Care Home: The Manor, Exminster

What the care home does well Since the last inspection the home has replaced the interim manager with a permanent manager. This person started work here six weeks ago. Since then a deputy manager has also been appointed, who has been in post for two weeks. The manager and deputy have identified a number of issues which need attention. These include staff competence, training, care planning, some safety aspects and activities. The manager reports that the home now has a stable staff group and that training in caring for people with dementia has commenced. Some staff are studying this formally and others are receiving training within the home from the manager and via an information booklet introduced by the manager. The manager and deputy work alongside care staff showing them how to deliver quality care. They are showing them for example how to be more respectful and how to use the lifting equipment. The manager has identified those people living here who are at risk due to their high level of need. She has made referrals to appropriate agencies and put measures in place to help keep these people safe. In addition the fire in the lounge is now protected to help prevent people from accidental scalding, the free standing heating in the dining room has been removed and care records are kept securely. The manager has also made arrangements to help meet the social needs of people living here. Arts and crafts sessions have been introduced and one person is designated to provide activities and support people socially in the afternoons. What the care home could do better: Care plans do not provide the level of detail needed to ensure staff give appropriate care to meet needs. For example care plans do not tell staff how to support people at risk of developing pressure sores. No pressure relieving equipment is specified and whilst care plans tell staff to observe for pressure sores, staff we spoke with did not know what signs to report. We saw that staff had made a record that one person has signs of a potential pressure sore. However, this information was not known by the manager and the records are not reviewed on a regular basis. This means that this risk has not been addressed in a timely fashion. One person has been assessed as needing a pressure relieving mattress which the District Nurse is supplying. However, no other measures have been taken to reduce to the risk of this person developing pressure sores whilst waiting for the mattress to be delivered. This person who spends a lot of time resting in bed reports that the mattress is causing their skin to be sore. We talked to the manager about the concern raised with us. This related to someone alleging that people living here were not safe from abuse. The manager was aware of this situation. She says that this issue was addressed and that people are safe from abuse but that some staff were not being as respectful as they should be. The manager did not keep records relating to this issue as she should do. She had not consulted the procedures relating to safeguarding people from abuse and had not read the whistleblowing policy, and was not sure therefore if she had followed the correct procedure. The home does not have a copy of the document `The Alerter`s Guide` and the manager or staff are not familiar with the locally agreed procedures relating to safeguarding. Inspecting for better lives Random inspection report Care homes for older people Name: Address: The Manor, Exminster Main Road Exminster Exeter Devon EX6 8AP one star adequate service 07/01/2009 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: Teresa Anderson Date: 1 5 0 4 2 0 0 9 Information about the care home Name of care home: Address: The Manor, Exminster Main Road Exminster Exeter Devon EX6 8AP 01392824063 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) : The Manor, Exminster Ltd care home 25 Number of places (if applicable): Under 65 Over 65 25 0 old age, not falling within any other category physical disability Conditions of registration: 0 25 The maximum number of service users who can be accommodated is 25. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability (Code PD) Date of last inspection Brief description of the care home The Manor is a Georgian house set in its own grounds in the village of Exminster, Devon. The home provides service for up to twenty-five people who are aged over 65 years of 0 7 0 1 2 0 0 9 Care Homes for Older People Page 2 of 10 Brief description of the care home age. The premises have been extended to include 7 single ensuite bedrooms, all located on the ground floor with level access. Bedrooms on the first floor are accessed via stairs or a stair lift and have toilet and bathing facilities within close proximity. There are two lounges and a separate dining area. The garden area is situated at the front of the building. It is block-paved with an attractive fountain and seating. Local amenities are a short walk away and local bus services into the city of Exeter are within easy access. The homes current level of fees are available direct from the home. Fees do not include personal items, such as non prescribed medicines, hairdressing, chiropody, dentist fees, optician fees, newspapers and other personal items. Care Homes for Older People Page 3 of 10 What we found: We visited this home to monitor progress in relation to the requirements made at the last inspection. We had also received a concern that an allegation of potential abuse had not been taken seriously or dealt with adequately. We visited the home between 11.00am and 3.00pm. We spoke with the manager and with two members of staff. We visited approximately ten bedrooms and spoke with approximately 5 people who live here. We also looked at care plans. We found that some progress has been made in relation to some of the requirements set at the last inspection. We have agreed to extend the timescale for those that are not met. We also found that the manager had not responded satisfactorily to the allegation made as she had not followed the procedures relating to safeguarding, and had not kept any records of the incident and interviews undertaken. However, we have not found evidence that people are at risk of abuse. What the care home does well: What they could do better: Care plans do not provide the level of detail needed to ensure staff give appropriate care to meet needs. For example care plans do not tell staff how to support people at Care Homes for Older People Page 4 of 10 risk of developing pressure sores. No pressure relieving equipment is specified and whilst care plans tell staff to observe for pressure sores, staff we spoke with did not know what signs to report. We saw that staff had made a record that one person has signs of a potential pressure sore. However, this information was not known by the manager and the records are not reviewed on a regular basis. This means that this risk has not been addressed in a timely fashion. One person has been assessed as needing a pressure relieving mattress which the District Nurse is supplying. However, no other measures have been taken to reduce to the risk of this person developing pressure sores whilst waiting for the mattress to be delivered. This person who spends a lot of time resting in bed reports that the mattress is causing their skin to be sore. We talked to the manager about the concern raised with us. This related to someone alleging that people living here were not safe from abuse. The manager was aware of this situation. She says that this issue was addressed and that people are safe from abuse but that some staff were not being as respectful as they should be. The manager did not keep records relating to this issue as she should do. She had not consulted the procedures relating to safeguarding people from abuse and had not read the whistleblowing policy, and was not sure therefore if she had followed the correct procedure. The home does not have a copy of the document The Alerters Guide and the manager or staff are not familiar with the locally agreed procedures relating to safeguarding. 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 5 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 (1) (2) Each person living 27/03/2009 here should have a plan of care that details what their needs are and how these are to be met. This will help to ensure that peoples needs are met in a way that is appropriate, and is consistent. It will also help to ensure that reviews carried out are based on the care that is planned and given. 2 18 13 (6) Staff at the home should 27/03/2009 be familiar with the local procedures to follow if abuse were suspected or alleged. By doing this, it is more likely that appropriate actions will be taken to protect people living at the home. 3 31 9 The providers must make an 24/04/2009 application to register a manager with the commission. This will help to ensure that the overall management of this home is such that outcomes for the people living here improve, risks are managed or reduced and Care Homes for Older People Page 6 of 10 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action that staff benefit from consistent leadership. 4 38 13 (4) (e) Risk assessments in relation to the hot to touch fire and the free standing heater in the dining room must be carried out and action taken to ensure that these risks are managed. This will help to ensure that people are safe from accidental burns. 13/03/2009 Care Homes for Older People Page 7 of 10 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 (1) (2) Each person living 26/06/2009 here should have a plan of care that details what their needs are and how these are to be met. These plans of care should be reviewed using all the information available. This will help to ensure that peoples needs are met in a way that is appropriate, and is consistent. It will also help to ensure that reviews carried out are based on the care that is planned and given. 2 8 12 (1) (a) People must be assessed to determine their risk of developing pressure sores. An accredited risk assessment must be used. Actions must be taken to address the risks identified. This will ensure that appropriate actions are always taken to prevent people from developing pressure sores. 29/05/2009 Care Homes for Older People Page 8 of 10 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 18 13 (6) Staff at the home must 29/05/2009 be familiar with the local procedures to follow if abuse were suspected or alleged. This will help to ensure that people are kept safe from abuse. 4 18 13 The home must have a whistleblowing policy and staff and management must be familiar with this. In this way people will know what their rights are if they whistleblow and will be protected if they do this. 29/05/2009 5 31 9 An application must be made 26/06/2009 to the commission to register a manager for this service. This will help to ensure that the overall management of this home is such that outcomes for the people living here improve, risks are managed or reduced and that staff benefit from consistent leadership. 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 Care Homes for Older People Page 9 of 10 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: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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