Care Home: The Manor House

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What the care home does well The staff are friendly and work together to deliver care to the people living in the home. Staffing levels are designed to meet people`s needs throughout the day and night. The person in charge is fair and consistent in her manner and style of running Manor House. What has improved since the last inspection? Since our random inspection in December 2009 there has been significant noticeable change in care being given in an individual, person-centred approach. The attention to individual people as individuals was seen in practice by the majority of the care staff. It was evident that the dementia care and person centred awareness training, and supervision from the person in charge, is being embraced as a philosophy of care. What the care home could do better: Care plans must continue to improve to show what individual needs each person has and show how these needs can be met in a person centred way. Communication between staff should also continue to improve so that staff have accurate information on changes and needs of each person. Information about individuals must be recorded on their care files to ensure confidentiality. Changes to work practices and cultures must continue to ensure that people are cared for in a flexible way. Staff must ensure their work practices fit around each person rather than the other way around. Staff must also remember that people less able to express their views are consulted about choices about, for example, the time they are woken up or what they would like for their breakfast. Staff must also make sure they do not assume that some people consistently want the same things or routines each day. By ensuring the staff culture and attitudes continue to change at the home will mean that people will feel able to take more control over their daily lives. The safety of people in the home must continue to be a priority. Recruitment procedures and practice must be robust so that people residing at Manor House know they are safe from harm. Key inspection report Care homes for older people Name: Address: The Manor House 135 Looseleigh Lane Derriford Plymouth Devon PL6 5JE     The quality rating for this care home is:   two star good 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: Megan Walker     Date: 0 3 0 6 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: The Manor House 135 Looseleigh Lane Derriford Plymouth Devon PL6 5JE 01752777572 01572776628 info@southwestcarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): South West Care Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 30 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 are within the following categories: Old age, not falling within any other catetgory (Code OP) Dementia (Code DE) Date of last inspection Brief description of the care home Manor House is registered with the Care Quality Commission to provide residential accommodation and personal care, for up to 30 persons for reasons of age and who may also have a dementia. The home does not provide intermediate care and it is not registered to provide nursing care. South West Care Homes Limited owns Manor Care Homes for Older People Page 4 of 30 Over 65 0 30 30 0 0 9 1 2 2 0 0 9 Brief description of the care home House. It is one of eleven care homes owned by the company across Plymouth, Cornwall and Somerset. Manor House is located in the Derriford area of Plymouth, close to the hospital, transport routes and other amenities. The home consists of a detached two-storey house with a two-storey extension and has been modified with ramps and a shaft lift. There are twenty-eight single bedrooms - sixteen on the ground floor and twelve on the first floor. There is one shared room on the first floor. Seventeen bedrooms have en-suite toilets. Bathing, showering and toilet facilities are available on each floor, close to bedrooms and communal rooms. There are a lounge and dining room on the ground floor, as well as a smaller lounge with a dining table. There is a call bell system installed throughout the home. The home has a large garden at the rear and there is car parking at the front of the home and on street parking is available nearby. Weekly fees are according to assessment of the persons individual care needs. Additional charges include hairdressing, chiropody, toiletries, newspapers, magazines, journals etc, all charged at commercial rates, and escort for hospital and GP appointments. Written information including information about additional charges is available for people considering going to live at Manor House and for those who are resident from the home. A copy of the most recent inspection report is also available from the home. Care Homes for Older People Page 5 of 30 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: two star good 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 quality rating for this service is two star. This means the people who use this service experience GOOD quality outcomes. This was a Key Inspection undertaken by one regulation inspector. The fieldwork part of this inspection was unannounced. It took place on Tuesday 18th May 2010 between 10:00 and 16:30, and on Thursday 3rd June 2010 between 07:30 and 17:40. An Expert by Experience joined the inspection on the first day. He visited individuals in their rooms during the morning, and ate lunch with the people eating in the main dining room. The Care Quality Commission considers an Expert by Experience as a person who either has a shared experience of using services or understands how people in this service communicate. The person in charge of the daily running of Manor House (whom we met at our last key inspection when she was new in post) was available during our visit for consultation and information such as the day-to-day routines as well as the management of the home. She was also able to give us an update on things that have Care Homes for Older People Page 6 of 30 happened/are planned at Manor House. This inspection included talking to and observing a number of the people who live at the home. We also spoke to relatives of people who live at the home. We spoke to care staff working at the time of this visit as well as observing interactions between the staff and the people using this service. We conducted a tour of the premises, inspected four care plans, four staff files, medication and other records and documentation. Two surveys were returned from relatives of people residing in the home. Throughout this report, the term we will be used as the report is written on behalf of the Care Quality Commission (CQC). There is one outstanding requirement from the previous inspection and five good practice recommendations made as a consequence of this inspection. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? 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 8 of 30 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 9 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not Inspected Evidence: Since the last inspection Plymouth Social Services has imposed its commissioning policy upon Manor House because of its rating. Therefore no new residents have moved into Manor House since the last inspection. We therefore did not inspect this outcome group. Care Homes for Older People Page 10 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Manor House are treated with respect and their personal and health care needs are met. There are arrangements in place to ensure that medication is administered in a safe way. Evidence: We spoke to fifteen people living at Manor House. They told us that usually there were sufficient staff on duty to meet their needs. Residents said there were no communication difficulties. Comments about the staff included, The staff are as good as gold, The staff can be cheeky, a bit of fun but they are very helpful and there is not one I dont like, Staff alright, Girls OK and Staff are very nice. A visitor said, The staff are excellent, they have time for residents. I cant praise the staff enough. They call the doctor with no hesitation. Relatives who returned surveys told us Personal care of my relative has always been good.Staff phone/contact readily if there is anything I need to know. [My relative] Care Homes for Older People Page 11 of 30 Evidence: is extremely well looked after by the staff members, encouraged to be independent and do things for herself. The staff treat the residents very well. The people we spoke to told us that call bell response time was within five minutes both day and night. We found that bells are linked to two call bell panels that are not linked together. We observed the staff and found they had to check each board. The staff told us that a new system had been installed without the original being removed. We found that in the lounge and the Pink Room, the call bells are switches on the wall. They look like light switches. People who were sitting in these rooms were able to tell us where to look for the call bells. They also told us that in order to to use them they have to be able to walk over to the switch and press it whilst standing. After observing staff confusion about which room to go to because of a fault on the call bell panel and two bells not working, we requested that a compete audit of the call bells was undertaken before our return for day two of this inspection visit. We also asked the provider to consider removing the original system as well as ensuring all bells worked for the room stated. We also noted that it is impossible to undertake a regular comprehensive audit of call response times because there was no way of prioritising who had called first. It is not therefore possible to ensure an equality of response time. On our tour of the home as people were waking and rising, we found that all the bedroom doors were open. In one of these rooms someone was using a commode. We spoke to the person in charge who reminded the care staff about preserving and promoting the privacy and dignity of people. Throughout the rest of our visit care staff were seen and heard to knock on bedroom doors and await a reply before entering. Staff were heard to speak respectfully to people using their first names. One person told us I find some of the younger staff very patronising, always calling me darling which I do not like. Care plans have improved since the last inspection. Four we looked at were detailed, well completed and clear to follow. Two of the four had a full medical history. These had been obtained from the persons GP because no information was previously available to which staff could refer. We found that reviews of care plans were detailed with changes in bold print to highlight important factors. We saw evidence of good liaison with health care professionals such as district nurses and GPs. It showed timely action by the care staff, and appropriate interventions by the primary care teams to provide treatment plans for the staff to follow. There was also provision of any additional equipment if it was needed. Allergies, medications, and personal preferences for assistance with personal care were all documented. People are able to choose to have dental checks, eye-sight checks and chiropody services and these can Care Homes for Older People Page 12 of 30 Evidence: be provided at the care home by visiting contractors. We found the care plans had charts that would usually be kept by a care home providing nursing care. Care staff are held accountable for gathering information and to take appropriate action on that information. We were concerned that there is an over expectation on the care staff skills of knowing what and how to do things, and the expected outcomes of using these forms. We suggested to the person in charge that she ensures all the care staff have comprehensive training regarding the use of these forms. We also found the care plans had some generic forms for risk assessments. These forms were unsatisfactory as they were contradictory. We suggested to the person in charge that as these are generic forms they need to be modified to suit the service and not the other way around. We found detailed information about individuals recorded in the staff communications book. We advised the Team Leaders on duty that staff should record information in the individuals care files to protect confidentiality. Since the last inspection there has been significant improvement and changes to the way in which care is delivered. The care staff have enough time to enable and encourage people living in the home to make decisions with respect to their care and so far as it is possible to ascertain and take into account their wishes and their feelings. There were some care plans that had not been updated or needed further revision to reflect the hands on care we observed. The person in charge is working towards delegating writing and reviews of care plans to the Team Leaders. This however still requires training and one to one work with the Team Leaders to ensure they are able to reflect in detail how peoples care needs are to be met and their support follows current best practice. The storage, recording, administration and disposal of medicines has improved since the last inspection. We found that medications are now stored in a lockable purpose built cupboard. There are two lockable medication trolleys and a separate controlled drugs cupboard. We saw specimen staff signatures. In the controlled drugs book we found double signatures and double signatures for any medications errors. Medication returns were recorded as approximately once a month although this is flexible. The person in charge explained that a Significant Events record is now in use at the home, issued by the Plymouth PCT pharmacy team for pooling information that can be used as local intelligence across care homes in the area. A new medicines refrigerator recently delivered to the home was found to have been damaged in transit. A Care Homes for Older People Page 13 of 30 Evidence: replacement was expected soon after this visit. Care Homes for Older People Page 14 of 30 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. The routines in Manor House are relaxed, relatives and friends can be confident that they are welcomed, and social activities are arranged. The dietary needs of the people who live here are catered for with a balanced and varied selection of food that reflects their tastes and choices. Evidence: A relative who returned a survey told us: The newsletters are a very good innovation and now there are more activities on offer and much more staff interaction with the clients. [previously] concerned about the lack of outings/activities and stimulation for the clients plus areas of the home seemed chaotic and untidy. There was a lack of information in a general way. However I now feel extremely happy with the way things are going. [The person in charge] and her staff are doing a really great job and addressing the above issues. Lots of activities, the office area has been reorganised and the newsletters are great - nice to read through with ones relative and also they help to engender a feeling of community with the home and its residents. We asked people about the arrangements in the home for getting up and going to bed. With one exception everyone we spoke to told us that they rose and retired at Care Homes for Older People Page 15 of 30 Evidence: times of their choosing. The exception said they were awoken each morning at around 6am by the banging of doors in the corridor outside their room. One person added, You can have a lie in if you wish and another said, I usually go to bed around 9.30pm as I think the night staff like everyone to be in bed by 10 oclock. People spoke well of the older staff and several people said they preferred the older staff to the younger ones who they thought lacked dedication and maturity. An instance was given by a visitor of an older carer being found in tears as three younger carers had failed to report for duty one morning. The people we asked told us that visitors are welcomed by the staff and usually offered refreshments. A care assistant is allocated four hours per week to organise bingo sessions which are a favourite with many of the people living at Manor House. Other care assistants deliver quizzes, skittles and dancing. An organist and a singer also visit on a regular basis. Some people told us that their relatives take them out. A recent innovation is a monthly trip out for a small number of people. The person in charge explained that the people living at Manor House were unused to having a variety of activities aside from bingo and she has been encouraging them to join in new events. Recently there was an afternoon when people could participate in still life painting. Currently there is no provision for religious observance, As there is no need according to the person in charge. Regard will be paid to this aspect when new people move into the home. Library books serviced by Plymouth Library Services and other books are available in the conservatory. Since the last inspection the person in charge has introduced the Manor News, a monthly newsletter for families and friends to keep them up to date with events at the home. During the morning a member of staff was seen and heard asking people their menu choice for lunch and tea. We suggested to the person in charge that it could be confusing to ask people about lunch and tea at the same time. We were told that this should not happen as a trolley is taken around with a selection of food at tea time. A staff member told us that they prefer to ask so they can gauge how much of each dish to prepare. The cook refuted this point and said that invariably food was eaten over both tea time and supper time so it was unnecessary to ask until actually serving food. People said that they could have an alternative if they did not like the menu choices. We were told that at lunchtime there is a choice of two meat dishes and one meatless dish daily. There is a main dessert and people are also offered ice cream or crackers and cheese. On the day of our visit the there was either beef casserole with boiled potatoes, carrots and cabbage or vegetable hotpot. The dessert was fresh strawberries with pouring cream, ice cream or cheese and biscuits. The plated meals looked appetising and were of a suitable temperature. Most diners cleared their plates. Some Care Homes for Older People Page 16 of 30 Evidence: people chose to eat in their bedroom or in the lounge. No one in the two dining rooms was seen to require assistance with the meal although we saw staff encouraging those people who needed this. Ergonomic cutlery was available and used by one person. We observed the preparation of the teatime meal that was a choice of hot or cold food: a variety of sandwiches, soup, corn beef hash, fish fingers and beans, and/or cauliflower cheese. These were all offered with bread and butter. As most people choose to eat their tea in their rooms or the lounge, the food is taken around on a trolley which one member of staff told us they do not like having to do. The cook emphasised this was introduced to ensure that people had a choice for tea every day. She said that this is the same at breakfast time, and , for example, because the cook constantly reminded staff to offer porridge as well as cold cereals, this has become popular. People are slowly realising they can have a selection for breakfast such as juice, cereal, toast, fruit and tea, not only toast or cereal, juice or tea. A cooked breakfast is offered on Saturdays and Sundays however no-one has yet requested this. At teatime and supper time, some people may have a little of one thing for tea and then something else at supper time. Because people have not had choices before they are finding it difficult to grasp that if they fancy soup and sandwiches then they may have both. The staff said that people still need a lot of encouragement to have a little of everything they fancy. The cook told us that the kitchen policy is little and often and staff are able to provide a 24hr kitchen service. Night staff have access to the kitchen to make drinks, sandwiches and toast if people ask for it. Comments about the food included, I like the fresh veg, Very good food here, Cant grumble about the food, If I dont like what is on offer they will always ask what I would like instead and get that for me, Food alright, Dont like the cold ham, its not very nice, They dont starve us here, The food is no problem, its very good, Foods very nice and plenty of it and Food brilliant. We observed at lunchtime that for some of the diners, lunch was a social occasion with good exchanges and laughter. The care staff said this occasionally happens at tea time however it is still variable who comes down to the dining room as people are used to eating in their rooms. The cook advised that she has a free hand in ordering produce as required and prefers fresh items against frozen. Fresh fruit, vegetables and meat are sourced from trusted local retailers of good repute. We found that mealtimes were relaxed and arrangements have been put in place so staff do not congregate in the kitchen as on our previous inspection. Breakfast is at 08:00 however anyone wishing or needing to eat earlier is able to do so. Everyone is offered a cup of tea when they wake up. Care Homes for Older People Page 17 of 30 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. The people who live in Manor House can be confident that any complaints or concerns will be listened to and acted upon by the home. Evidence: Since the last inspection the Complaints Procedure has been moved to a more accessible position. It is still high up and we suggested that moving it around with the Employers Liability certificate would bring it into a more readable position. It still has not been updated to tell people clearly how they can contact CQC. We looked at the homes Statement of Purpose and found that all the information regarding complaints had been updated, including CQC contact details. CQC has not received any complaints about Manor House since the last inspection. There have been no further safeguarding alerts. We found that by mid-July this year, the majority of the staff team will have attended the local authority Alerters course about safeguarding vulnerable people. All the staff at the home have completed an elearning course about the the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS), and have a broad understanding of what this legisaltion means for staff working with people in registered care services. This is legislation that came into force on 1st April 2009 and applies to people living in services registered under the Care Standards Act 2000, regardless of who funds their place. Care Homes for Older People Page 18 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Manor House is clean, tidy, comfortable and warm so provides a better environment for the people who live here. Evidence: Two relatives who returned surveys told us The home (communal areas and my relatives individual space) is always clean and fresh. The kitchen area and newly arranged residents dining area is very clean and pleasant....The interior of the building is constantly being improved. The home is clean. We found the home warm and welcoming on both days of our inspection visits. It was tidy, clutter free and the general standard of cleanliness is good throughout. The bedrooms are homely with personal memorabilia. Picture signage has been put up throughout the home. The hallways and landings have been named after local, well known areas and streets in Plymouth. Plain carpets have replaced the heavily patterned ones, and where, in places, the floor is uneven with small slopes, these have been marked to alert people to potential trip hazards. A number of rooms have been redecorated and furnished. The lounges are attractive rooms with good quality furniture. We found that individuals had been assessed for chairs suitable for their personal needs and comfort. Some of the dining chairs lack arms and are to be replaced shortly. The temperature in the conservatory was been found to be excessive and a reflective film is to be applied to the roof panels. In the meantime net curtains Care Homes for Older People Page 19 of 30 Evidence: have been hung over the side windows. The smaller dining room has been refurbished and is now known as The Pink Room. It is being set up as tea room with a small shop facility. The person in charge told us that it could be booked in advance for family visits, birthdays and other events when a larger room would be more suitable. Since the last inspection the person in charge has carried out a review of all the storage in the care home. More practical arrangements are in place, for example, all food is now stored in the kitchen and not on the first floor. Further shelving is planned to facilitate the storage of linen on the first floor as well as on the ground floor. This will be more practical for the staff when they are making up clean beds. Bathrooms are serviceable as equipment is no longer stored in the them. The flower beds and hanging baskets by the front entrance were attractive and work is in progress to improve the rear garden. Some of the woodwork at the front of the building would benefit from repair and re-painting. Whilst there is easy access to the rear lawn there is a potential hazard with an unguarded four foot drop to the patio. A visitor raised concerns about an ongoing problem with the hot water in his relatives bedroom. We tested the hot water in the bathrooms and toilets and found deficiencies. In one bathroom the last entry in the bath book was made in 2005 indicating a problem then. We asked the care staff about the hot water system. Those who have worked at the home for a number of years told us that it had always been temperamental. The recently appointed maintenance person was aware of a lack of hot water in four bedrooms but was unaware of the hot water deficiencies in several of the ground floor bathrooms and toilets. During our visit a heating engineer was called in to look at the hot water system. He found a poor water flow that needed regulating and also identified a need for a water pump for the bathrooms and four bedrooms. We found that the laundry was orderly and clean. There were individual named laundry baskets for everyone living at Manor House. There was a dispenser for disposable gloves and aprons in the laundry, and at various positions around the home. The overall impression was that this building has been neglected in the past and there is much work to be undertaken. Care Homes for Older People Page 20 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient numbers of caring, trained staff support the people who live in Manor House. Recruitment procedures need to be more robust to protect the people who live here from risk of harm. Evidence: A relative who returned a survey told us, I realise that good personal care and the availability of activities is not the full picture but I feel the staff are striving towards a better understanding of the residents - what they were, what makes them tick, etc. This is a hard job as mental and physical health is deteriorating with many residents. I do feel that Manor House is now a caring, happy, comfortable and forward looking care home. We found significant improvement in the provision of care being provided at Manor House. Our observation of the staff during our visit found that they were kind and caring. They talked to the people for whom they care, and treat everyone respectfully. We found that care was much more person-centred than on our visit in December 2009. At the time of our visit twenty-seven people were employed to work at Manor House. Shifts and staff deployment are organised according to an assessment of dependency. Care Homes for Older People Page 21 of 30 Evidence: The rota showed the mornings from 08:00 until 14:00, one Team Leader and three care assistants. From 14:00 until 20:00 one Team Leader works with two care assistants. There is the option for a third care assistant to work with these staff if dependency levels are judged to require this. Otherwise, the third care assistant takes responsibility for preparing tea. This allows the Team leader and two care assistants to lead activities or spend one to one time with individuals. The person in charge explained how she was trialling a split in the third care assistant hours to provide additional cover across the twilight hours. The first trial was the week prior to our visit and this, we were told, had worked well. There have been changes to the housekeeping staff arrangements. The person in charge explained she is also trialling the housekeeper hours to provide cleaning cover through the whole day, and half days on Saturdays and Sundays. The housekeepers now have additional duties that include empty commodes (and record output if required), responsibility for deep cleaning the kitchen once a week, and cleaning the laundry. Housekeepers are expected to attend and participate in the staff hand-overs at the beginning of each shift. We looked at four staff files. They all had an application form, and police checks had been undertaken. Only one file had a staff contract although we were advised the others were possibly still with the Human Resources Officer. Only one file had a photograph of the staff member on it. We found two written references for two staff. A third staff file needed a second reference and the reference on the file had no confirmation of employment dates. The fourth file had three references as one reference had no confirmation of employment dates. One staff file had a copy of interview notes on it. Two files had induction records. The person in charge explained that the homes induction checklist includes issuing new staff with a copy of the Skills For Care induction book. We were advised that new staff usually complete this workbook over a period of approximately three months, although this is variable and some staff take longer. We were advised that information not on staff files was probably still with the companys Human Resources Officer who is based elsewhere and not in the home. We advised the person in charge that all information pertaining to recruitment must be kept on staff files and stored securely in the home. A comprehensive training plan has been put in place by the person in charge. First Aid was booked for ten staff in June for a one day course with an external trainer. Fire training, also with an external facilitator, was booked over two days to enable all staff to attend. Other mandatory training included the Alerters training run by the local authority for the safeguarding of vulnerable adults, staggered due to limited places across June and July; the Deprivation of Liberty Safeguards(DOLS) Officer has Care Homes for Older People Page 22 of 30 Evidence: provided training on the Mental Capacity Act and DOLS. All the staff have completed an e-learning programme, and the majority of staff had completed the training course too. Infection Control; practical moving and handling; and dementia care training had all been provided since the last inspection. We were told there are plans to introduce dementia care mapping for all team leaders. All the staff who have responsibility for the handling and administration of medicines were due to attend a refresher course shortly after our visit. Thirteen staff had attended Liverpool Care Pathway training in February 2010. Three Team Leaders have a NVQ L3 in Management and Care. Some staff have attended training about Sensory Awareness. The training plan is ongoing for the rest of the year. We found that the staff office was orderly and tidy. A lot of the bags of paper and forms cluttering the office on our last visit had been archived or disposed of accordingly. Noticeboards were also clutter free, with up to date information for staff reference. The room was being repainted during our visit and rearranged to make it more user-friendly. The staff told us it was a much better working environment. Care Homes for Older People Page 23 of 30 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. People living in Manor House can be confident that it is well managed. The health, safety and welfare of the people living here are promoted and protected. Evidence: At the time of our last key inspection in December 2009 the person on charge was newly appointed. A number of serious concerns were found at that inspection and the responsible individual, with the then new person in charge agreed they would draw up a plan to review all aspects of care provided at Manor House. Two relatives returned surveys to us. Their comments included:I think Manor House under [the new manager] is making massive improvements both physically but also in the area of engagement. Social interaction and activities and the retention of skills for the clients. I have thought that a key worker for my relative and possibly a short meeting twice a year to discuss things might be a good idea however it has to be said that all the staff I see on my visits do seem to know what is going on regarding my relatives diet, general health and other issues. The new manager is very hard Care Homes for Older People Page 24 of 30 Evidence: working and is always willing to make time to discuss concerns. The person in charge has liaised with the CQC throughout the period of time between inspections, keeping us up to date with the homes action plan, and how things are moving forward. On our return we found that the person in charge had embraced the challenge and along with many physical changes to the home, she has successfully begun to change the culture and staff attitudes. Everyone we spoke to was positive about the person in charge. One member of staff told us I am more confident about doing things. The manager has given us more responsibility and we can do it. Other staff told us how they had initially been very resistant to changing long time habits and ways of working however the person in charge had explained why she was asking for things to be done differently. The staff told us that now they can see the benefits for the people living in the home, and how daily life has improved for them. The staff also told us that the person in charge is fair and consistent with everybody. At the time of our visit we found the Statement of Purpose named and described the person in charge as Assessed by CQC as being a fit person. We asked the person in charge to delete this sentence as we have not yet received her application and it is therefore misleading. The South West Care Homes Limited fire risk assessment was reviewed and specific to Manor House in March 2010. We advised the person in charge that risk assessments about residents who smoke in their bedroom and staff who smoke in the staff room, need to be updated to reflect the homes no smoking policy. Each person residing at Manor House has an individual evacuation risk plan in the event of a fire. They each have a badge above their bedroom door that indicates to staff Evacuate or Refuge. These are reviewed daily and changed as needed according to the persons physical and mental wellbeing. A high visibility jacket and torch are kept at the muster point, however we were concerned by the height of the fire panel that requires the use of a step ladder (kept in a nearby cupboard) to be able to see it. We asked the maintenance person to check that all heat and smoke detectors, especially in all the bedrooms, were working. This was because the fire risk assessment was unspecific about these. We were unable to confirm fire drills and testing of fire safety equipment from information in the fire log because the staff on duty at the time did not know where it was kept. The maintenance person confirmed that all the necessary maintenance checks were up to date. He also showed us a book in which the staff can record any maintenance issues they find around the home. By the end of our visit the heating engineer had regulated all the taps in the home however he had advised a new boiler was necessary Care Homes for Older People Page 25 of 30 Evidence: to even out the pressure of the hot and cold water. The registered provider confirmed he had been advised of this and it would be included in the homes routine maintenance and refurbishment plan. We were also told that consideration was being given to a new call bell system with pendants for each person to wear. This is a system that can be audited to enable the person in charge to keep a record of call bell response times. The Accident Book was seen and accidents had been recorded correctly. The person in charge regularly reviews this to check any recurrence and to seek resolution about preventing further accidents. On the day of our visit the home was clean and tidy, free from offensive odours throughout. The person in charge at the time of this visit knows and is able to communicate her responsibilities to achieve the aims and objectives of providing a homely place where people are treated as individuals, and know their dignity and self respect will be preserved. Care Homes for Older People Page 26 of 30 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 19 Staff recruitment practices must be robust including correlation of information and ensuring all necessary checks are in place before someone starts work at the home. This will mean that the people using this service can be confident they will be protected from harm and safe. 29/01/2010 Care Homes for Older People Page 27 of 30 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 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 7 You should continue to ensure that people with dementia type illness accommodated at the home have care plans that describe in detail how their needs are to be met and their support follows current best practice. You should continue to ensure that all care plans and risk assessments are accurate, are reviewed to show changes and contain informative, up to date information to enable staff to provide care in a safe and consistent way. This will ensure staff know at all times what care an individual needs. 2 7 3 10 You should ensure that at all times arrangements for personal care is conducted in such a manner that the persons privacy and dignity are respected at all times. You should ensure that the Complaints Procedure is displayed in a place that it is can be read easily and that all the details included in this procedure are up to date. You should ensure the premises both inside and outside are suitable for the purpose of achieving the aims and objectives set out in the statement of purpose, and are Page 28 of 30 4 16 5 19 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 appropriate to the needs of the people using this service. 6 29 You should ensure that all staff recruitment records are kept at the home on the staff members file. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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