Care Home: The Manor House

What the care home does well People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. A relative commented: "I visited the home four times (at different times of the day) with no appointment and I was always impressed with what I found". People are treated respectfully and relatives are positive about the care being provided. Relatives told us: "They care well and encourage resident`s to get active those that can". "X was very ill and ended up in hospital, the Manor House spent a lot of time getting X back to their old self, X is very happy there". "Myself and all my family have always found the standard of care to be excellent". People living in the home are supported to maintain their independence and interests to enhance their quality of life. One person commented: "The range of activities and outings that are arranged are marvelous and undoubtedly helps to stimulate and maintain an interest by all those who are able to take part in these". Mealtimes are celebrated as a social occasion and people benefit from a varied and nutritious choice of food. People living in the home can be confident that their concerns will be listened to and acted upon. The home is generally well maintained providing a safe and homely place for people to live in and enjoy. People were positive about the staff working in the home. People told us: "The staff are friendly and efficient and are always occupied and busy either on general duties or on a personal level". "Very polite and always caring towards all residents and visitors". There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. What has improved since the last inspection? Areas of the home have been redecorated including the entrance foyer which is now brighter and more welcoming for people. The front porch has had a new roof and has been painted so this no longer leaks. Maintenance has been carried out on the lift and this now gives verbal prompts to assist people using it. Five new bedroom chairs have been purchased to provide added comfort for people living in the home. The ensuite bathroom in the bedroom known as the "annex" has been redecorated so this is more pleasant for the person occupying this room. The use of the dry laundry room has been extended and can now be used by the hairdresser, GP, District Nurse and families if required. What the care home could do better: Staff duty rotas need to clearly show the hours and staff designated to complete ancillary duties such as cleaning and laundry. This is so it is clear there are sufficient staff to support the needs of people living in the home. One person commented: "Organise the carers better, sometimes I have had to hunt for someone to take X to the loo". When ancillary staff are on holiday, suitable arrangements need to be in place to cover these shifts to make sure the services provided by the home continue to be provided effectively. One person commented: "Have more than one cleaner, if the one cleaner is off ill/holiday I found the carers having to do the cleaning". Systems should be in place to consult people on the quality of care and services provided on an ongoing basis so it is clear the service is being run in the best interests of people. A review of medicine management is required to ensure this is being given as prescribed to maintain the health of people. Care plans need to be managed so that staff have all the information they need to care for people effectively. They also need to be kept in a secure location to maintain the confidentiality of information relating to people living in the home. The Service User Guide needs to be reviewed to ensure it contains all of the required information to enable people to make an informed decision on whether to stay at the home. Key inspection report Care homes for older people Name: Address: The Manor House 6 Bawnmore Road Bilton Rugby Warwickshire CV22 7QH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Wade     Date: 1 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: The Manor House 6 Bawnmore Road Bilton Rugby Warwickshire CV22 7QH 01788814734 01788814734 manorhouse@pinnaclecare.co.uk wolston@pinnaclecare.co.uk Pinnacle Care Ltd care home 26 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) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 26 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 26 Date of last inspection Brief description of the care home The Manor House is a mature building with parts dating back to the 16th Century, and is set in its own grounds, adjacent to the village green, in Bilton, Rugby. The Manor House was converted from a private dwelling into a care home in 1985. The Manor is registered to take 26 older people with dementia. The Manor House has twenty-two single bedrooms, twenty-one of which have en-suite facilities. One of the two double rooms also has en-suite facilities. There are two communal bathrooms and four communal toilets. The home has three large communal lounges with south facing gardens. The accommodation is over two floors reached via Care Homes for Older People Page 4 of 34 3 1 0 3 2 0 0 9 26 Over 65 0 Brief description of the care home two passenger lifts. The local shops and amenities are a 2-minute walk away. Information in the homes brochure states that the weekly fees for care and accomodation at The Manor House are between £530 and £800 per week. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This inspection took place between 9.25am and 7pm. Two people who were staying at the home were case tracked but specific care issues relating to other people were also reviewed. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives where possible, looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Questionnaires were sent out to people living in the home as well as their relatives and Care Homes for Older People Page 6 of 34 some staff to ascertain their views of the service. Responses and comments from these questionnaires have been included within this report as appropriate. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, complaint records, quality monitoring records and medication records. People were observed in the lounge and dining areas to ascertain what their daily life might be like. A brief tour of the home was undertaken to view specific areas and establish the layout and decor of the home. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? Areas of the home have been redecorated including the entrance foyer which is now brighter and more welcoming for people. The front porch has had a new roof and has been painted so this no longer leaks. Maintenance has been carried out on the lift and this now gives verbal prompts to assist people using it. Five new bedroom chairs have been purchased to provide added comfort for people living in the home. The ensuite bathroom in the bedroom known as the annex has been redecorated so this is more pleasant for the person occupying this room. The use of the dry laundry room has been extended and can now be used by the Care Homes for Older People Page 8 of 34 hairdresser, GP, District Nurse and families if required. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may not always have the information they need to make an informed decision on whether to stay but they can be confident their needs will be assessed prior to them staying at the home to make sure these can be met. Evidence: We asked for a copy of the homes Service User Guide that is made available to people who may be interested in staying at the home. This was viewed and contained information about the facilities, services provided and fees. This document did not contain any information about the staff or manager qualifications/experience to make people aware that there are appropriately trained staff working in the home. The Service User Guide also did not contain a Statement of Terms and Conditions, a complaints procedure, address and telephone number of the Care Quality Commission, summary inspection report or standard form of contract for the service as required. This information is needed to help people make a decision on whether they would like Care Homes for Older People Page 11 of 34 Evidence: to stay at the home. We looked at the care files for two people living in the home to see if an assessment of their needs had been carried out prior to them coming to the home. Both files contained a pre-admission assessment of each persons needs and abilities. The manager said that it was usual practice for her to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. We found that sufficient information was available to enable the home to confirm they could meet each persons needs and to enable suitable care plans to be developed showing the staff support required to help meet these needs. People spoken to were unable to recall detailed information about the admission process. One person said they had been in hospital and when they arrived at the home staff just gave me a room. They stated that they knew when meals would be provided because there was a board up on the wall. A relative has commented I visited the home four times (at different times of the day) with no appointment and I was always impressed with what I found. Care Homes for Older People Page 12 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will be treated respectfully by staff delivering personal care. Care records are not always clear to demonstrate people are receiving the support they require to maintain their health effectively and promote their well being. Evidence: People looked cared for in that their hair had been combed, their nails were trimmed and clean and they were wearing clothing appropriate for the time of year to reflect their personal preferences. We observed people being supported to maintain their abilities such guiding people with frames to mobilize across the room. In one case where the person was finding this difficult, staff recognised this and obtained a wheelchair to support them for the rest of the distance. Comment cards received from relatives included the comments: They care well and encourage residents to get active those that can. X was very ill and ended up in hospital....the Manor House spent a lot of time getting X back to their old self, X is very happy there. Myself and all my family have always found the standard of care Care Homes for Older People Page 13 of 34 Evidence: to be excellent. Of the five comment cards received from people living in the home (some supported by relatives to complete), all stated they always receive the care and support they need. Care plans and daily records were available for each person. Each care file contained assessments of the persons abilities and identified some of their needs. We found that sometimes information about care needs was not always in the care files that staff use to support people which could lead to an oversight in providing care. We looked at the care files for two people identified for case tracking. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives where possible, looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The manager explained there are two files for each person. We established that the detailed care files were being stored in the managers office. A separate document describing the action staff should take to meet peoples needs was in each persons bedroom along with daily records. It was not evident that peoples capacity had been assessed to check they were able to make a decision for their records to be openly available in their room or if they wanted them to be kept in their room where any visitors could view personal information about them. The manager explained that both files should contain up-to-date and duplicate information where appropriate but we did not find this to be the case. We were told that one person had a pressure sore so looked at the care plans specifically relating to the management of this. The care plan file in the persons room contained no specific care plan for the management of pressure sores although it did state in a Personal Care care plan that their skin should be checked daily and cream applied. We were told that the district nurse was involved in this persons care but records did not demonstrate how, when or what support was being provided. The person was not able to tell us if this was happening due to their poor health. A care plan review record for September 2009 held in the file in the managers office indicated that the person was on a pressure relieving mattress and was to be turned two hourly to prevent any further damage to the skin. This information was not in the Care Homes for Older People Page 14 of 34 Evidence: care plan documentation staff were using. Current records did not make if clear if the person continued to have any sores and if so where they were. The manager said that the person did have a sore and the district nurse was applying dressings to this. A nutritional screening form which had been completed in August 2009 showed a high score meaning this person should have been assessed as high risk of poor nutrition. On viewing the care records that staff were using, this stated the person was at low risk from poor nutrition. We asked staff about how they were supporting this persons nutrition and they confirmed they were keeping records of what the person had eaten and any fluids they had taken. Charts were seen to confirm this in the persons room and those viewed indicated the person was eating and drinking well. We also found that this the person was being given four food supplements per day although records indicated the person was eating well. The person looked thin and frail but it was not possible to check any recent weight loss as they had not been weighed recently due to a deterioration in their health. Care plan reviews in many cases consisted of a date to indicate that the care need had been reviewed as opposed to staff recording if there was any changes to the persons health or staff support required. This meant it was difficult to evidence what had actually been reviewed. We found one persons personal care needs had changed from having a weekly bath to a daily bed bath but it was not evident from the care reviews when this change had occurred. If these changes are not clearly recorded this could result in an oversight in providing sufficient support to maintain the health of the person. We observed the behaviours of one person during the day and viewed this persons care file to see if this was their normal pattern of behaviour and how staff were to manage this. Care records gave no clear indications of how this persons dementia presented itself and the types of behaviours this person would normally display or how staff should manage this . This is important to ensure there is a consistent approach by staff in managing the persons care. Staff spoken to were knowledgeable of the persons behaviours and were able to give examples of what they had done to manage this without causing them any anxiety. Daily records were being completed each day but contained limited information about how peoples needs were being met. There were a lot of entries stating eaten and drank well, or appears to be fine and sleeping well as opposed to providing information about the persons health, how they have been supported during the Care Homes for Older People Page 15 of 34 Evidence: day/night and information about their behaviours. This information helps to build up a picture of the persons health to help staff identify any improvements or deterioration in their health as well as demonstrate the persons needs are being met consistently. We looked at the way the home manages peoples medication. We were told that medicines are only administered by staff who have received training in the safe administration of medicines. The member of staff responsible for medicines administration holds the keys on their shift to prevent any unauthorised access. Medicines were being kept in a small locked room and the majority of these were in blister packs (where tablets and capsules are in sealed pockets that staff push out when they are administered). These were being stored on rails on the wall but were not in a lockable medicine storage cabinet. The manager said that she was awaiting the maintenance person to fit a suitable cupboard to the wall to make the medicines more secure and this should be done very soon. There were more secure storage facilities arrangements in place for medicines that were not in blister packs. We audited the medicines of people involved in case tracking as well as others by comparing the quantity in stock against the signatures on the medicine administration records (MAR). One person had refused to take their medicines and staff had therefore discussed this with the doctor who had taken the decision to stop all of their medicines. A pain relief medicine had been prescribed for one person to take two when required. Records showed that sometimes staff were giving one. It was not possible to check that the amount received, given and remaining were correct as records were not clear. Staff said that the person did not always take all of this medicine and the person was not in pain anymore. A food supplement had been prescribed one to be given twice daily but records showed this was being given four times a day which is not how this had been prescribed. It was not evident from care plan records that four a day were required. A cream had been prescribed to be applied twice daily sparingly. Staff were signing the MAR to say this was being applied four times a day. People living in the home were observed to be treated with respect and were spoken to respectfully. For example people were asked discreetly if they needed to use the bathroom and any personal care was provided in private. We did find that personal care records were openly available in bedrooms viewed which means, private and Care Homes for Older People Page 16 of 34 Evidence: confidential information may be seen by visitors. It was not evident that this was something people wanted. Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from being able to participate in a variety of social activities to maintain their independence and interests and are able to choose from a good range of meals to help maintain their health and wellbeing. Evidence: Care records viewed indicated peoples hobbies, interests, likes and dislikes as well as topics of conversation that should be avoided by staff. This information helps staff to provide person centred care by supporting people with daily activities and interactions in a way that they would wish. The home does not have a planned programme of activities but we were told that social activities are provided on a daily basis and records are kept of activities that people participate in. On the day of our visit staff provided manicures and hand massages to some people during the morning while music was playing in the lounge. One person who was offered a manicure said Thats very kind, everything that you do is very kind. One person told us they regularly help with the washing up and they were seen helping to clear the tables after lunch. In the afternoon some people chose to play skittles. Care Homes for Older People Page 18 of 34 Evidence: Records of social activities showed that activities provided included: helping with the laundry, making Christmas decorations and magnets, playing with a ball, bus trip to Coventry Transport Museum, listening to music and helping in the kitchen. Staff spoken to were familiar with the preferences of people and how they liked to spend their day. Some people were observed to interact with one another or with staff and people seemed at ease to make requests of staff. Comment cards received by us from six people showed that five always felt there were social activities they could take part in and one person felt there usually was. A relative commented: The range of activities and outings that are arranged are marvelous and undoubtedly helps to stimulate and maintain an interest by all those who are able to take part in these. The home has an open visiting policy and people are encouraged to maintain links with their family, friends and local community. We were told that staff support people on shopping trips and weekly pub lunches. One person told us, On Fridays go out to a pub have a lunch out and thats where we go, we order it when we get there. Another person said that could go out if they wanted to and are mostly given choices on a daily basis about how they spend their day. They confirmed food choices are given and that they had eaten a cooked breakfast today. Menus seen showed that a good choice of meals were being provided including a variety of cooked items at breakfast time and a range of main courses including a vegetarian option. There were two deserts indicated each day and at teatime there were hot choices available as well as home made cakes. Supper in the evening included the provision of a range of sandwiches as well as hot drinks and alcoholic beverages. At lunchtime staff assisted people to the dining room to have their meal. Each of the tables were laid with tablecloths, napkins and cutlery and a choice of drinks was provided. Some people chose to have their meals in the lounge or their own rooms and meals were taken to them by staff. People were offered a starter of salad with mushrooms followed by a main course of shepherds pie or lamb chops or a savoury rice vegetarian option with a choice of seasonal vegetables. Semolina was provided for desert. Meals looked hot and appetising and people were given portions of their choice. Assistance was given to Care Homes for Older People Page 19 of 34 Evidence: people who needed help to eat their meal and some people were discreetly prompted to encourage them to eat. People were able to eat their meals in a relaxed environment at a pace suited to themselves. Comment cards received from six people living in the home showed that four usually liked the meals provided and two always did. Care Homes for Older People Page 20 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. Evidence: No complaints have been received by us since the last inspection and the manager of the home stated they also had not received any complaints. We received three concerns involving investigations by the local authority. One relating to a member of staffs behaviour and two relating to issues concerning the care of people. The home had been co-operative in supplying information and undertaking appropriate actions to investigate these matters. A complaints procedure was available although this was not seen on display in the home. This contained instructions for people to speak to a senior member of staff or the manager but did not list names or telephone numbers of these people should a visitor or relative wish to raise a complaint when not visiting. Details of a person at the organisations headquarters were given although the persons title/role within the organisation was not listed so that it was clear who people would be making contact with. Our contact details were included but were not up-to-date and the manager corrected this during the inspection. Care Homes for Older People Page 21 of 34 Evidence: The procedure did not contain details of who people should contact if they wanted their complaint to be investigated independently such as the Local Authority or an advocacy service. Comment cards received from six people in the home showed that they all felt there was someone they could speak to informally if they were not happy. Four people stated they knew how to make a formal complaint and two people said they did not know how to do this. Relative comment cards received from five relatives showed that they all knew how to make a complaint . Four out of the five felt that any concerns they had raised had always been responded to and one person had stated they had usually been responded to appropriately. We looked at the homes policy for responding to suspicion or allegations of abuse. The policy was clear in giving direction to staff on how to recognize abuse and how to respond to allegations or incidents of abuse. The training schedule for staff showed that they had completed training in recognising and responding to signs of abuse. Staff spoken to were aware of what actions they should take in the event of any allegations being reported to them or if they should observe this happening. Care Homes for Older People Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a generally well maintained environment but some attention to hygiene practices is required to ensure the home continues to be a pleasant place for them to live. Evidence: The home has two large lounge areas leading into one another, both of these areas were pleasant and homely with a variety of seating to suit all people. Chairs had been arranged in a way that encouraged people to interact but there was limited space for small tables for people to put their drinks on. One person was observed to have their eyes closed holding their cup of tea. Another person attempted to wake them up to ask them to drink it and prevent it from spilling but after several attempts gave up. A member of staff then removed the cup. In addition to the lounge areas there is a large area between the second lounge and dining room which has an attractive fireplace, seating and a dining table. At lunchtime some people chose to sit in this area. The dining room is large bright and welcoming and people were observed to use this area which was quieter than the lounges during the day. We looked at the bedrooms of the people involved in case tracking. Rooms were Care Homes for Older People Page 23 of 34 Evidence: comfortable and pleasantly decorated and people had bought in some of their own personal possessions to make them more personalised and homely. The home was bright and tidy and there were no unpleasant odours but there were areas of the home that were in need of cleaning. Corridors were in need of vacuuming, a bathroom was not clean and had no toilet rolls, soap or hand drying facilities. During the inspection the manager requested that a member of staff attend to the bathroom. Some of the bedrooms we looked at did not have handtowels and were dusty. The manager confirmed that no cleaning staff work over the weekend and that on the day of our visit the cleaner was on annual leave. She also explained that any light cleaning is completed by carers as required. It was not evident that any additional staff had been rostered to complete the cleaning of the home in the absence of the cleaning staff. We were told that since the last inspection there had been some improvements made to the home. This included maintenance of the lift which had resulted in the lift now giving vocal instructions when in use and redecoration of the foyer to the home. The function of the dry laundry room had been changed to a multi functional room which the district nurse, GP and visitors could use. Systems were in place for the management of dirty laundry including the use of protective clothing such as gloves and aprons. The laundry room was viewed and there were laundry bags for staff to use for transporting dirty laundry. We found that dirty washing had been placed in baskets which staff confirmed were for clean laundry. This does not promote good hygiene practices to help prevent the spread of infection. We also found a used incontinence pad on the floor in one of the bathrooms which also does not promote good infection control practices. The manager immediately removed this. Comment cards received by us showed that four our of six people felt the home was usually fresh and clean and two people felt it always was. One person commented: The Manor House would benefit from some decorating and replacement of furniture. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will be supported by friendly and approachable staff who are subject to ongoing training to ensure they care for people safely and effectively. Staff are subject to recruitment checks to ensure they are deemed safe and suitable to work with vulnerable people. Evidence: On the day of our visit there were 23 people accommodated in the home. The manager told us that three care staff are on duty during the morning and afternoon from 7.30am to 9.30pm plus a Team Leader or Deputy Manager and at night there are two care staff. The manager confirmed she works in a supernumerary capacity most of the time which means she is available to supervise and support care staff. Since the last inspection the deputy manager has left and another person identified to fulfill this role. The manager was hopeful that they would be able to commence their new position soon. We were told there is a member of catering staff in the kitchen between 8am and 2pm each day to prepare breakfast and the main midday meal. Kitchen staff prepare the evening meal but it is heated and served by care staff. The home has one person undertaking cleaning duties between 8am and 1pm during the week, there are no cleaning staff on duty at the weekends. We were told that care Care Homes for Older People Page 25 of 34 Evidence: staff undertake cleaning duties during this time if required. Care staff also undertake laundry duties. We identified during the inspection that the person who usually undertakes the cleaning was on annual leave. No member of staff had been identified to complete the cleaning in this persons absence. We observed that care staff were busy in supporting the care needs of people living in the home with little time to allocate to any cleaning tasks. During the tour of the home we found areas that were in need of cleaning. Duty rotas seen did not make clear how many hours were allocated to laundry and cleaning duties and who was to complete these duties. This means we cannot be confident there are sufficient hours being allocated to ancillary duties as well as care duties so that this does not impact on the quality of care and services people receive. Duty rotas also did not define the hours of each shift to show there are sufficient numbers of staff on duty at all times. This information was discussed with the manager during the inspection. People spoken to about the staffing arrangements said, They are very good the staff. Staff are not bad, not too bad Comment cards received from five relatives showed that one person felt the home always responded to the different needs of individual people, three felt they usually did and one person stated they sometimes did. Two felt the service always gave the support to their relative as they would expect and two felt they usually did. One person did not respond. Staff comment cards stated that they usually felt there were enough staff to meet the individual needs of people. Comment cards received from six people living in the home showed that three people felt staff were always available when they needed them and three people felt they usually were. Comments received relating to staffing included: In terms of caring my family have always found the standard of care to be excellent. Very polite and always caring towards all residents and visitors. Organise the carers better, sometimes I have had to hunt for someone to take X to the loo. The staff are friendly and efficient and are always occupied and busy either on general duties or on a personal level. Have more Care Homes for Older People Page 26 of 34 Evidence: that one cleaner, if the one cleaner is off ill/holiday I found the carers having to do the cleaning. The home does not use agency staff to cover holidays or unplanned absence such as sickness but relies on permanent staff working overtime. This means that people living in the home have some continuity and are cared for by staff that are familiar with their needs. We observed that there were periods during the day when staff were rushed but there were also periods of time when staff had time to spend talking to people. Staff spoken to were knowledgeable about peoples needs and abilities and offered appropriate support while encouraging people to retain their independence. The personal files were viewed for two staff working in the home. Both contained evidence that Criminal Record Bureau (CRB) had been applied for and received. Protection of Vulnerable Adult (PoVA First) checks and satisfactory references were also obtained prior to them commencing work at the home. It was not evident that additional information had been explored in regard to a criminal record bureau check. This was discussed with the manager with a view to demonstrating that all information received is fully explored and considered prior to staff employment . Induction training is provided for new staff but it was not clear that staff competencies had been assessed against the Skills for Care common induction standards. Staff competency needs to be demonstrated so that is clear staff are deemed safe and competent to work with people safely and appropriately. Staff training records demonstrated that staff had completed mandatory training including abuse awareness, fire safety, food hygiene, manual handling and medication. Records showed that fourteen care staff are employed by the home and of these there are five with a National Vocational Qualification in Care (NVQ). Additional staff are identified to complete this training which should bring the home up to the fifty percent standard required. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an effective manager in place to ensure the home is competently managed. There are not always opportunities for people to contribute to the quality monitoring of the care and services provided to demonstrate the home is being run in the best interests of the people living in the home. Evidence: The registered manager has been in post since February 2007. She is qualified to NVQ level 3 in Care and has completed the Registered Managers Award. She is experienced in the care of older people and dementia care. Staff spoken to said that they felt well supported by the manager. Comments included: I like it here, I am very happy. Its a pleasure to work as part of the team The manager told us there have been no further surveys sent to people or their families since September 2008 to seek their opinion on the services and care provided by the home. Care Homes for Older People Page 28 of 34 Evidence: There was some evidence that other methods of monitoring the quality of the service had been used such as medication audits and bedroom audits. We could not evidence that the service had involved people in giving their opinions on the quality of care and services they receive on an ongoing basis. Comment cards received from people contained the following comments about the home: They care well and encourage residents to get active those that can I feel they are doing their best This year they invited relatives and friends to join the resident for dinner on Mothers Day, Fathers Day and Christmas Day, I thought this was an excellent idea. X gets looked after very well and is always dressed nicely when I visit, staff are always there to answer any questions. I am very pleased with the home that I chose for X The service does not hold personal monies of people or valuables for safe keeping. The service operates a monthly invoicing system on a any expenditure of people such as hairdressing or chiropody. Effective systems are in place for the ongoing maintainance of the home to promote the safety of people, this includes regular maintenance checks. Staff can complete a maintenance request form if they identify anything needing attention which is then addressed by the maintenance person who supports the home. A sample of service and maintenance records were examined including Gas, Hoists, Lift, Electrical Wiring and Fire and all were found to be up to date as appropriate. We found that some of the hot water temperature checks were lower that the recommended temperature which could mean that sometimes the water may not be warm enough for people to wash in. The manager agreed to look into this. Incidents and accident records were viewed and had been completed appropriately. Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 34 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 7 12 People with pressure areas/sores must have a care plan in place showing the required actions to be carried out by staff to prevent further damage to the skin and detailing any actions required to manage the pressure areas/sores. Records must also demonstrate these staff actions have been carried out. This is so that any person with a pressure sore/area can be confident this will be appropriately managed to maintain their health. 18/02/2010 2 9 13 Medicines must be given as 18/02/2010 prescribed. This includes ensuring the correct number of tablets/capsules/food supplements are given at the times alloted and creams being applied in Care Homes for Older People Page 31 of 34 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 accordance with prescribing instructions. This is to ensure people receive their medicines in accordance with professional advice to maintain their health. 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 1 The Service User Guide for the home needs to contain all of the required information to make sure people have all of the information they need to make an informed decision to stay. The practice of keeping two care plans should be reviewed to ensure staff have all the information they need to provide effective care and are working with up-to-date information. The practice of keeping confidential and personal care plan information openly available in peoples rooms should be reviewed. This is because confidential information may be disclosed to visitors that the person may not wish to happen and which may not be in the persons best interests. The complaints procedure should be reviewed to ensure this contains sufficient information in relation to contacts, addresses and telephone numbers for people to raise any concerns both within the home as well as externally. Consideration should be given to making small tables available in the lounge areas next to where people sit so that people have somewhere to place their drinks and any personal items of their choosing. All areas of the home need to be maintained in a clean condition consistently so that people can live in a clean, Page 32 of 34 2 7 3 7 4 16 5 19 6 26 Care Homes for Older People 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 pleasant and safe home. 7 26 Toilet rolls, soap and handtowels should be readily available to people in their rooms as well as bathrooms at all times so that effective hygiene can be maintained. Action should be taken to ensure dirty laundry and clean laundry is managed separately and there are suitable storage facilities available for both which are clearly labelled to help promote good infection control practices. When ancillary staff are on holiday, suitable arrangements should be made to cover these shifts to ensure people continue to receive effective services. Duty rotas need to demonstrate the hours and names of staff allocated to complete ancillary duties. This includes cleaning and laundry so that it is clear there are sufficient hours being provided to support the needs of people living in the home. The service needs to demonstrate that any information provided on Criminal Record Bureau checks is explored and risk assessed as appropriate to safeguard people living in the home. Staff competencies need to be demonstrated as part of the induction training in line with the Skills for Care common induction standards so that it is clear staff have been deemed suitable to provide safe and appropriate care to people. People living in the home and/or their representatives should be consulted on the ongoing quality of care and services they receive so it is clear the service is being run in their best interests. Quality monitoring systems should be reviewed to ensure the service can demonstrate this. The hot water temperatures in the home need to be rechecked and monitored to ensure all hot water outlets are providing sufficiently hot water for people to wash in consistently. 8 26 9 27 10 27 11 29 12 30 13 33 14 38 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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. 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