Care Home: The Manor Clinic

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What the care home does well The clinic provides care and treatment in a well maintained, pleasant, spacious and welcoming environment by a well managed, supported, motivated, welltrained stable and qualified staff who work as a closely coordinated team in a manner that recognises service users needs for personal privacy, dignity and independence Areas of particular note were the environment and arrangements for staff training. What has improved since the last inspection? Not applicable as this is the first inspection since registration. What the care home could do better: There were no areas of concern and no requirements or recommendations were made. CARE HOME ADULTS 18-65 The Manor Clinic The Manor House Mansbridge Road West End Southampton SO18 3HW Lead Inspector Peter J McNeillie Key Unannounced Inspection 4th December 2007 09:00 The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 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 The Manor Clinic DS0000070187.V353415.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 Adults 18-65. 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. The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Manor Clinic Address The Manor House Mansbridge Road West End Southampton SO18 3HW 02380 464721 02380 472292 tomfinlay007@hotmail.com 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) suejones@themanorclinic.com The Manor House Clinic Ltd Mrs Susan Elizabeth Jones Care Home 15 Category(ies) of Past or present alcohol dependence (0), Mental registration, with number disorder, excluding learning disability or of places dementia (0) The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) 2. Past or present alcohol dependence (A). The maximum number of service users to be accommodated is 15. Date of last inspection First inspection since registration on 21/06/07. Brief Description of the Service: The Manor Clinic is a registered residential service offering accommodation, rehabilitation and treatment for up to fifteen people suffering from alcohol abuse and depression usually for a minimum of seven and a maximum of twenty eight days but times can be extended in response to individuals needs, and progress subject to an ongoing therapeutic and clinical assessment. The facility is located in a large house set in its own grounds within two miles from the centre of Southampton and easy access to the M27 motorway. Parking is available on site. Accommodation for service users is in single rooms with ensuite facilities. Twin rooms are available for service users to share with visiting partners. Fees at the time of this visit were £2850 per week The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report was produced after taking into consideration a number of sources of information and evidence including a site visit to the premises, pre registration documentation, the homes statement of purpose, examining service users and staff training and recruitment records, talking with residents, staff and management, responses by the manager to a pre inspection Annual Quality Assurance Assessment. (AQAA) and the results of in house satisfaction questionnaires completed by service users. During this inspection, which took place on 04/12/07/ between the hours of 9.00am and 2.00pm and was the first inspection since registration in June 2007, all of the designated key standards for younger adults were inspected. In the absence of the registered manager two directors of the clinic and other staff on duty assisted us during our visit. As a result of this visit no requirements or recommendations have been made. The results and findings contained in this report will determine the frequency and type of future inspections. What the service does well: 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. The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a very comprehensive disciplinary system of assessing risks and identifying service users needs which ensures service users safety and that their assessed needs can be met. EVIDENCE: Three service users well maintained records were viewed. These confirmed the information in the AQAA that an admission policy and procedure was in place that required no service user be admitted without a full assessment of their needs and any risks being undertaken. Prior to any admission taking place a referral from the potential service users G.P. is required however service are able to self refer for an initial assessment but will not be admitted without the agreement of their GP. Accredited therapists using a standard diagnostic methodology (ASSI) carry out all in house assessments of needs and risk. A major factor in all assessments is that of risk to which great weight is placed before an admission is agreed in line with health and safety considerations relating to the potential resident as well as other service users and staff. The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 8 As part of the pre admission procedure all potential service users are made aware they will be expected to sign an agreement that will require them whilst undergoing treatment to forgo some rights including giving up drinking alcohol, control of their own medication and the willingness to allow themselves to be breathalysed when asked. Should a service users on admission be under the influence of alcohol, or a breath test indicate they have been drinking, they would be asked to re-sign the agreement when alcohol free. The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a system of planning and reviewing care, which reflects service users, wishes, aspirations and ensures service users needs are met within a risk management policy and involves service users or their representatives in decisions that affect them. EVIDENCE: Three service users detailed, user friendly and well-presented care/ treatment plans that were securely stored were viewed and a number of service users were spoken with. All of the plans viewed which were based on very detailed assessments of needs and risk (Section 1-5 of this report refers) included information on how staff was to meet identified individual needs within a risk-assessed framework. The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 10 Records viewed also indicated consultation between the clinic, service users and external and internal health care professionals such as GPs, phychiatrists, therapists, and other disciplines as required who all contributed in the formulation of a plan of care and treatment designed in minute detail to meet the needs of the individual service user. All of the service users spoken to confirmed they were treated with respect and were satisfied with the quality of the service offered and stated that whilst they found some restrictions placed upon them irksome agreed these had been fully explained to them prior to admission and were necessary to achieving the aims and objectives of their stay at the clinic. The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The social activities, family contacts and the provision of varied and nutritious meals were well managed and reflected service users interests and choices. EVIDENCE: Service users are only admitted for a short period of time for a specific purpose linked to a very strict treatment plan. Due to the specialist nature of the service, the needs of service users and the intense treatment programme, service users have little free time for regular social activities including the evenings when they are expected to attend external support groups. Service users spoken with informed us they did not require activities organised for them as the treatment programmes were very tiring. All were totally satisfied with the resources provided by the clinic that reflects those found in the normal family home eg.television etc. The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 12 Service users are free to access the local community in their free time subject to the conditions previously mentioned in this report. Many service users on a twenty-eight day programme go home subject to a therapeutic and clinical and risk assessment on the second weekend of their stay. Where this is difficult, relatives may visit and can be accommodated in twin rooms with the service user should they wish. Service users confirmed they were satisfied with the food available, which external caterers provide. The quality, quantity and choice of food served is closely monitored via a service user satisfaction survey referred to in a following section of this report. Access to the satellite kitchen is also available for service users to prepare meals. Tea, coffee and other non-alcoholic drinks are available at all times. The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements are in place, ensuring the personal emotional; health care and medication needs of service users are met. EVIDENCE: Following their detailed assessment, on admission following an alcohol free period all service users receive a consultation from qualified therapists, a psychiatrist or Doctor. Consultation with a doctor is essential as many treatment programmes involve the use of prescribed medication. All of the procedures involving health care professionals had been explained to the service users prior to admission as part of the initial assessment process. In the event of a medical emergency the existing local accident and emergency resources would be used. Due to the short nature of their stay, residents would normally retain the GP who was responsible for the original referral as described earlier in this report. As part of their agreement all service users agree to forgo the right to control their own medication. The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 14 It is seen as essential for their well-being and safety that the clinic handles all service users drugs and medication in tandem with any prescribed medication as part of the agreed treatment programme. Service users spoken to confirmed they had agreed to this measure as part of the pre admission procedure. Records viewed confirmed that a qualified nurse administers all securely stored medication to service users. The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The clinic has clear policies and procedures in place which ensures service users are able to complain and are protected from abuse . EVIDENCE: An in house Adult Protection policy and procedure and a whistle blowing policy and procedure that operates in tandem with the policy and procedure produced by Hampshire County Council designed to protect service users from abuse was available. Records viewed, management and staff spoken with confirmed they had received training in recognising abuse; all were able to demonstrate they were familiar with the procedure to follow should they witness or suspect the abuse of any service user. The complaints procedure, which is also included in the service users guide was available and included information on how to contact The Commission for Social Care Inspection (CSCI), was seen, as was the record of complaints, which indicated no complaints, had been received since the last inspection. Service users confirmed they knew who to speak to should they have a complaint. All members of staff spoken with of stated they felt confident in discussing any concerns, complaints with management either in house or external on behalf of any service user. The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A safe, spacious, well maintained, clean and suitably furnished home and accessible garden is provided for service users which meets their needs. EVIDENCE: All areas of the service were clean and free from unpleasant odours and obvious hazards. Furniture was comfortable, homely, met service users needs and was in keeping with the décor. Service users spoken with confirmed the environment is always clean, smells fresh, all said they were happy with their accommodation, which was described to us as four to five star hotel standard. A great deal and of time, resources and expertise had clearly gone into the furnishing, equipping and tastefully decorating the spacious building in which all bedrooms and communal rooms were equipped with furniture designed to meet service users needs. The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 17 Throughout the building there are examples of best practice and forward planning, e.g. a passenger lift, wide corridors, wide doorways, ramps, grab rails and walk or ride in showers etc ensuring any service user or visitor including a wheelchair dependant person could be accommodated and access all areas of the building and the extensive well maintained gardens. The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are met by sufficient numbers of well-trained and supported staff who are recruited and selected using a procedure designed to protect all service users. EVIDENCE: Due to the specialist nature of the service and the absence of personal care provided, staffing levels are very fluid; the skills mix of staff available being seen as more important and key in ensuring the wellbeing of the service users and the quality of the service being delivered. During the day service users are expected to attend a very structured programme of lectures, support groups and individual therapy sessions led by a number of in house trained professionals such as phychiatrists, therapists, peer supporters, and councillors. Service users spoken to confirmed there was always qualified staff available twenty-four hours a day should the need any additional support, help, guidance, therapy or counselling? The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 19 A sample of three staffs recruitment and training records were viewed. All records indicated that prior to commencing their employment all staff who have completed a detailed application form and signed a rehabilitation of offenders declaration were interviewed followed by at least two reference (including their last employer) a criminal records bureau (CRB ) and protection of vulnerable adults (POVA) checks. Staff turnover is low many of the staff having worked with each other for the past ten years at other similar services. Within the staff group there are a number of disciplines including qualified nurses, therapists, phychiatrists and counsellors. Records confirmed on commencement of their employment all staff are involved in an in house induction. Subjects covered during the induction period would include the protection of vulnerable adults, infection control, control of substances hazardous to health (COSH), first aid, diversity, aggression, needs of the disabled, data protection and confidentiality, life support, and moving and handling, food hygiene and fire safety etc. All these courses are delivered by external training consultants. In addition to attending the above all staff apart from those qualified in a particular discipline such as nurses are expected to participate in National Vocational Qualification Training (NVQ) to at least level two in care. At the time of the visit the AQAA provided by the homes manager indicated 33.3 of care staff had completed their level two courses with a further 20 currently on a course. In addition internal training for the roles of Peer Supporter and Counsellor are also available. Apart from care staff a number of support staff are also available including housekeeping, maintenance, administration and external caterers. The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home seeks the views and opinions of service users and their representatives and safeguards the health and safety of staff and service users through the implementation of safe working practices. EVIDENCE: At the time of this visit the manager was absent having just completed a night shift on the previous night. From information given by staff we were satisfied that the service is well managed by the registered manager who is a qualified first level nurse who is currently undertaking a course leading to an NVQ level 4 registered managers award. Staff said that they felt well supported by the manager, who organised regular team meetings and ensured they had regular supervision. All staff confirmed to us they had a clear understanding of what needs to be done and how to do it. The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 21 All confirmed management have an open door policy, and encourage them to share any concerns or ideas they have to better the service. The inspector viewed responses to a satisfaction questionnaires completed by service users on completion of their treatment, which indicated a very high degree of satisfaction, and gratitude to the management and staff of the clinic. A detailed analysis of the service users responses and the actions taken by management to address those areas indicated that required attention was available. We were informed no money is being held by the manager on behalf of service users. A health and safety policy and procedure was in place designed to protect service users and staff. During the visit no obvious hazards to health and safety were seen. Protective clothing, gloves, control of substances hazardous to health (COSHH) assessments, risk assessments, equipment servicing and accident records were available as were records to confirm all staff have received training in the techniques of moving and handling, infection control, first aid health and safety and the procedures to follow in the event of fire, including evacuation. All of the hot water supplies to baths were fitted with thermostatic controls set at 43 degrees centigrade and all radiators and hot pipes were covered. The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 1 2 3 4 5 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 4 X X X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 4 X X 3 X The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Manor Clinic DS0000070187.V353415.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection The Oast – Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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. 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