Care Home: The Manor House

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What the care home does well The home is situated at the end of a quiet road with views of surrounding countryside and landscaped gardens. Residents and visitors commented very positively on the environment, and the recently developed patio and garden areas provide pleasant outdoor facilities for residents to enjoy. Inside, the home is well furnished with comfortable furnishings and fittings, and good facilities for those who have special needs in relation to their mobility or cognitive impairments. There is a hydrotherapy bath, though all residents also have en suite facilities. Communal areas include lounges with a TV, and quieter areas for reading or relaxing. Their is a hairdressing salon, and aromatherapy, Indian head massage, and reflexology are also available. The home purchases a selection of newspapers each day. There are good arrangements in place for assessing new residents and for planning their care. Those care plans sampled were regularly reviewed and and the health and personal care needs of residents are well catered for. There are two part time activities co-ordinators, and restaurant style dining facilities. The chef speaks personally with each resident on the ground floor each day to check their preferences for lunch. Residents and visitors spoke highly of the staff and confirmed that staff treated people respectfully. One recently bereaved relative returned to the home on the day of the inspection and told the Expert by Experience that their relative had been treated `wonderfully` and added: `It has been such a relief to me to know she was being so well looked after.` Another visitor who used to have a relative at this home now visits other residents and told the inspector that The Manor House is just like a `family.` What has improved since the last inspection? Some environmental improvements have been made including the development of patio and the garden areas; the manager successfully obtained funding from Southern Cross for this project which was in the final stages of completion at the time of this inspection. Stylish covered seating areas have been provided, with raised beds so that residents can be more involved in the garden. A greenhouse has also been erected since the last inspection. Activities for people with dementia have been further developed and the activities coordinators arranged for the craft group on the ground floor to make tactile and sensory objects for those residents with dementia on the middle and upper floors. The home now has three `Dignity` champions at the home who promote dignity and respect in all areas of activity. Staff are kept up to date with progress and the staff room information board has regular features on how the dignity campaign is progressing. There is also information in the reception area which highlights this campaign. The AQAA stated that care plans are now more person centred and comprehensive, and daily shift plans are more explicit about staff responsibilities. A new deputy manager has also been appointed since the last inspection. The home has developed `Yesterday, Today and Tomorrow` trainers, as part of the Alzheimer`s Society course promoting good practice in the care of older people with dementia. This encourages good practice, for example reminiscence opportunities, and the training is being cascaded to all staff. What the care home could do better: One Requirement has been made following this inspection, relating to ensuring that the correct staff recruitment information is sought for each staff member. A number of Recommendations have also been made and these can be seen at the end of this report. Key inspection report Care homes for older people Name: Address: The Manor House Church Road Windsor SL4 2JW     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: Helen Dickens     Date: 1 8 0 8 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 33 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 33 Information about the care home Name of care home: Address: The Manor House Church Road Windsor SL4 2JW 01753832920 01753830530 manorhouse@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross OPCO Ltd The registered provider is responsible for running the service care home 62 Name of registered manager (if applicable): Type of registration: Number of places registered: 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 to be accommodated is 62. The registered person may provide the following category of service only: Care home with nursing only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age- not falling within any other category (OP) Dementia (DE). Date of last inspection Brief description of the care home The Manor House Care Centre is a purpose built care home with nursing provided by Ashbourne Senior Living, part of the Southern Cross Healthcare Group, and was opened in June 2007. It is situated in Old Windsor, in a quiet location at the end of a residential road, and has secluded gardens with views of the river Thames. It is a three-storey building with communal and private areas on each floor. There are 60 Care Homes for Older People Page 4 of 33 Over 65 0 62 62 0 Brief description of the care home private rooms, all with en-suite shower facilities, seven communal toilets, five communal bathrooms with assisted facilities, three dining areas and four lounges. There is a hairdressing room, three library/quiet rooms, a laundry room and a kitchen, and there is lift access to the upper floors. All areas are wheelchair accessible, and there are car-parking facilities to the front. The fees range from £875 to £1000 per person per week, and people should contact the home for more details about fees, which may be negotiable. Care Homes for Older People Page 5 of 33 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: This Key Inspection was unannounced and took place over 7 hours. The inspection was carried out by Mrs. Helen Dickens, Regulatory Inspector, and the Registered Manager Shahnaaz Mohamad represented the establishment. A tour of the premises took place and a number of files and documents, including three residents care plans, three staff training records, and two recruitment files, and quality assurance information, were examined as part of the inspection process. Residents, visitors and staff were spoken with, and the results of surveys returned to the Commission prior to this inspection were all included in this report. The inspector arranged for an Expert by Experience to assist with this inspection, and this person spent four hours in the home on the day of the Key Inspection. The Expert by Experience had lunch with residents, and spoke with residents, staff and visitors on a number of issues. She submitted a report to the inspector for inclusion in this Key Care Homes for Older People Page 6 of 33 Inspection Report. Please look at the CQC website for more information on how the Expert by Experience scheme works. The inspector and the Expert by Experience would like to thank the residents, staff and the manager for their time, assistance and hospitality. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? Some environmental improvements have been made including the development of patio and the garden areas; the manager successfully obtained funding from Southern Cross for this project which was in the final stages of completion at the time of this inspection. Stylish covered seating areas have been provided, with raised beds so that residents can be more involved in the garden. A greenhouse has also been erected since the last inspection. Activities for people with dementia have been further developed and the activities coordinators arranged for the craft group on the ground floor to make tactile and sensory objects for those residents with dementia on the middle and upper floors. The home now has three Dignity champions at the home who promote dignity and respect in all areas of activity. Staff are kept up to date with progress and the staff room information board has regular features on how the dignity campaign is progressing. There is also information in the reception area which highlights this campaign. The AQAA stated that care plans are now more person centred and comprehensive, and daily shift plans are more explicit about staff responsibilities. A new deputy Care Homes for Older People Page 8 of 33 manager has also been appointed since the last inspection. The home has developed Yesterday, Today and Tomorrow trainers, as part of the Alzheimers Society course promoting good practice in the care of older people with dementia. This encourages good practice, for example reminiscence opportunities, and the training is being cascaded to all staff. 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 33 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 33 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. Residents needs are assessed prior to them being offered a place at this home, though residents would benefit by more detailed information being sought. Evidence: The AQAA returned by the manager prior to this inspection stated that all prospective new residents are assessed by the home manager and this involves the resident, family and other professionals. Three residents files were sampled including their initial assessments, and all three had a suitable assessment on file. The Southern Cross assessment template is used and covers all the basic information needed. Those being assessed for the dementia unit also have a dementia assessment. Those with Local Authority funding also have the care managers assessment. Other professionals specialist assessments were also seen on file. During examination of the three files that were sampled, it was noted that some had important information missing for example one had no information Care Homes for Older People Page 11 of 33 Evidence: about the individuals hearing, sight, or sleeping pattern on the assessment, and another had very little on the activities the person liked. This is discussed in more detail later in the report, and the manager undertook to ensure these shortfalls were remedied. Assessments and care plans are all handwritten and therefore the clarity of the information can sometimes be compromised by the handwriting of the assessor. Six surveys were returned to CQC from service users, and all ticked they had received enough information about the home prior to moving in, and five of the six said they had been given written information about the homes terms and conditions; the sixth left it blank. Surveys from health and social care professionals ticked that the homes assessment arrangements either Always or Usually ensured that accurate information was gathered about new residents. Care Homes for Older People Page 12 of 33 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. Residents health and personal care needs are met in a respectful and caring way, and they are protected by the policies and procedures on the safe administration of medication. Evidence: The AQAA stated that care is given according to individualised care plans and all care staff have received training in health and safety and are aware of universal precautions. Three care plans were sampled and found to be well organised, following a set company format. Care plans were drawn up following the initial assessment of each resident. All the important areas were included for example mobility, diet, communication and personal care. Risk assessments were seen on each file including for falls, nutrition, use of bed rails, and skin integrity. These were noted to be reviewed monthly, as were the care plans. Some aspects of the care plans contained a good level of detail on each persons Care Homes for Older People Page 13 of 33 Evidence: needs, but some areas needed to be more personalised, for example all three needed more detail on how that individual would like their personal care to be delivered, and what activities they enjoyed prior to moving in, and would enjoy now. The manager said this would be reviewed and more detail would be added. The home has staff from diverse ethnic backgrounds and this enables them to provide more person centred care to residents from similar backgrounds. One social care professional noted this on their survey to CQC, commenting that The service has a number of bi-lingual carers which has enabled me to recommend a service to people speaking Punjabi or Hindi. On their surveys, five out of six service users ticked that they Usually received the care they needed, and one ticked Always. All six said staff were Usually available when they needed them. Five said staff Usually listened to them and acted upon what they said, with a sixth ticking Always. Health care arrangements are well organised with regular visits from the local GP surgery and residents health needs being noted on their care plans. Suitable risk assessments are carried out, for example the recommended MUST tool is used for nutritional screening. Staff who work with clients in the dementia units have specialist training. Residents expressed no concerns about their health needs being met, and all six who returned surveys ticked that they Always got the medical care they needed. A GP spoken with on the day of the inspection also completed a survey and commented favourably on the home. She ticked that peoples social and health care needs are Always properly monitored, and the service Always seeks advice and acts on it to meet peoples social and health care needs and improve their well-being. She added that The Manor House Caters for dementia patients well, and encourages residents to socialise. Medication is administered by trained nurses who have both medication training, and regular competency tests. Medicines are obtained from a local pharmacy and staff interviewed said they followed the company policies and procedures on the administration of medication. The medication record for one resident whose file was sampled by the inspector was checked for the last month and there were no unexplained gaps on the medication records. Staff said medication records are checked by trained nurses at each shift handover. The local pharmacist checks the medication arrangements at the home and during their last visit in July 2009 made only a few minor recommendations. The manager said these matters had now been dealt with. Care Homes for Older People Page 14 of 33 Evidence: Residents were seen to be treated respectfully by staff. For example they were seen to knock on doors before entering, and to give residents choices. Those residents spoken with did not express any concerns in this regard. Six service users who returned surveys to the Commission said that staff either Always or Usually listened to them and acted on what they said. The GP who returned a survey ticked Always to the question about whether the care service respected peoples privacy and dignity. Five health and social care professionals who returned surveys said staff Always or Usually treated residents with dignity and respect. The Expert by Experience who assisted with this inspection made a number of observations on this section of the report which are summarised below. She came to these conclusions and quoted specific comments, as a result of speaking with eleven residents and two visitors. She said there were No complaints whatsoever regarding the standard of care given to residents. Every resident I spoke to said they were treated respectfully, were assisted with bathing, showering, dressing and toileting as required. The call bells were answered promptly. Doors were knocked on before staff entered. One recently bereaved relative came back to the home on the day of the inspection, and asked to speak with the Expert by Experience when they heard that she was on the premises. This relative was full of praise for the home and said; My mother had only been here three months but she has been treated wonderfully. It has been such a relief to me to know she is being so well looked after. The staff have been so kind this morning, giving me so much support at this difficult time. Care Homes for Older People Page 15 of 33 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 home offers a range of activities but residents would benefit by having more information about what is on offer and how they might participate. There are some opportunities for residents to be part of the local community, and for them to make choices in their day to day lives. Meals and mealtimes offer a pleasant dining experience, though residents views should be sought with regard to some changes that they would like to be made. Evidence: The AQAA states that activities are provided daily and there are regular residents meetings. It noted activities such as gentle exercises, board games and craft work, as well as manicures, Pat the Dog and flower arranging took place regularly. The AQAA also noted, under What we could do better; Activity co-ordinator to evaluate the impact of activities for each individual resident to assess areas that require improvement. It was noted by the inspector that residents care plans had little information on their interests and hobbies. Two part time activities organisers are employed and both were spoken with during the day. They were able to outline the range of activities and special projects they were working on, for example residents on the ground floor had made tactile tiles Care Homes for Older People Page 16 of 33 Evidence: and sensory bags for use with the dementia care residents upstairs. Two therapists visit the home and offer Reiki, Indian head Massage, and aromatherapy. Service users had mixed opinions on activities, and out of six surveys returned to the Commission, only one ticked that there were Always activities they could join, one ticked Sometimes, three chose Usually and one ticked Never. A relative assisted with a survey and made some comments on activities which were passed directly to the manager. Other staff help with activities and a plan was seen of the activities which staff said are available each day. On the day of the inspection the monthly visiting entertainer was advertised on each floor and staff were reminding residents about this during the morning. Albums in the reception area showed the activities and outings that residents have participated in. Outings have included trips to the Magna Carta Tea Rooms at Runnymede and lunches at a local restaurant in the homes own minibus. The Expert by Experience was asked to speak with residents about the activities at the home, following the mixed reviews on the surveys. She also noted some mixed comments from residents and relatives on activities, and the following is an extract from her report: Some mentioned particular activities they enjoyed, for example the mobile library, and Pat the Dog Scheme. Others mentioned skittles, bingo and one said they liked their own company and watching TV. None of the residents spoken with substantiated the managers assertion that residents went on regular outings. When asked if they enjoyed the outings, one resident replied What outings? They said they had only been on one outing which was a lunch trip and they came straight home afterwards. Another said I would like to go out in my wheelchair but staff are too busy. Several said they did not really know what activities were happening. A discussion followed with the activities workers, the manager, the Expert by Experience and the inspector. There seemed to be a discrepancy between what the home actually had on offer, including putting some considerable effort into the activities, and the outcomes for residents. It was concluded that one way to improve the situation would be for the activities plan to be available in places where residents would see it, so they knew in advance what was on, where it was happening, and this should be in an accessible format for example for those residents with a cognitive impairment. The arrangements for activities should also be reviewed to ensure Care Homes for Older People Page 17 of 33 Evidence: outcomes for residents are improved. Residents have some opportunities to be part of the local community including using the homes minibus for outings. Community organisations visit the home, for example a church choir visits on a regular basis. Relatives are made welcome, and those relatives spoken with during the day commented favourably on the home, one told the inspector Staff are very helpful to visitors. The inspector looked at the comments and compliments folder where the manager keeps thank you letters etc. The majority were from relatives of past residents and thanked staff for their Kindness and care and for the Respect they had shown. One wrote that their whole family had been touched by the way their relative had been cared for at The Manor House. Residents are given some opportunities to exercise choice and control over their lives including being given choices about what they had to eat and drink, and whether they participated in activities. Rooms were seen to be very personalised and residents could bring in their own possessions, including furniture. Those spoken with said they liked their rooms, and those bedrooms visited were found to be spacious with nice views over the gardens or surrounding countryside. The manager is aware of her obligations under the Mental Capacity Act in relation to the Deprivation of Liberty Safeguards Guidance, and outlined to the inspector what steps had been taken where residents did not have capacity to make their own decisions. The AQAA stated that meals are served in restaurant style dining rooms with fresh flowers, soft music, freshly ironed table cloths and matching napkins, and this was found to be the case during the inspection. The menu is devised from the companys nutmeg system which focuses on the nutritional content of each meal. Sherry is served in the library on each floor for those who would like it. Relatives can come for meals and celebrations are held, for example for birthdays. Care plans contained nutritional risk assessments and residents records showed they are weighed regularly. Surveys from residents gave the food at this home rather mixed reviews. Out of the six who responded, three ticked that they Usually liked the meals; two chose Sometimes; and one ticked Always. Two made additional comments stating that meals could be improved. The Chef was seen to ask each resident on the ground floor what they would like for lunch as they arrived in the dining room; each table had a printed menu with the options. The chef was seen to go back after lunch to ask people what they thought Care Homes for Older People Page 18 of 33 Evidence: about their meal. As the survey results had been mixed, the Expert by Experience was asked to enquire about meals and she had lunch with residents in the dining room. The following excerpts are taken from her report. Comments on food included: Not bad; The portions are just right; OK, but you cant please everyone all the time. The chef came and spoke to residents and was knowledgeable on their likes and dislikes. Those who needed a soft diet were given a very appetising looking meal. One resident needed assistance and a carer sat beside her and assisted as necessary. The Expert by Experience said her own meal of roast chicken was excellent, though the gravy could have been hotter. A few other comments were received about the temperature of some items of food and this was passed to the chef. Other comments on meals including puddings being unimaginative were also passed to the chef and following conversations with the manager, it was suggested that a food survey might be carried out to review residents experiences of the meals, and any changes they would like to see. Care Homes for Older People Page 19 of 33 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. Residents at this home know how to make a complaint and there are policies, procedures and training in place which should safeguard residents from abuse. Evidence: The AQAA states that the complaints procedure is widely available and that staff receive training in safeguarding adults. The Manager had noted two complaints on the AQAA, and said both had been resolved within their 28 day time frame. More details were given to the inspector on both these matters. Residents have opportunities to raise concerns including daily with the manager or staff, monthly during the Regulation 26 visits, or during residents meetings. The manager also holds a weekly open session for any relatives who would like to speak with her. Surveys returned from six service users showed that they would know who to speak to if they were unhappy. During the inspection copies of the complaints procedure were seen throughout the home. One relative sent a letter to CQC with a returned survey, highlighting a number of issues which were then discussed with the manager. As well as recording complaints, the manager also keeps a compliments folder. Dozens of favourable letters and cards had been received since the home opened, and the inspector looked at those received in the last 12 months. The following is a selection: I was so impressed with the facilities, excellent condition of the home, and the feeling Care Homes for Older People Page 20 of 33 Evidence: of goodwill among the various staff I met on the visit. A very heartfelt message of thanks to you and all your staff. Thank you to all for the care and comfort, and everything you did for Mum. She always spoke highly of the carers who looked after her. Staff records showed that both the new staff whose files were sampled, had received training in safeguarding adults, and the general training records showed 95 of staff had had this training in the last 12 months. Three safeguarding adults incidents have been reported at this home since the last inspection. Two have been concluded and a third is nearly concluded. One of these residents files was sampled by the inspector who then followed up with the care manager at the local authority. The care manager said they were satisfied with what the home had put in place for this particular resident. Shortfalls in recruitment records, which could potentially affect the safety of residents, are discussed under the staffing section later in this report. Care Homes for Older People Page 21 of 33 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. Residents live in a well maintained environment which is comfortable and nicely furnished throughout, and they benefit by the arrangements for maintaining a clean and pleasant environment. Evidence: The AQAA states that the home is set in beautiful country grounds, and has a five star service attached. It noted that dining rooms are restaurant like, and tables are set to a high standard. A partial tour of the premises was carried out by the inspector including visiting all three floors, some individual residents bedrooms, all three dining rooms, one clinical room to check medicines, and some communal rooms such as the libraries and lounge areas. The reception area contained a variety of information for visitors and residents though the Expert by Experience did not think this was a very homely introduction to the premises. She commented that there was no residents artwork on the walls in the home. Conversations with the manager suggested this was the policy, and overall the home did have a hotel type ambiance, with good quality furnishings and fittings, and restaurant like dining areas. In addition to the main lounge areas, there were also quiet rooms for residents who wished to read or entertain visitors. Special equipment Care Homes for Older People Page 22 of 33 Evidence: is provided in the communal bath rooms, though individual residents have their own en suite facilities as well. Bedrooms visited were personalised and residents commented favourably on their surroundings. Comments included; Nice place, I like it. and Yes, Im very happy with my room. The home is set in landscaped gardens, and last year they won the Blooming Marvellous competition organised by Southern Cross. They have also entered the National Association of Providers of Activities Fresh Air Competition. They have been awarded £13,000 from the company to develop their garden area and work was well underway on the main patio which had stylish covered seating and tables, and the manager said she was hoping to have it ready for a barbecue at the end of the month. Raised beds had been built and the manager said these would enable residents to play more of a part in the gardening and vegetable planting. It was noted that there was a lack of storage space and hoists were being left in corridors. Whilst they were usually placed in alcoves, nevertheless they were in full view of residents and visitors and detracted somewhat from the ambiance the manager was trying to create. She said she would review storage arrangements. The AQAA stated that the home has a plan to deliver best practice in infection control, and that 44 or the 47 staff have received training in infection control measures. Three individual staff training records sampled by the inspector showed all three had completed this training. Domestic staff are employed at The Manor House, and surveys returned to the Commission by residents showed the home is either Always or Usually fresh and clean. Residents spoken with during the inspection also commented on the high standard of cleanliness with one saying The home is spotlessly clean. During the tour of the premises it was noted that all the communal areas were fresh and clean, though two of the bedrooms visited had slight odours; the manager said she would review arrangements for carpet cleaning and look at whether the current floor coverings were appropriate. The Expert by Experience noted in her report that: I visited several rooms and they were all very clean, neat and tidy, the residents were very happy at the level of cleanliness. Care Homes for Older People Page 23 of 33 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. Service users needs are met by the numbers and skill mix of staff and more work is being done to ensure care workers gain qualifications in care work. Arrangements for staff recruitment must be reviewed to ensure the safety of service users. Staff training arrangements ensure residents at this home are looked after by competent staff. Evidence: The AQAA states that the skill mix of staff reflects the current needs of service users, and that staffing levels are determined by the needs of service users. All care staff now have dementia training. During the inspection it was noted that there were sufficient staff to assist residents, and ancillary staff such as activities workers, and housekeeping and catering staff were employed in sufficient numbers to ensure the nursing and care staff concentrated their efforts on working with residents. The Expert by Experience was asked by the inspector to speak with residents about whether they got the help they needed in a timely way. This was because surveys returned to the Commission showed that residents ticked that staff were Usually as opposed to Always available when they needed them. The following is an excerpt from her report: Care Homes for Older People Page 24 of 33 Evidence: There were no complaints whatsoever regarding the standard of care given to the residents. Every resident I spoke to said they were treated respectfully, were assisted with bathing, showering and and toileting as required. The call bells were answered promptly and doors were knocked on before being entered. It was also observed that those who needed assistance at mealtimes were offered help in a timely way, and with respect for their dignity. Whilst everyone praised the staff, the manager needs to keep staffing levels under review to ensure they are available in sufficient numbers. In addition to the trained nurses who are always on duty at this home, it is also recommended in the National Minimum Standards that at least 50 of care workers who are not trained nurses, should hold a qualification in care work, such as an NVQ qualification. The manager and deputy manager worked out that of 37 care staff, 13 already have an NVQ qualification (or the equivalent from overseas), and a further 7 are currently on an NVQ programme. The manager added that a further 8 staff have been identified as ready to start NVQ qualifications. Two recruitment files were checked for recently recruited staff, both of whom were now working at the home. Both had application forms, photographic identification, and CRB checks had been applied for. One had appropriate references. Records of training were on each file. One person is a trained nurse and they had been checked to ensure they were currently registered with the appropriate nursing authority. Both had induction records. There were however a number of shortfalls in recruitment records. Both files showed gaps in employment history. Taking on staff without a full working history could compromise the safety of residents. There was no record of when either person had completed their full time education so it would have been difficult to know when a full employment history would have started. One person had had proper references taken up, but the other had only one reference from an educational establishment, and none from their last care employer. The manager arranged for the missing reference to be faxed over from this persons last care employer during the inspection. Both staff had started with POVA first checks only, whilst waiting for a full CRB to come through one full CRB had subsequently been received, and the other was still awaited. Guidance on the CQC website advises managers that employing staff before receipt of a full CRB should only happen in extenuating circumstances, and only when all other checks have been received, for example appropriate references. The manager was referred to this Guidance on the CQC website. A Requirement is being made in regard to the shortfalls in recruitment records. Care Homes for Older People Page 25 of 33 Evidence: The home has good systems in place for staff training and they follow Southern Cross policies on staff training. There is a central training record so it is easy to demonstrate which staff have attended which training courses. The manager reports to the company on staff training rates and the last report was sampled and it showed that for example 89 of staff had received moving and handling training, 95 had safeguarding adults training, and 80 had completed health and safety training. These figures show the number who are up to date with training, the manager said the remainder are due to have refresher training. The manager noted in the AQAA that all care staff have had dementia awareness training, and currently specialist dementia training is being rolled out to staff from the Alzheimers Society called Yesterday, Today and Tomorrow. Other examples of staff training noted on the three staff records sampled included customer care, bed rail safety, managing challenging behaviour, food hygiene, fire and first aid. Only trained nurses give medication and they complete both a medication training course and have regular clinical competency assessments from the manager. Both the manager and deputy manager (plus one other staff member) are qualified as trainers for moving and handling. Currently 11 of staff are due for refresher training on this subject which they have each year on a rolling programme. Care Homes for Older People Page 26 of 33 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. Residents benefit from living in a well run home, with well developed quality assurance processes. Policies and procedures are in place to protect service users financial interests. The health and safety arrangements should protect residents, staff and visitors to this home. Evidence: The manager is experienced and skilled and according to the AQAA has over 15 years experience in home management. She completed the Registered Managers Award in 2002 and is a qualified NVQ assessor. She has completed further specialist nursing courses in the care of older people and managing continence. She also has a health and safety training certificate, and is one of the three moving and handling trainers at the home. In the past she completed a one year modern matron leadership course run by the Department of Health. Staff, residents and visitors commented favourably on the manager, saying she was approachable, dealt with problems quickly, and that she is fair. Two staff surveys returned showed that both staff had Regular support from their manager. Care Homes for Older People Page 27 of 33 Evidence: Quality assurance arrangements are well developed and the company policy includes Regulation 26 visits to the home on behalf of the provider, and various auditing processes for example looking at medication, care plans, cleaning and catering. The home is using the new Southern Cross Audit Tool based on the National Minimum Standards outcome areas and home scored 94 on this in the previous month. Complaints and compliments are recorded and monitored, and the results of a recent survey are being collated. The AQAA notes a number of changes have been made in response to feedback from residents including an increase in activities, twice weekly outings in the minibus, and a monthly newsletter has been introduced. Feedback is also gained through residents and relatives meetings, and the manager has a dedicated session each week during the evening where relatives can come and speak with her. There is an ongoing Business Action Plan which identifies goals and outcomes for both the business and care side of running the home. Whilst the quality assurance arrangements are well developed, they need further work to ensure that any shortfalls relating to residents safety, for example the shortfalls in staff recruitment procedures, are identified and dealt with in a timely fashion. Similarly, the lack of detail in care plans should also have been identified and dealt with in the care plan auditing regime. The home does not get involved in managing residents finances though people who would like to have money available for paying their day to day bills such as hairdressing, chiropody and newspapers, can pay money into an individual and interest bearing account, from which they can either pay bills or withdraw cash. The arrangements were not checked during this inspection but the manager said a sample of these are checked during Regulation 26 visits on behalf of the provider, and the accounts are subject to Southern Cross auditing procedures. Health and safety arrangements follow the Southern Cross policies and procedures and the company issues health and safety bulletins to ensure the manager and staff are aware of any current issues. The manager said she copies this for each floor, and the handyman carries out regular health and safety checks. Relevant training is given to staff for example on fire safety, safe moving and handling, managing hazardous substances such as cleaning materials, and general health and safety training. It was noted that the last Environmental Health Officers visit was when the home first opened and before any residents moved in. The manager was asked to follow this up with the local council, and confirmed to the inspector that she had done this and that Care Homes for Older People Page 28 of 33 Evidence: the home is now scheduled for a visit. Care Homes for Older People Page 29 of 33 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 33 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 29 19 Recruitment records for all 18/09/2009 staff must contain all the information listed in Schedule 2 of the Care Homes Regulations 2001 (as amended). For the safety and welfare of service users. 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 3 Assessment arrangements should be reviewed to ensure that all the relevant information has been collected and used to draw up the care plan for each new resident. Care plans should be reviewed to ensure there is sufficient detail about how residents would like their personal support to be delivered. Arrangements for providing activities should be reviewed, and more thought given to ensuring residents are aware of what is on offer. Residents views should be sought on the current arrangements for meals, and on the menus and choice of 2 7 3 12 4 15 Care Homes for Older People Page 31 of 33 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 food available. 5 26 Arrangements for preventing odours should be reviewed in the two rooms identified to the manager during the inspection. The home should refer to Guidance on the CQC website in relation to recruitment checks, and have particular regard to the advice on CRB checks. 6 29 Care Homes for Older People Page 32 of 33 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. 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