last key inspection. Some progress has been made to ensure risk assessments are more detailed and up to date however, there are still matters which could pose a risk to people who use the service and no evidence to demonstrate that they had been risk assessed nor of the action needed to reduce potential risks. (See also evidence contained in relation to the environment standards). For example there was no evidence to demonstrate that the attic hatch in the new unit had been risk assessed, bedroom window restrictors in some rooms were inadequate, and whilst no boiler fumes were noticed there are two flues near a bedroom and no evidence to demonstrate whether these had been risk Care Homes for Older People Page 6 of 15 assessed nor to demonstrate that any action had been taken to measure the chemical content to ensure people were not at risk from any fumes they may produce. Some of the concerns raised with ourselves have also been raised with other agencies with expertise in specific areas such as the Health and Safety Executive and Fire Safety Officer. There was evidence provided of a recent Fire Safety Officers visit (19/09/08) which the manager said had not raised any specific matters needing attention however they are still awaiting a report confirming the visit. We have asked to be kept informed of the outcomes of these visits. Matters are still outstanding relating to the environmental health officers last kitchen safety inspection visit, which included redecoration of the kitchen, although some progress has been made. There is evidence of some quality monitoring of the service such as questionnaires used with people who use the service and their families to enable them to give their opinions about the service. However, there was only one report available to demonstrate what areas had been checked by the company director on his visits to the service even though he had confirmed in writing to us after the previous key inspection that written reports were being completed. Nor was there sufficient systems and records in place to demonstrate that other areas of the service were being properly monitored, for example to show that the maintenance of the building is regularly checked. Staff spoken to felt well supported by the manager, but less so by the director. This visit was announced, however the director did not attend. There is evidence through records kept that staff have regular meetings with their supervisor as well as staff meetings, although we were told that company representatives do not attend staff meetings, although the manager confirmed that they do make weekly visits to the service. Fire safety records were checked on this occasion. They showed that fire alarms are tested weekly, monthly fire drills are held and checks are made on the emergency lighting and generator on a weekly basis. Records showed when issues had arisen such as a fire door not closing properly and when this matter had been addressed, although it was noticed one door was still not closing properly and this was drawn to the managers attention who agreed to take appropriate action. We were also given information and records confirmed that quotes had been obtained to address some of the maintenance issues such as the call bell system in the dementia care unit, which cannot be heard effectively in the main home. Fire risk assessments were in place and included a risk assessment of the dementia care unit. What the care home does well: Staff are committed to the work they do and people who use services were positive about their relationships with staff who work in the home. For example they said they had no complaints and felt safe. They also commented that they felt well cared for and found their rooms to be comfortable. Staff were observed to treat people in a polite and courteous manner. They receive training to ensure that they have the knowledge and skills to provide appropriate care Care Homes for Older People Page 7 of 15 for people who use the service. The care needs of people who use the service are being met by the current qualified and care staffing levels. Questionnaires are used with people who use the service and their relatives on a six monthly basis to obtain their views. A comment from the most recent survey was caring is excellent. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 15 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 19 12(1) To ensure the health and welfare of people who use the service those matters outstanding from the environmental health officers report of 12/07/07 must be addressed. 30/07/2008 2 35 17 (3) In order to ensure that the 30/07/2008 welfare and safety of people is well protected. Records kept of any money held in safe keeping on behalf of people who use the service must be kept up to date and accurate. Not inspected during the random inspection. 3 37 26 (4)(c) There must be up to date 30/07/2008 records kept which demonstrate on a monthly basis visits by a representative of the company detailing areas checked and people spoken with. This will ensure that the quality of the service is being well monitored and that the views of people who use the service, their representatives and staff have been obtained in order to develop the service. Care Homes for Older People Page 9 of 15 The director has agreed to forward these by e-mail to us for the next six months to demonstrate progress made in this area. Care Homes for Older People Page 10 of 15 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 All parts of the home must 27/02/2009 be reasonably decorated and kept in a good state of repair internally and externally. For example, gutterings should be kept clear, where window restrictors have been provided they should be in good working order, some plaster work is needed in the kitchen fire place area, some redecoration is required in corridors and lounges and the ramp on the main landing is chipped and must be repaired or replaced. This will ensure that people who use the service live in a well maintained and comfortable home. 2 19 12 Attention must be given to 27/02/2009 ensure all matters relating to the environmental health officers report of 12/12/07 are addressed, for example the redecoration of the kitchen and some wall resurfacing. This will ensure the health and welfare of people who Care Homes for Older People Page 11 of 15 use the service. 3 19 20 Although there has been some progress made, risk assessments of the environment must be in sufficient detail to show that all areas of the home internally and externally which are accessible to people who use the service have been identified and minimised. This will help to ensure the health, safety and welfare of people who use the service. 4 26 16 Commodes provided for 27/02/2009 people who use the service should be kept well maintained and of a material that is easy to clean. This will ensure hygiene standards are well maintained and reduce the risk of cross infection. 5 29 19 There must be records kept which demonstrate that any agency staff or volunteers who work in the home have been through a thorough recruitment procedure. This will help to ensure people who use the service are well protected. 6 38 23 Action must be taken to 27/02/2009 ensure that there is sufficent staff time allotted to ensure the maintenanace of the environment. This will help to ensure that people who use the service are living in a comfortable and safe environment. 7 38 10 There must be satisfactory 27/02/2009 27/02/2009 27/02/2009 Care Homes for Older People Page 12 of 15 systems in place which ensure standards in the home are being well monitored and audited. For example, to show there are regular audits undertaken of the maintenance of the environment. This will ensure that peoples health and safety is promoted and protected and that the service is being run in peoples best interests. 8 38 13 Action must be taken to 27/02/2009 ensure there is a satisfactory risk assessment audit undertaken of the environment internally and externally and evidence to show action taken to address any issues identified. For example any ramps which are considered to be a trip or slip risk to people who use the service and records to demonstrate that any fumes emitted from flues sited near residents rooms do not pose a chemical hazard to people who use the service. This will help to enusre the health and safety of people who use the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 10 It is recommended that staff who reside on the premises are given clear information, through for example tenancy agreements, about the terms of their residency in the home. Any agreements should ensure the privacy, dignity and protection of service users who live in the home. For example, whether staff are able to receive personal visitors Page 13 of 15 Care Homes for Older People or not. 2 19 In order that people have sufficient space to store toiletries and personal items in en-suite facilities it is recommended that they are provided with additional storage areas such as shelves. In order to promote peoples independence with their personal hygiene needs, it is recommended that mirrors are provided in en-suite facilities. 3 21 Care Homes for Older People Page 14 of 15 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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