Care Home: The Manor House (Residential)

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What the care home does well People told us in surveys and during the visit that they are happy with the care they receive at the home. One person said in a survey "We are well looked after in every way" Relatives confirmed this and told us "They provide security, comfort and care to a high standard" People were also complimentary of the staff saying "The staff ensure that their clients welfare is attended to" and "staff are always helpful, friendly and professional" People told us that they enjoy the food and we found the home to be clean and comfortable. Health care professionals told us that the home is "well organised" and provides "good quality care to all residents". They said they were kept well informed of any changes or concerns about people. What has improved since the last inspection? Since the last key inspection the manager has responded to requirements made by the Commission and documentation relating to care such as care plans and risk assessments have been reviewed and rewritten. They have also obtained new medication trolleys to aid the administration of medications process. The management team have acknowledged the need for continuous quality monitoring of their service. What the care home could do better: More detailed documentation is needed in relation to pre admission assessments, care plans and some assessments. This is to make sure that staff know what to do to support people properly. Care plans also need to be kept under review to make sure they reflect people`s current needs. Some staff time needs to be dedicated to engaging people in social and leisure activities. Two relatives who responded to our surveys felt that this was needed one said "I would like to see more activities or organised outings" Meals are good but more attention needs to be given to making sure that people`s special diets, for example diabetic diets are adhered to. Changes need to be made in the way medications are dealt with to make sure the systems are safe. Staff need to be more considerate in making sure that they do not compromise people`s privacy and dignity and that they talk to people discreetly about their personal care. Staff would also benefit from some practical as well as video training, particularly in areas such as moving and handling to make sure that they can demonstrate practical understanding of their training. People living at the home need to be consulted more about their choices and their views about how the home is run. This will help in making sure people are treated as individuals and in the continuous quality monitoring of the service. Key inspection report Care homes for older people Name: Address: The Manor House (Residential) 127 Wakefield Road Lightcliffe Halifax West Yorkshire HX3 8TH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Gillian Walsh     Date: 0 2 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 32 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 32 Information about the care home Name of care home: Address: The Manor House (Residential) 127 Wakefield Road Lightcliffe Halifax West Yorkshire HX3 8TH 01422202603 01422204113 oliverjamesthomas@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Jean Thomas care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Manor House Residential Home is a family run home providing care and accommodation for up to thirty older people. The home is set in its own extensive grounds within walking distance of a bus route. There is plenty of car parking available. There are two lounges and a comfortable dining room. The majority of the bedrooms are single rooms and some have en suite toilet facilities. There is a pleasant outdoor seating area overlooking adjacent fields. The manager told us in November 2009 that the fees are £365 - £410 per week. 0 Over 65 30 Care Homes for Older People Page 4 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out to assess the quality of care provided to people living in the home. The inspection process included looking at the information we have received about the home since our last key and random inspections as well as a visit to the home. Two inspectors carried out the visit over one day and it lasted for approximately eight hours. During the visit we spoke to people living in the home, some members of staff and the management team including the manager. We observed care staff delivering care, looked at various records and looked around the home. Before the visit we sent surveys to 10 people living in the home and their relatives, 5 staff and 5 health care professionals involved in the care of the people at the home. Care Homes for Older People Page 5 of 32 This gives people the opportunity to share their views of the service with us. Information received in this way is shared with the home without identifying who has provided it. We received comments from 9 people living at the home and their relatives, 3 health care professionals and 3 members of staff. Their comments have been used in this report. We asked the manager to complete an Annual Quality Assurance (AQAA) document so that she could tell us how she thought the home was doing, any improvements they have made or have planned and any problems they may be facing. The document also provides us with some numerical information about the home to assist us in our inspection process. The AQAA was completed and returned to the Commission within timescales. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: More detailed documentation is needed in relation to pre admission assessments, care plans and some assessments. This is to make sure that staff know what to do to support people properly. Care plans also need to be kept under review to make sure they reflect peoples current needs. Some staff time needs to be dedicated to engaging people in social and leisure activities. Two relatives who responded to our surveys felt that this was needed one said I would like to see more activities or organised outings Meals are good but more attention needs to be given to making sure that peoples special diets, for example diabetic diets are adhered to. Changes need to be made in the way medications are dealt with to make sure the systems are safe. Staff need to be more considerate in making sure that they do not compromise peoples privacy and dignity and that they talk to people discreetly about their personal care. Staff would also benefit from some practical as well as video training, particularly in areas such as moving and handling to make sure that they can demonstrate Care Homes for Older People Page 7 of 32 practical understanding of their training. People living at the home need to be consulted more about their choices and their views about how the home is run. This will help in making sure people are treated as individuals and in the continuous quality monitoring of the service. 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 32 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 32 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. The home do not document their own thorough assessment of a persons needs prior to offering them a place at the home in the care plan. This means that care staff cannot be sure that they are able to meet their needs appropriately. Evidence: The manager told us that when people make an enquiry about coming to live at the home they are, wherever possible, invited to visit the home and join with the people who live there for lunch. This is to help the person in their decision about moving into the home. At the time of the visit, the home did not have a form for staff to use to record their initial assessment of the persons current needs, lifestyle and personal preferences. The need to do this to assist staff in deciding if they could meet the persons needs was discussed and the manager said that she would look at developing an appropriate assessment form. Care Homes for Older People Page 10 of 32 Evidence: Although an assessment form is not in use, we saw notes that had been taken by the manager relating to a person who had recently been admitted. However these notes had not been included in the care file for all staff to read and be aware of. An initial care plan was being developed and some initial assessment forms relating to various areas of care were in place. All of the care files seen included information from either the social worker or health care professional involved in the persons care prior to them being admitted to the home. The manager said that, apart from in an emergency, they would always make sure they had obtained this information prior to a person being admitted. The manager should consider that this information is not always up to date which is another reason to make sure that the home completes its own assessment. The home does not provide intermediate care. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Better care planning and medication procedures need to be in place to make sure that peoples needs are met consistently and safely. Staff do not always consider peoples dignity. Evidence: We looked at five care plan files. All of the files seen contained a plan of care which the manager said they had been working on to improve since the last inspection. The care plans had been developed around the individuals activities of daily living including personal care and hygiene, eating and drinking, behaviour and resting and sleeping. Some care plans also included a plan for meeting social and recreational needs. Although the manager had started work on the care plans they were in need of more detail for staff to follow to make sure that they knew exactly what the persons needs were and what actions they should take to meet them in the way the person preferred. Care Homes for Older People Page 12 of 32 Evidence: One of the care plans we looked at said that the person was experiencing confusion possibly as a result of infections which were not responding to anti-biotics. There was information saying that blood tests had been organised over two months ago but no record had been made of the blood tests taking place or of the results. There was also confusion within this care plan about the persons nutritional and skin integrity needs. The nutritional screening tool said that the person was losing weight and should be weighed weekly. The weight chart showed that the person was being weighed monthly. The manager said that she had discussed the matter with the doctor and agreed monthly weights. Information such as this should be recorded on both the nutritional assessment and in the care plan so that all staff are clear about the care and support they need to give. There was also a lack of clarity about the persons skin condition. We saw that the district nurse was involved and their notes referred to a sacral sore although the homes own notes appeared to refer only to an ulcerated ankle. It is important that the home develops its own plan of care to support the interventions of the district nurse. This is so that the person will receive the care they need on a daily basis to promote healing and to keep the person comfortable. For example a care plan should say what actions care staff can take to relieve pressure and what they should do if the dressing, applied by the district nurse, comes off. Another file contained a skin assessment which said that the person had dry skin and needed to have cream applied. A care plan had not been developed for this and there was no information about which cream to use or how often to use it. The manager said that she understood these issues and would make sure that such plans are put in place. Records show that care plans are reviewed monthly but one of the care plans, which had been signed as reviewed in October, was out of date and not at all relevant to the persons current situation. The care plan throughout referred to the persons spouse, who had lived at the home with them but had died prior to the review date of the care plan. It was disappointing that not only had the care plan not been reviewed but nothing had been recorded about how staff should support the person in their bereavement. Care staff said that they had been told to tell this person that their spouse was at work when they asked about them. This was discussed with the Care Homes for Older People Page 13 of 32 Evidence: manager who said that this had been advised by the community psychiatric nurse. Nothing could be found within the documentation to substantiate this. The manager accepted that this was poor practice and said she would make sure that the care plan was reviewed. Care plan files included some risk assessments covering areas such as falls, pressure sores, moving and handling and nutrition. Fire risk assessments seen in each file were confusing and lacked clarity. We discussed with the manager the need for risk assessments to be developed to support people in leading as independent a lifestyle as possible, for example leaving the home unaccompanied and using wheelchairs independently. Many of the assessments, care plans and other documentation held within care files had not been signed or accurately dated. The manager said she would make sure this would done in future. Whilst we saw problems with documentation, people told us in surveys and during the visit that their health and care needs are met. The manager acknowledged the problems with documentation and recognised the need for improvement. Documentation showed that healthcare professionals are involved in peoples care as necessary. This includes the GP, district nurse, dentist and optician. Healthcare professionals who responded to the Commissions surveys said that they felt the home provided a good service. A district nurse told us they are always informed of any concerns or changes in a persons condition and finds that the home provides good quality care. A GP told us that they find the service to be well managed. During the visit we observed a few instances of care staff calling out to people regarding their care needs. Examples of this were calling across the room loudly asking people if they needed the toilet or if they had any pain. To make sure that peoples dignity and privacy needs are met, staff should ask questions such as this as discreetly as possible. Generally people were nicely dressed and looked as though they had been well supported in meeting their personal care needs although the majority of ladies were not wearing stockings or tights and some of the men were without socks. Care staff Care Homes for Older People Page 14 of 32 Evidence: said that if there were no tights or stockings in a persons room they would assume that their family had not brought any in for them because they didnt like to wear them. One lady spoken with said that she would like some stockings on. One of the care plans for personal care said that the person used the bath hoist as did all the residents in the home. People should be assessed on an individual basis for personal care needs and the care plan written to inform staff of their individual needs and preferences and should not refer to other people living in the home. This was discussed with the manager who accepted the need for individual assessment. The day after the inspection the manager of the home contacted the Commission to confirm that she had already made a number of changes to the care planning process. This should make sure that more detail is included regarding peoples needs and preferences and staff will be able follow this to meet peoples needs. During the visit, we looked at the way the home stores, manages and administrates medication. We saw that when medications are administered, one care assistant puts the medication in the pot and another takes and gives it to the individual. When asked about this the care staff involved said that they always use a runner. This practice is not safe and is not in line with the guidelines issued by the Royal Pharmaceutical Society for safe administration of medication. This was brought to the attention of the manager who confirmed to the Commission the following day that the practice had stopped. Some of the medication administration record (MAR) charts had been completed using the letter F as a code for administration. According to the MAR chart the letter F indicates other and therefore an explanation of why the F code has been used needs to be written on the reverse of the MAR chart. No explanation had been recorded and the carer said that on one MAR chart the F was being used to indicate that the medication was not being given and on another the carer said that it was being used to indicate that the person was self administering the medication which in this instance was a cream. Wherever a person wishes to self administrate, the MAR chart should show this clearly Care Homes for Older People Page 15 of 32 Evidence: and a care plan and a risk assessment should be developed to support the process. None of this was in place. One of the MAR charts was for a person receiving Warfarin, a medication for which the dosage may change regularly depending on the results of regular blood tests. The MAR chart still included previously used dosages of Warfarin as well as the ones currently in use. An X had been used on most occasions in the signature of administration box but on other times the box had been left blank. This practice is confusing and potentially unsafe. Where a medication, or a prescribed dose of that medication, is no longer in use, the MAR chart should clearly indicate this. It was also noticed that staff were taking the pulse of a person prescribed digoxin and would administer or not administer the drug according to the pulse rate. However the prescription on the MAR chart was for the drug to be given once a day and did not mention pulse rate. Medications not in current use were being stored in unlocked cupboards inside the locked clinical room. During the inspection the manager arranged for suitable locks to be put on the cupboard doors. The manager should discuss this with the prescriber as staff in the home should not be put in the position of having to make a clinical decision about the administration of this medication. Care Homes for Older People Page 16 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A more individualised approach to establishing and meeting peoples social and leisure activities is needed to promote individually satisfying lifestyles. People enjoy the food at the home. Evidence: The manager told us in the AQAA that their objective is to try to enable people to live an individually satisfying lifestyle. We saw from the activities programme and from our observations that the staff do try to engage people in activities although this, on the day of the visit, was only for a short period of time when staff engaged a small number of people with singing and dancing. The home does not employ an activities person and therefore care staff are responsible for engaging people in activities in between their care duties. At the time of the visit the home was decorated for Halloween and the manager told us that they had enjoyed a Halloween party and were planning a bonfire night party. One of the owners of the home plays the organ during the evening several times a Care Homes for Older People Page 17 of 32 Evidence: week for people to enjoy if they wish and other entertainment is organised periodically. We saw that some people did have some information in their care plans about how they liked to spend their leisure times although this needs to be expanded upon to include details of peoples particular interests and hobbies and how they can be supported to maintain these interests on an individual basis. We saw some evidence of peoples choices and preferences within their daily lives being sought but again this area needs to be explored further with people to make sure that they are supported to follow their individual routines and lifestyle choices. Examples of this are people could be taken to previously attended clubs, churches or sporting events. The manager told us that a local vicar attends the home to provide a service and Holy Communion to people of all denominations. The manager confirmed to us the day after the visit that she is looking at how they can better establish peoples choices and preferences within their lives and therefore support them in a more individual life style. People told us in surveys that they enjoy visiting the home and that they feel welcome. We saw, during our visit, one person take their visitors to their room so that they could enjoy their company in private. The midday meal on the day of our visit was a choice of shepherds pie with vegetables or vegetable bake. A choice of desert was also available. The cook told us that both deserts were diabetic friendly and therefore suitable for people needing a diabetic diet. However when we looked at the ingredients in the sponge and custard mixes we saw that they were not suitable for diabetics. We discussed with the manager that to maintain peoples health, she must make sure that people receive the diet they need. The manager said that she would make sure that ingredients were checked in future. People told us that the food was of good quality and that they enjoyed the meals. We saw that people were offered drinks at various times during the day and with their meal. People were not always offered a choice in the drink and when one person called out that they were thirsty and wanted a drink of tea, a carer called back that they Care Homes for Older People Page 18 of 32 Evidence: would be getting a drink soon. Staff should make sure that people are always offered a choice in their drink and that they can have one whenever they like rather than just at designated times. The manager told us that suppers are served at various times to make sure that people who like to go to bed early get a drink and snack before retiring. Care Homes for Older People Page 19 of 32 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 know what to do if they wish to make a complaint. People are safeguarded form abuse. Evidence: The manager said that the home has not received any complaints since the last key inspection. The complaints book situated on the desk in the entrance to the home was empty. The homes complaints procedure is on the wall for people to see. The Commission has not received any complaints about the service since the last key inspection. People who live at the home and their relatives told us in surveys that they knew what to do and who to speak to if they had any concerns or complaints. The manager said that she has an open door policy and always tries to check with visitors if they have found everything to be alright. Staff training files showed that staff have received training in protecting people from abuse and reporting of abusive situations. Staff spoken with were able to identify forms of abuse and knew that any such situation should be reported. The manager said that they had tried to access training from the local authority but this was not available at the present time. Care Homes for Older People Page 20 of 32 Evidence: During the visit the manager produced a revised abuse policy including the number within the local authority to ring if staff had any concerns. Care Homes for Older People Page 21 of 32 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. The home provides a safe and comfortable place for people to live. Evidence: We walked around the home and looked at a number of bedrooms, bathrooms and all communal areas. Generally the home appeared clean and tidy although some areas such as some toilets and bathrooms were in need of a thorough clean. This was attended to during the visit. People told us in surveys that the home is usually clean and tidy. The manager told us that they have recently installed new boilers and have had a lot of work done within the grounds. They also said that they have a rolling programme of redecoration and would prioritise as necessary. We saw that some of the bedrooms and bathrooms are showing signs of wear and need redecorating. Some people brought in personal items to make their bedrooms more familiar and homely to them. Care Homes for Older People Page 22 of 32 Evidence: Generally the home appeared comfortable although chair protectors on all of the chairs in the lounge took away somewhat from the feeling of homeliness. This could also give the impression that the home did not manage peoples continence needs well. The manager said that she had not considered this and removed all of the protectors during the visit. We spoke with the maintenance man who confirmed, and showed records to confirm, that regular checks are in place to make sure that the home is maintained as a safe place for people to live. Staff files showed that staff have received training in infection control. However we noticed that neither liquid soaps not paper towels were available in communal toilets or in the staff toilet. The manager provided both of these during the visit. Care Homes for Older People Page 23 of 32 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 are supported by a team of staff who have been appropriately recruited and have undertaken training to enable them to do their job. Evidence: People we spoke with during the visit and people who responded to our surveys were generally very complimentary of the staff at the home. One person said The staff at the Manor House provide excellent support One person said that they thought the service could improve with better staff cover and training. We found that sufficient staff were available to support people with their personal care needs but this left little time to engage people in social and leisure activities. The manager should consider building this into the staff rota to make sure that staff have time to support people in meeting their needs in this area. We looked at staff training records and saw that all of the staff had undertaken recent training in a number of areas including moving and handling, health and safety and safeguarding. All of this training had involved watching a video and then answering questions about what they had learned. We discussed with the manager that it would be beneficial for staff to have some practical training along with the videos Care Homes for Older People Page 24 of 32 Evidence: particularly in areas such as moving and handling. The manager said that a member of staff trained to deliver this had recently left their employment but they would look at sourcing practical training. We also saw that staff had received video training in dementia care. From our observations during the visit we feel that staff would benefit from further training in this area to help them in understanding the needs of and communicating with people who are living with dementia. We saw that staff follow the homes induction procedure. The manager told us in the AQAA that newly appointed staff following the common induction standards in line with the skills for care guidelines Although we did not see any evidence of this. The manager told us in the AQAA that six of the nine care staff employed have achieved the National Vocational Qualification (NVQ) level two in care . This means that staff are appropriately qualified to meet the needs of the people who live at the home. We looked at the recruitment files for three of the people who work at the home. we saw that in the main all appropriate checks and clearances are obtained before a person is offered employment. In one case, where the employee had come to the home via a training scheme, the home had not taken references. The manager said that this was because the person had initially come to the home on a placement and the training agency had taken references for them. They confirmed that if the situation arose again they would take their own references. It is important that employers obtain these references so that they can be satisfied that staff are suitable for the position they are offering. Staff told us in surveys that they feel well supported and trained in their work. Care Homes for Older People Page 25 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of people using and involved with the service need to be more actively sought to ensure the home is run in the best interests of the people who live there. Evidence: The manager of the home is also one of the owners. She is supported in the day to day management by her son and her husband. The manager does not have the registered managers award but her son does. The home returned their Annual Quality Assurance Assessment (AQAA) to the Commission as requested. The AQAA give the providers the opportunity to tell the Commission how they feel they are performing and what improvements they think they can make within the service to enhance the lives of the people who live there. The manager told us in the AQAA that they are immediately willing to implement changes for the better when something becomes apparent However they did not tell Care Homes for Older People Page 26 of 32 Evidence: us what processes they have, or would put in place, to make them aware of any changes or improvements people might like to see. We did not see any evidence of meetings held within the home for people who live there or their relatives and friends. We saw that the home do send out quality assurance questionnaires to the people who live at the home so that they can score the home on identified areas of service. The manager said that they always try to speak to people when they visit the home to ask how things are. We discussed ways in which the manager might more actively seek the opinions of people who live at the home and their relatives and representatives. All of the management team were willing to discuss this and informed the Commission the day after the visit of a range of new processes they had put in place to try and obtain peoples views and therefore look at the continued improvement of the service. The manager told us in their AQAA that they do not hold or manage money on behalf of any of the people living at the home. We found that processes for maintaining the health and safety of people living in the home were generally good. We saw that maintenance processes and systems for such as fire safety were good. We also saw that risk assessments are now being put in place within peoples care plans. However we did not see evidence of how these risk assessments, in particular falls risk assessments, are monitored and reviewed and record made of any actions taken to further reduce the risk. It is important that risk assessments are kept under review together with any accidents that have occurred so that staff know what they can do to minimise the risk for the future. Care Homes for Older People Page 27 of 32 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 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Care plans must be reviewed 04/12/2009 to make sure that they include the current needs of the individual. So that all staff are aware of the persons current circumstance and what actions they need to take to promote their health and wellbeing. 2 9 13 Medications must be given and signed as given by the same person. To make the administration of medication procedure as safe as possible for the people living at the home. 23/11/2009 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 Full assessments of peoples needs should be made and Page 29 of 32 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 recorded before they are offered a place at the home. This is to make sure that the home is able to meet the persons individual needs. 2 7 Care plans should contain sufficient detail to inform staff of the actions they need to take to make sure that peoples health and welfare needs are me Staff should speak to people about their care needs privately and discreetly to make sure that peoples dignity is not compromised. Peoples individual interests and lifestyle choices should be explored and actions taken to support them in maintaining these choices. This will help to maintain peoples individuality and enhance their quality of life. 5 14 More work should be done to make sure that peoples choices in their daily lives are established, recorded and supported. This will help people to maintain their individuality and feelings of self worth. 6 7 15 27 People should receive the diet they need to maintain their health. The manager should consider providing dedicated staff hours for engaging people in social and leisure activities.This will make sure that peoples needs in this area are met. References should be obtained and retained on file for all staff working in the home. Practical training in areas such as moving and handling should be arranged in conjunction with video learning. This makes sure that staff have the practical ability as well as the theory. The registered manager should undertake the registered managers award to make sure that she is up to date with management issues. The home should actively seek and act upon the views of the people living at the home and their representatives. Page 30 of 32 3 10 4 12 8 9 29 30 10 31 11 33 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 This is to make sure that the home has a continuous quality improvement plan. 12 38 Risk assessments should be monitored and reviewed and any necessary actions taken to minimise risks to people living at the home. Care Homes for Older People Page 31 of 32 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. 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