Care Home: The Manor House

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What the care home does well The Manor House provides a homely atmosphere for persons with sight impairment. The Service User Guide is produced in both a written and Braille form. The Registered Provider/Manager ensures appropriate assessments and care planning takes place to give staff clear information about service users` needs. Service users live in a supportive environment that provides appropriate education, training and equipment to enable them to maximise their independence, and to prepare for an independent life in the community. What has improved since the last inspection? The Registered Provider/Manager responded to the requirements and recommendations following the inspection in February 2008. There is a programme of maintenance, and redecoration of the hall, stairs and back lobby had been carried out, with further improvements planned. The home`s policies and procedures have been reviewed and updated where necessary. What the care home could do better: Requirements: This is what the home must do to improve. There must be a commitment to staff training and development over the next six months linked to the aims of the home and the specific needs of the service users, with recorded mandatory updates. This should cover such things as an understanding of their roles and responsibilities for safeguarding vulnerable adults, food hygiene, first aid, infection control, medication administration and diabetes.Recommendations: This is what the home could do to improve. Whilst it is acknowledged that the service users administer their own medication it is recommended that staff should receive medication training to enable them to administer medication safely should this be necessary. The complaints policy should be updated to include timescales for action and the contact details of local Social Services and CSCI. Staff should receive annual recorded appraisals and regular, recorded supervision so that training needs can be identified and addressed. An annual quality assurance monitoring system should be implemented to ensure that feedback from service users, and others, helps to improve the service that the home provides. CARE HOME ADULTS 18-65 The Manor House Main Street Fleckney Leicestershire LE8 8AP Lead Inspector Mrs Carole Burgess Unannounced Inspection 29th September 2008 09:45 The Manor House DS0000001724.V372616.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 House DS0000001724.V372616.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 House DS0000001724.V372616.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Manor House Address Main Street Fleckney Leicestershire LE8 8AP 0116 2403147 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) edithtownsend@talk21.com Dr Michael Edward Townsend Mrs Edith Townsend Dr Michael Edward Townsend Mrs Edith Townsend Care Home 6 Category(ies) of Sensory impairment (6) registration, with number of places The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No additional conditions of registration. Date of last inspection 21st February 2008 Brief Description of the Service: The Manor House is situated in the village of Fleckney, in Leicestershire and is registered to accommodate up to six adults with a sensory impairment. The home is a mature, historic listed village manor house, within walking distance of the local amenities and close to a local bus route. The accommodation is on three floors, which is accessed by two stairways. Service users have self-contained flats that are personalised and promote individual independence. At the time of the inspection the service users were sharing their facilities with tenants, some of which have visual impairment. The Statement of Purpose, Service Users Guide & Inspection Report were available on request (these provide information on how the home is organised and what services it provides). The Service Users Guide and Terms and Conditions were also available in Braille. Weekly Fees at the time of inspection were: £230 - £324. Extras may include travel expenses other than local travel. The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. ‘We’ as it appears throughout the Inspection Report refers to ‘The Commission for Social Care Inspection.’ The focus of the inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who use the service and their views of the service provided. Planning for the inspection included reviewing the previous inspection report, reviewing the Annual Quality Assurance Assessment (AQAA) - a selfassessment completed by the providers, assessing notifications of significant events and reviewing the service history to date. The CSCI have not received any complaints about the home. The site visit was unannounced and took place over four hours. We selected two service users and tracked the care they received through a review of their records, discussion with them (where possible), the care staff, and observation of care practices. We spoke with staff members regarding training and support. We sent out pre-inspection surveys to people who use or are involved with the service. We received two, one from a member of staff and one from a service user. Both replies indicated that they were satisfied with the service provided. A service user said that she was very happy living in the home and was supported to be independent and have a full and active social life. The Registered Manager staff and service users spoken with were positive and helpful during the inspection. The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Requirements: This is what the home must do to improve. There must be a commitment to staff training and development over the next six months linked to the aims of the home and the specific needs of the service users, with recorded mandatory updates. This should cover such things as an understanding of their roles and responsibilities for safeguarding vulnerable adults, food hygiene, first aid, infection control, medication administration and diabetes. The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 7 Recommendations: This is what the home could do to improve. Whilst it is acknowledged that the service users administer their own medication it is recommended that staff should receive medication training to enable them to administer medication safely should this be necessary. The complaints policy should be updated to include timescales for action and the contact details of local Social Services and CSCI. Staff should receive annual recorded appraisals and regular, recorded supervision so that training needs can be identified and addressed. An annual quality assurance monitoring system should be implemented to ensure that feedback from service users, and others, helps to improve the service that the home provides. 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 House DS0000001724.V372616.R01.S.doc Version 5.2 Page 8 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 House DS0000001724.V372616.R01.S.doc Version 5.2 Page 9 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): 1 & 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are provided with information about the home, and have their health, welfare and social care needs assessed, so that they can be met once they move into the home. EVIDENCE: The home provides prospective and current service users with a Statement of Purpose and Service Users Guide (both give information about the home) to help them decide if the home is the right one for them. The Service User Guide was also available in Braille. The assessment process and documentation were satisfactory. These were supported by a Social Service needs profile, reviewed and updated annually with the involvement of the service user thereby ensuring that the service users’ health, welfare and social needs continued to be met. The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 10 Prospective service users have the opportunity to visit the home before moving in. A service user said that she and a relative had been invited to stay for a weekend to see if the home was the right one for them. The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 11 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 & 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ independence is promoted and supported enabling them to make decisions and choices that affect their daily lives. EVIDENCE: Care plans and daily records contained information about the support service users required in their daily lives to maximise their independence. Both service users were fully involved in their annual reviews with their social worker and Registered Provider/ Manager to ensure their care plans were up-to-date and reflective of their changing needs. The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 12 Care Plans focused on the service users strengths, needs and personal preferences. They detailed how current needs and goals were to be met through individualised support. Daily diaries written by the service users supported these and showed that service users were provided with individualise support and guidance to enable them to enjoy their life in the way they chose. Risk assessment and specific training were provided to promote maximum independence and enable service users to take acceptable risks, which promote self-determination and independence, such as walking to the shops unaided. One service user said she had been assisted through Vista training to travel by bus to a specific location enabling her to have more independence. The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 13 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 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy, experience and participate in different activities and interests, and are supported to maintain their preferred individual daily routines. EVIDENCE: Service users have various interests and attend activities, such as: VISTA, Torch Trust, craft sessions and the church. Service users were independent and use the services within the local community such as the library, shops and local health centre with minimum support from the care staff. The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 14 One service user had contact visits and short holidays with her family, and the home made her family welcome and provide overnight accommodation where necessary. Staff do not keep daily records because service users were assisted to maintain their own diaries. The diaries were word processed and kept in the services users’ files and provided a detailed daily record of the service’s daily life. Staff prepared the main meal of the day but service users were encouraged to prepare their own meals and staff assisted service users where necessary. Stock items were bought from a well-known supermarket but service users also to did their own shopping for small items at the local stores so that they were able to be more independent and exercise choice and personal preferences. The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 15 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 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are well supported in respect of their health and personal care. And their independence is promoted by receiving support, when required, in the preferred way. EVIDENCE: Neither service user required help with intimate personal care although checks and prompts were in place to ensure that they were dressed appropriately, i.e. clothes not inside out, which may cause the wearer embarrassment, and in coordinating and preferred colours. Colour preferences were recorded in care plans as one person stated that she did not like dark colours. The service users living in the home were very independent and had an active and full life. A service user said that she could get up, wash, dress and make her own meals and come and go as she leased on a daily basis. She did their own washing, and kept her flat clean and tidy, with a little assistance from The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 16 staff. Equipment such as the washing machine and microwave are adapted to enable visually impaired people to use them unaided. One of the serviced users has her own phone and rings the GP if she needs to and both service users were largely independent and managed their own healthcare needs. Although service users were risk assessed and managed their own medication there was an instance where a service user was unwell and required assistance. Carers said that they were not entirely comfortable with the extent of their roles and responsibility as the medicines had not been pre-dispensed, and there was no prescription sheet to sign. It is recommended that staff should receive medication training, and advice should be sought from the GP and local pharmacist, to ensure that the correct procedures are in place should this occur in the future. The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 17 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 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were protected by the complaints policies and procedures, and arrangements for receiving and responding to complaints were satisfactory. EVIDENCE: The CSCI has not received any complaints regarding the home. The home has not received any complaints from service users or their relatives since 1996. Minor concerns are dealt with informally on a day-to-day basis, within a family style environment, which was preferred by the service users. The complaints procedure was available in Braille and included in the Service Users Guide. A service user said that she could discuss concerns with the home’s staff. However, information regarding complaints required additional information which should include timescales for action and the contact details of local Social Services and the CSCI. The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 18 The home’s complaints and safeguarding policies and procedures reflect the current local Multi Agency Policy & Procedure For The Protection of Vulnerable Adults from Abuse, No Secrets’ publication and a copy was available for staff. However, all staff spoken with remain unclear about adult safeguarding procedures, and how to manage allegations of abuse and had they had not received any training on this topic to ensure that they know what their roles and responsibilities were. This should be addressed and training provided to ensure that service users are fully protected. The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 19 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 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A comfortable, clean and homely standard of accommodation is provided for service users. EVIDENCE: The home was comfortable and homely, and provided service users with an environment that helped and supported their independence. There was a four-year maintenance plan in place and some redecoration had been completed since the last visit in February 2008. The décor, in places, and the garden needs some attention. There were some uneven paving slabs leading to the front door that could be hazardous to a visually impaired person and should be attended to as soon as possible. The ground floor windows were The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 20 in a poor state of repair and require replacing. The Registered Provider/Manager said that they would be done when finances allowed, as they would be very expensive to replace as it was a listed building. The laundry was domestic in nature, and in keeping with the independence needs the current service user group. The home had adaptations to suit service users’ specific needs and was fresh and clean on the day of the inspection. The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 21 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 & 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff at the home are sufficient in numbers to meet the service users’ needs. EVIDENCE: On the day of inspection the Registered Provider/Manager was on duty with two other care staff. A resident member of staff covers the ‘sleeping-in’ night shift. The small, stable staff group provides almost one-to-one support for the service users in a family orientated atmosphere. A service user said that there was always a member of staff on duty, who provided the support they needed. Three staff files were checked and contained satisfactory evidence of preemployment checks, such as an application form, references and Criminal Records Bureau (CBR) clearances. Tenants had also been CRB checked to ensure the safety of the service users. The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 22 Staff have ‘in house’ training and support in the care of people whith a visual impairment. However, there was no evidence of any recent training for staff, although one member of staff had completed a National Vocational Qualification (NVQ), in Care, Level 2 and another had evidence of training from a previous employment. This remains unchanged from the previous visit in February 2008. Staff indicated that they would welcome training in specific areas: First aid, food hygiene, safeguarding vulnerable adults, understanding diabetes and medication training, with annual mandatory updates planned thereafter, to ensure that staff had the necessary knowledge to support the service users. Staff do undertake a basic induction, which was recorded, and the Registered Provider/Manger said that she provides “in house” training, enabling staff to assist in clients’ independence but this was not recorded to show that staff receive the specific training required to care for service users with visual impairment or loss. The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 23 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): 37, 39 & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Provider/Manager provides supportive guidance to staff and service users. EVIDENCE: The home has a Registered Provider/Manager who has many years of experience in caring for people with visual impairment, although she has no formal qualifications in care. The Registered Provider/Manager is in daily contact with both her service users, and has amassed a great deal of expertise The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 24 over time to run the home. There is an ethos of warmth and openness in the home and staff deliver a good standard of support for the people in their care. As identified following the previous visit in February 2008, there was no formal quality assurance system in place to collect information from interested parties in contact with the home. Although it is recognised that this is a small home with daily contact with service users in a family orientated atmosphere it is recommended there should be some method to elicit feedback from other stakeholders such as relatives, local GP’s and healthcare professionals to help identify where improvement to the service could be made. As noted at the last visit staff meetings do not take place as the Registered Provider/Manager stated the majority of staff worked part time and would find it difficult to attend. Regular, recorded staff appraisals and supervision (a regular review of staff’s personal and training needs in relation to their work) were not in place. This would help to identify individual experiences and training needs and also compensate for the lack of staff meetings. Service users have their own bank accounts and manage their own finances with minimal support from staff if required. There was a risk assessment for a service user who wanted water hotter that the recommended 43 degrees Celsius. Health and Safety Policies and Procedures, such as regular gas boiler checks, Potable Appliance Tests (PAT), fire equipment checks and fire drills were completed; which ensures the health and safety of the service and staff. The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 25 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 Score 1 3 2 3 3 X 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 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 2 X 3 X 3 X X 3 X The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA35 Regulation 18 (1) (c) Requirement There must be a commitment to staff training and development linked to the aims of the home and the specific needs of the service users, with recorded mandatory updates. This should include an understanding of their roles and responsibilities for safeguarding vulnerable adults. Timescale for action 01/04/09 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 YA20 Good Practice Recommendations Whilst it is acknowledged that service users administer their own medication it is recommended that staff should receive medication training to enable them to administer medication safely should this be necessary. It is recommended that the complaints policy be updated to include timescales for action and contact details of local Social Services and CSCI. DS0000001724.V372616.R01.S.doc Version 5.2 Page 27 2. YA22 The Manor House 3. 4. YA36 YA39 It is recommended that staff receive annual recorded appraisals and regular, recorded supervision. It is recommended that an annual quality assurance monitoring system be implemented to ensure that feedback from service users, and others, helps improve the home. The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 The Manor House DS0000001724.V372616.R01.S.doc Version 5.2 Page 29 - 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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