Care Home: The Manor House

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What the care home does well The service is located near to the town of Willenhall easily accessed by the people using the service. The people using the service had easy access to the courtyard at the side of the service where in the Summer they can enjoy the plants. It is proposed by the provider to include a greenhouse, this will be available to encourage people with gardening. The AQAA told us about the activity programme, which is exceptional, the person responsible has innovative ideas, the results were displayed in the dining room. From details in the AQAA, records and confirmation of the staff during the inspection we identified that staff training was current and on going. This ensures that the people were protected and supported by the staff, training included: the Mental Capacity Act, National Vocational Qualification (NVQ) level 2/3, Dementia, First Aid. Further training was to include Challenging Behaviour. The menus showed a balanced and nutritional diet. People using the service were offered a choice on a daily basis. The service is operated by a qualified, committed manager, her priority was the people using the service. What has improved since the last inspection? The AQAA told us that the service continues to provide a good environment for the people using the service. Since the last key inspection the service had continued with the rolling programme of refurbishment and decoration in a number of areas. This was evidenced during the look around the service. The service continues with the commitment to staff training. What the care home could do better: The staff need to be mindful of the importance of returning or securing any personal toiletries within individuals rooms.This will ensure that people using the service were protected from harm. To review the medication practices of the staff by ensuring they attend the planned mediction training. This will ensure that people are administerd their medication approrpiately. To ensure the safety and well being of the person in the bedroom identifed by securing the wardrobe, and to replace the broken window within this room. To discuss with the staff the relevance of supervision on a regular basis. To ensure that the Statement of Purpose and service users guide contain the relevant information. This will ensure that people are provided with information to make an informed choice. Key inspection report Care homes for older people Name: Address: The Manor House 1 Walsall Road Willenhall Walsall West Midlands WV13 2EH     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: Wendy Grainger     Date: 1 0 1 1 2 0 0 9 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 25 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 25 Information about the care home Name of care home: Address: The Manor House 1 Walsall Road Willenhall Walsall West Midlands WV13 2EH 01902603754 01902636747 jhhorton88@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Jason Harold Horton care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Age: Dementia - Code DE age 55 and above. The maximum number of service users who can be accommodated is: 29 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) 29 Old age, not falling within any other category (OP) 29 Date of last inspection Brief description of the care home Manor House is a large Victorian property converted and extended to offer residential care for up to 29 older people. Situated near the centre of Willenhall the property is located near to local amenities and is easily accessible to local transport. There is a courtyard at the side of the property with adequate, off-road parking to the rear of the Home. Care Homes for Older People Page 4 of 25 Over 65 0 29 29 0 Brief description of the care home The Home currently charges £353.15 weekly for residency; this fee does not include extra service charges for hairdressing, newspapers and dry cleaning. The reader may wish to contact the service for more current fee information. Care Homes for Older People Page 5 of 25 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 overall quality rating for this service is 2 star. This means that the people using the service experience good quality outcomes. One inspector carried out this unannounced inspection on one day between 7:30 and 15:30 hours. We used the National Minimum Standards for Older People as the basis for the inspection and the outcomes for the people using the service. Prior to the inspection we had sent out to the service an Annual Quality Assurance Assessment (AQAA) for the manager to complete, this was returned to us prior to the visit and within the timescale. The document provided information, however in some areas we were unable to cross reference the information with the records and evidence we found. The completion of the AQAA is a legal requirement and it enables us to see how well Care Homes for Older People Page 6 of 25 the service focuses on the outcomes of the people using the service and how their needs are being met. The AQAA also gives us some numerical information about the service. Prior to the inspection we had requested surveys to be sent out to the staff and people using the service. Surveys give us additional information about the service training and roles of the staff and care provided for people using the service. We were told by the manager that no surveys had been received by the service. We were provided with documents, which included: menus, care plans, risk assessments, training record for the staff, medication records, fire records and activity records. We spent time with the people who use the service, observing their interaction with the staff. We spoke to and spent time with the staff including the activity person, each one confirmed that their training needs were met by the training programme. We were told by the staff that they were aware of the complaints process and would not hesitate to use it. We looked around the premises to see the standard of comfort and safety. We spent time with the manager and met the provider. The manager operates the service on a day to day basis, to the best interests of the people using the service. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: The staff need to be mindful of the importance of returning or securing any personal toiletries within individuals rooms.This will ensure that people using the service were protected from harm. To review the medication practices of the staff by ensuring they attend the planned mediction training. This will ensure that people are administerd their medication approrpiately. To ensure the safety and well being of the person in the bedroom identifed by securing the wardrobe, and to replace the broken window within this room. To discuss with the staff the relevance of supervision on a regular basis. To ensure that the Statement of Purpose and service users guide contain the relevant information. This will ensure that people are provided with information to make an informed choice. Care Homes for Older People Page 8 of 25 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 25 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 25 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 who wish to move into the service were not always provided with current information about the service, which means they can not make an informed choice about the services suitability of their needs. People can be assured their health and personal needs can be met following an assessment of their needs. Evidence: The AQAA told us that the service had a comprehensive package of information to prospective people who choose to use the service. It details the philosophy of the service, activities and breakdown of the current fees. We could not evidence the current fees in the Statement of Purpose or service users guide. We were told by the provider that the Statement of Purpose is under review to update the information. Within the Statement of Purpose the complaints procedure did not reflect the correct address and information for the Care Quality Commission. Care Homes for Older People Page 11 of 25 Evidence: We evidenced the collated information for the recently admitted person, it was detailed, contained risk assessments, health and mental need requirements with any action to address anxieties. The care plan had been signed by the person agreeing to the plan and information gathered. The service does not provide intermediate care. Care Homes for Older People Page 12 of 25 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. Arrangements were in place for peoples continued health and personal care based on their detailed care plan. Although the medication storage systems are satisfactory, people would be prevented from harm if administration procedures are reviewed to make sure that administration is safe and sound. Evidence: The completed AQAA told us that individuals are assessed based on their needs. We evidenced two care plans, which contained relevant details for the care required as part of the daily routine. Care plans contained evidence of people having access to other professional agencies. The plans were reviewed on a regular basis and contain a nutritional assessment, risk assessment, and action to address and changes in the people. Staff were observed to be attentive to the daily needs of individuals. People seen today were well presented, they accessed different parts of the service freely. We Care Homes for Older People Page 13 of 25 Evidence: were told by people using the service I had a lovely birthday I am well looked after. One visitor told us that I dont have a problem its a fine place, I feel welcome each time I call, the girls are great. We evidenced the medication round, we discussed with the manager the need for the person responsible to attend the refresher course planned for later in the week. She expressed her nervousness at being observed. We observed her sign for medication before it had been administered. This practice should not be encouraged. We observed that the medication prescribed for eyes had not been dated, this could put people at risk if out of date medication was administered. Advice was given to date the prescribed creams and to record where the cream was to be applied. Staff confirmed and records evidenced that staff training had taken place for the safe handling and administration of medication. The storage of medication including controlled medication was satisfactory. Care Homes for Older People Page 14 of 25 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 using the service can be assured that their lifestyle will be supported by the manager and staff. Meals and menus seen on the day offered choice and a balanced diet. Evidence: The completed AQAA told us that the service recognised the need to offer stimulation to the people using the service. Records seen evidenced that regular meetings were held with the people to ascertain their preference for activities, and menus. One of the people invited us to look in her room, which contained many personal possessions. The service had an impressive activity programme, which was evidenced from the diverse craft displayed in the dining room. They included Christmas crackers and small metallic bags all decorated by the people. Paintings done by the people of painted butterflies were also displayed. The records identified that the local Saturday market was visited. During the day the people decided to play Bingo instead of the planned reminiscence.The activity person works over five days each week, she recognised that people were different and tried to stimulate individuals to suit their personality, concentration and ability. Care Homes for Older People Page 15 of 25 Evidence: Menus were based on a four week basis, specialist diets can be prepared, two soft diets were seen to be presented appropriately. We observed a member of the staff sit and assist one person. The meal was served sensitively on a small spoon and not piled up and undertaken at a pace to suit the person. The menus seen offered alternatives on a daily basis, we were told by the catering staff who maintained records that people can have a meal prepared that was not on the formal menu. This practice offers choice when requested. Care Homes for Older People Page 16 of 25 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 using the service are able to make a complaint and are safeguarded by the procedures in place. Evidence: We evidenced in the Statement of Purpose and service users guide incorrect and outdated information for individuals to raise a complaint with us. We were told by the provider that the Statement of Purpose and service users guide was being updated along with the policies for the service. People using the service and the staff confirmed that they were aware of the complaints process. Staff would not hesitate to raise a concern no matter what the status of the person was. I would tell the girls, I would tell the boss. The service had received one complaint since the last key inspection, from the records we saw that it had been addressed to the satisfaction of the person. No referrals had been made to the safe guarding team or us since the last key inspection. From the staff training records we evidenced and the staff spoken with confirmed that they had undertaken training for the protection of the people in their care. Care Homes for Older People Page 17 of 25 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 using the service were provided with a warm, comfortable and homely environment. The plans to undertake more refurbishment will further enhance the environment for the people using the service. Evidence: The AQAA told us that the service places a strong emphasis upon the quality of life and safety. The service had a rolling programme for the refurbishment and upgrading of the environment. Located near to the town of Willenhall, the service had been extended over a period of time. Parking is at the rear of the building. At the side of the home behind a high wall and gates was a large courtyard, we saw pots of flowers for people to enjoy. This area we were told was used fully in the clement weather by the people. The large lounge was arranged to enable small groups of people to have contact and a conversation easily. We evidenced this in practice during the inspection. People were able to move around freely within the environment. Bedrooms seen were personalised to suit individuals taste, decoration was tasteful, bedrooms were located on two floors, people can access the first floor via the lift or stairs. One bedroom that we looked at required the wardrobe to be secured and the broken window repaired. The dining room is not big enough to accommodate all the people in one sitting. Care Homes for Older People Page 18 of 25 Evidence: However, we found from our observations at lunch time that some people chose not to use the dining room but eat elsewhere. During the look around the premises, we identified to the manager toiletries including a topical cream left in one bathroom. Staff had failed to return the items to the peoples rooms. This practice could put people at risk in the event they were ingested. The manager removed the items and destroyed the cream. Care Homes for Older People Page 19 of 25 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. People using the service were protected by the recruitment process. Staff are trained and knowlegable so able to protect the people using the service. Evidence: We saw the staff during the inspection interact with the people using the service, they addressed and supported them to continue their daily routine. People using the service were observed to be comfortable and relaxed with the attention. Staff spoken with told us about their skills acheived from the training programme, which included: Demetia, the Mental Capacity Act, First Aid, Moving & Handling, Adult Protection. They told us they were aware that further training was planned for 2010.This was confirmed from the training records seen. Future training included, Fire Safety, Food Hygiene, more Mental Capacity Act, Dementia, Report Writing, First Aid, Health & Safety and Challenging Behaviour. The staff confirmed they received supervison with the manager, this was also evidenced in the staff files seen. We looked at two staff files, each of them contained the required checks required before an employee can commence working at the service, including: Criminal Records Bureau (CRB) Protection of Vulnerable Adults (PoVA), references, application form, job description, supervision records, contract and training certificates. Care Homes for Older People Page 20 of 25 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. The service is operated and managed by a competent manager and staff to the best interest of the people using the service Evidence: The AQAA told us that the service continues to promote quality care. The manager develops her skills with training relevant to her role. Her experience has been in the caring profession for over 14years, and has an understanding and knowledge of the day to day operation of the service. The AQAA was completed by the provider, we were not able to cross reference some of the provided information. In effect the Statement of Purpose did not contain the current fees and clear details of the complaints process. The manager operates and open door policy this was evidenced during the inspection with staff seeking advice. We were told by the manager that staff are reluctant to have supervision because of the open door policy. We referred the manager to the National Minimum Standards, which she agreed to discuss with her staff at a meeting. Care Homes for Older People Page 21 of 25 Evidence: We evidenced regular audit of the service, fire and medication. The manager had a good understanding of the health and safety requirements. Her management role is not office based she does spend time with the people using the service. This was evident from our observations and from the response from the people using the service to her during the inspection. Since the last inspection she had delegated some roles and responsibilities to the senior staff. We evidenced the fire records , which were comprehensive and satisfactory. The manager ensured that the staff sign as individuals when completing a fire drill.The service had a contingency plan with the agreement of three houses opposite, we discussed the need to review these plans in the event of an emergency they may not be accessible to the service. The service does not handle personal finances for the people using the service. Care Homes for Older People Page 22 of 25 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 23 of 25 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 2 To ensure that the Statement of Purpose is current. This will provide people with information and details, to enable people to make an informed choice. To prevent out of date medication being administered eye medication needs to be dated when opened. This would safe guard the people prescribed this type of medication. To ensure that all the relevant staff attend the planned refresher medication training course. This would further protect the people by ensuring that medication is administered appropriately. To secure the wardrobe and repair the broken window in the bedroom referred to in the report. To ensure that personal toiletry items are returned to the individuals rooms. This will ensure the safety of individuals that choose to access parts of the service. 2 9 3 9 4 5 19 26 Care Homes for Older People Page 24 of 25 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. 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. 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