Care Home: The Manor Residential Home

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What the care home does well A person that visits the home said, `The home is exceptional in standards of care needs`. Another said, `Personal care is fantastic`. A health professional told us, `They are careful to follow instructions and give attention to the needs of resident`s`. A person living in the home told us, `We have some lovely meals which are beautifully prepared and presented. If there is something I don`t like on the menu, they go out of their way to alter the menu`. One person who visits the home said, `The home makes visitors welcome and will provide a table for them to share with their relative`. One person living in the home told us, `Staff encourage us to get involved with day to day activities and are very helpful to relatives` and `The home recently employed someone to make sure we have something different to do every day`. What has improved since the last inspection? The home has produced a welcome pack for new admissions which includes an introduction to the home and the staff, information about facilities, sample menus, information of activities and trips, advocacy and complaints information. The welcome pack is offered in colour and in electronic and large format. The home has also introduced a comprehensive website which includes a wide range of information for people looking to choose a home including, testimonials people have written about the home, the home`s care philosophy, how needs are assessed and accommodation and facilities available, including a virtual tour. The home has implemented a self assessment system and we viewed this and saw that it is used by measuring how well the service is delivering care based on the standards set by the Commission. An action plan is then implemented to improve the service where weaknesses are identified. A survey is also sent to people using the services each year and the results are on display in the reception area of the home. This self assessment and the surveys used by the home has produced a robust quality assurance system. What the care home could do better: There should be evidence in the care plans of people living in the home that they have been involved with the monthly reviews of their care plan. Medication Administration Record (MAR) charts must be signed immediately after the medication has been administered and not before it is administered. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Manor Residential Home 28 Church Street Arnold Nottingham NG5 8FB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lynda Dyer     Date: 1 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 26 Information about the care home Name of care home: Address: The Manor Residential Home 28 Church Street Arnold Nottingham NG5 8FB 01159535577 01159535588 lynne.crampton@ntlbusiness.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Manor Residential Home (Arnold) Limited care home 25 Number of places (if applicable): Under 65 Over 65 25 old age, not falling within any other category Additional conditions: Service users shall be within category OP Date of last inspection Brief description of the care home 0 The Manor House is an extended and converted building catering for the needs of older people. It is within walking distance of the town centre. The home has twenty-five single rooms seven of which are en-suites. There is a chair lift for access to the first floor for people with a physical disability. There is a lounge and a large dining room. A large conservatory overlooks the front garden and is in constant use throughout the year. This area is also used for service users and their families to meet in private if they want to. There are facilities for assisted bathing and toileting. All the rooms overlook the garden and are light, bright and fresh smelling. All areas of the home are maintained, and furnished to a very high standard. At the time of the inspection the manager told us that the weekly fees ranged from £395 to £420 and were dependant upon the room size and facilities, this is discussed at the point of enquiry. Care Homes for Older People Page 4 of 26 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last time we visited this service was August 1st 2006. The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people who live at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. We as it appears throughout the Inspection Report refers to The Care Quality Commission. We have introduced a new way of working with owners and managers. We ask them to Care Homes for Older People Page 5 of 26 fill in a document that gives information on how well their service provides for the needs of the people who live there and how they can and intend to improve their service, this is called an AQAA (Annual quality assurance assessment). We received the AQAA back from the manager in good time, the form was well completed and it helped us to plan our visit and to decide what areas to look at. We also sent out surveys called, have your say, to people who live in the home, staff that work there, health professionals and visitors. This meant we could get an idea of what people thought about the way the service was run. We had twenty-six completed surveys back and we have included some of the comments in this report. We have not included comments that could identify the writer as we want people to feel they can be open about the way they feel the service is run. We reviewed all of the information we have received about the service since we last visited and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called case tracking, which involved us choosing three people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. One inspector carried out an unannounced site visit to the Home, which took place over 6 hours. The Registered Manager and the owners assisted us during the site visit to the service. We spoke with three members of staff and two people who live in the home to form an opinion about the quality of the service being provided to people living at the home and we have included some of their comments in this report. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. We observed people during lunch and in other communal areas to see how staff interacted with the people that live there. A partial tour of the building was undertaken which included peoples bedrooms and communal areas they frequent to make sure that the environment is homely and safe and we read documents as part of this visit to form an opinion about the health and safety of people who use at the service. The Commission have a focus on Equality and Diversity and issues relating to this are included in the main body of the report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out 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 Care Homes for Older People Page 7 of 26 7535. Care Homes for Older People Page 8 of 26 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 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed before they move into the home so that staff know how to meet their needs. People are offered a range of information before they choose to move into the home. Evidence: The manager told us in the homes Annual Quality Assurance Assessment that improvements made since the last inspection include, updating the web site of the home to provide additional relevant information. Introducing a copy of the service users guide in each bedroom and improved procedure when first assessing potential service users needs. One person living in the home told us, The whole family was told they could call round at the home without an appointment and they suggested a visit to see if it was suitable and for an assessment to be done. Care Homes for Older People Page 10 of 26 Evidence: People told us that they received a contract and enough information before moving in to the home. We looked at the care plan of three people living in the home and they all contained a well documented needs pre-assessment. The home has produced a welcome pack for new admissions which includes an introduction to the home and the staff, information about facilities, sample menus, information of activities and trips, advocacy and complaints information. The welcome pack is offered in colour and in electronic and large format. The home has also introduced a comprehensive website which includes a wide range of information for people looking to choose a home including, testimonials people have written about the home, the homes care philosophy, how needs are assessed and accommodation and facilities available, including a virtual tour. The homes service user guide has been upgraded and is well detailed with a statement of purpose summary, organisational structure and sample letters from people who have used the service or are currently using it. The document also includes the homes complaints procedure, terms and conditions of residence and details of where the latest report from the Care Quality Commission can be viewed. In the main reception we saw a vast display of information about the homes facilities and about advocacy services that were available. The home does not offer intermediate care so standard 6 is not applicable. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have up to date and relevant care plans to enable staff to deliver the appropriate individual care and people are happy with the care they receive. Medication procedures are generally safe. Evidence: The manager states in the Annual Quality Assurance Assessment (AAA) that improvements since the last inspection include the introduction of an additional 30 hours per month to work on and maintain the service users plans. We viewed three care plans of people living in the home and they all included information that was important to them and showed how individual choices around daily living were being maintained. The care plans contained in depth life histories, information on what care support is needed and how staff will deliver that care. There are also activity records, risk assessments for falls and information on any equipment needed for mobilising and to prevent risks. Care Homes for Older People Page 12 of 26 Evidence: In surveys received back, people visiting the home told us that the home always supports the people living there to make choices. The care plans contained evidence that people living in the home had been consulted about their contents and about which representatives they wanted to be involved in reviewing the care plan. The reviews were taking place with input from the representative. However there was not any evidence that the people living in the home were involved in the reviews of their own care plan. The care plans gave clear evidence of people receiving care from health professionals and people living in the home told us how staff supported them to do this. One person living in the home told us, If I am ill I get full support and they call the doctor and inform my family. The staff never hesitate to call for medical support. Medication procedures around storage and administration were generally safe. However, we observed one member of staff sign the medication administration record before administering the medication. We observed peoples privacy and dignity being maintained on the day of the inspection. One person living in the home was being cared for in bed and their door was propped open to enable staff to monitor them without disturbing them. This was discussed with the manager and it was agreed that a risk assessment be put in place with the involvement of the person and their representative to ensure privacy, dignity and fire risks were managed effectively. Care Homes for Older People Page 13 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are given the opportunity to participate in recreational activities and maintain social contacts. People receive a nutritious and appetising diet with individual preferences being met. Evidence: The manager told us in the Annual Quality Assurance Assessment (AQAA) that Improvements made in the last 12 months include, increasing the number of outings by providing additional staff hours, encouraging a relationship with the local comprehensive school, visits by the school to help with the gardening and carol singing and a recent coffee morning. It also states that there are regular reviews of menus based on new service users likes and dislikes. One person living in the home told us, Staff encourage us to get involved with day to day activities and are very helpful to relatives and The home recently employed someone to make sure we have something different to do every day. The home has an activity coordinator two full days a week they do various things with people living in the home. The time table showed activities such as bingo, games, quiz, Care Homes for Older People Page 14 of 26 Evidence: trips to the shops, trips to the seaside, visits to the local school and the local church holds communion each month. We observed lunch being served in the well presented dining area and spoke with five people living in the home, during lunch. The meal consisted of four courses and one person living in the home told us, It is better than a hotel. There was not a choice of the main course available on the menu displayed but people I spoke with told me that they only had to say they didnt fancy what was on the menu and an alternative was offered. Another person living in the home told us, We have some lovely meals which are beautifully prepared and presented. If there is something I dont like on the menu, they go out of their way to alter the menu. One person who visits the home said, The home makes visitors welcome and will provide a table for them to share with their relative. Care Homes for Older People Page 15 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are safeguarded, they know how to raise concerns and feel that the concerns will be responded to appropriately. Evidence: The manager told us in the Annual Quality Assurance Assessment that improvements that have been made in the last 12 months are, all current service users are provided with a copy of the complaints procedure on arrival and the topic is discussed as part of the admission procedure. A copy of the complaints procedure forms part of the service users guide, which is given to all new service users on admission and each bedroom holds a copy. Training in safeguarding is provided to all staff. The Commission has not received any complaints about the home in the last 12 months. The home has received two complaints from the same person in the last 12 months and these have been dealt with using the homes procedures, were well documented and a satisfactory outcome obtained. The homes complaints procedure was seen on display in the main reception, along with some complaints forms for people to use if they wished. We also saw the complaints procedure within the homes service user guide and a copy on display in all of the bedrooms. Care Homes for Older People Page 16 of 26 Evidence: The home has the current local safeguarding procedures in place and the staff have all completed the safeguarding training. I spoke with three members of staff and they all gave an accurate description of safeguarding procedures. One person who visits the home told us, you only have to mention to the owner that something needs changing and they listen and act appropriately. I would have no problem approaching any member of staff if I was not happy at any time. Care Homes for Older People Page 17 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, comfortable and homely environment. Evidence: The manager told us in the Annual Quality Assurance Assessment that the improvements they have made to the environment include, the redecoration of four bedrooms, the reception area, main corridors and front stairs with new carpets fitted to some of these areas and a digital TV purchased for the main lounge area. On the day of the inspection we found the home to be very clean, decorated and furnished to a high standard and well maintained. There were new chairs in the conservatory and the surroundings were bright, cheerful and pleasant. The garden areas were well maintained and had furniture for people to sit in a pleasant area. One person living in the home told us, The home is bright, cheerful and extremely clean. Another said, The Manor at all times is spotlessly clean, the management and staff are to be commended on the high quality of cleanliness and upkeep. Peoples bedrooms were clean and well maintained and highly personalised for individual comfort. Care Homes for Older People Page 18 of 26 Evidence: A small number of doors were propped open to allow people who live in the home to move around more freely. A discussion was held with the manager and where a door is propped open a risk assessment around fire management will be implemented to show how staff will manage this risk. The home has effective infection control procedures in place and staff are trained in following them. Care Homes for Older People Page 19 of 26 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. The home operates a safe staff recruitment process and staff are trained effectively in supporting people living there. Evidence: The manager told us in the AQAA (Annual Quality Assurance Assessment) that staff are being supported to complete a formal qualification for the work that they do. The home has implemented a document to the recruitment procedure which includes a full ten years of previous work history. It also states that a training schedule has been introduced with a new method of recording training courses attended and they now have an on site trainer although external training is still undertaken for training around health and safety. One person who lives in the home told us, Staff are always attentive and will always listen and take notice. Standards are very high, it is obvious that staff take great pride in their work. One person who visits the home told us, The general atmosphere from all staff is caring and friendly. There is a good team spirit that gives confidence and the residents are happy and well cared for. Another said, Standards are very high, it is obvious that staff take great pride in their work. Care Homes for Older People Page 20 of 26 Evidence: The staff training matrix was viewed along with individual training plans and certificates of training achieved. These showed that the home recognises the importance of having a well trained workforce. We viewed the files of two members of staff and these showed that the home has safe recruitment procedures in place and that staff receive induction and regular training. There were plenty of staff on duty on the day of the inspection and three staff spoken with said that there are always enough staff on duty and two people living in the home confirmed this. One member of staff told us, It is a lovely home, I like working here. This is the best place I have worked, people are well cared for. Care Homes for Older People Page 21 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interest of the people living there. Evidence: The manager told us in the AQAA (Annual Quality Assurance Assessment) that the Manor introduced its own self assessment procedure in November 2006 and covered all the standards detailed in the care standards act 2000. They state they completed the first full self assessment in April 2008 and acted on the findings and that they were due to recommence the internal self assessment in September 2008. We viewed the self assessment and saw that it is used by measuring how well the service is delivering care based on the standards set by the Commission. An action plan is then implemented to improve the service where weaknesses are identified. The home also sends out annual surveys to people living in the home and staff. The surveys are then analysed and the analysis includes what action has been or is going to be taken as a result of the outcome of the surveys. The results are on display in the Care Homes for Older People Page 22 of 26 Evidence: reception area of the home. This self assessment and the surveys used by the home has produced a robust quality assurance system. The home has an organisational structure with clear chains of responsibility through the structure and this is all outlined in the homes statement of purpose. The manager has worked at the home since it opened and has the required qualifications as well as attending external training regularly to keep updated with new ways of working. The manager is supported by the provider in the daily running of the home. One person living in the home told us, I am very satisfied with the management of the home and all the staff. Everyone is extremely friendly and it feels like being part of a big family. A better home would be difficult to find A visitor told us, The home is all I could hope for, I cant praise the home enough. We saw health and safety systems in place that keep people safe around their daily living and also safeguard their finances. Care Homes for Older People Page 23 of 26 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 24 of 26 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 9 13 Medication Administration Record (MAR) charts must be signed immediately after the medication has been administered and not before it is administered. To ensure medication records are maintained appropriately. 12/05/2009 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 7 There should be evidence in the care plans of people living in the home that they have been involved with the monthly reviews. Meals would be further enhanced if the home offered a choice of two main dishes at mealtimes and this was displayed on the menu. The practice of using door wedges is not recommended. If a person living in the home is risk assessed as needing one then this should be discussed with the fire officer and a plan put in place that ensures the door is closed as a priority in case of fire. Page 25 of 26 2 15 3 19 Care Homes for Older People Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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