Care Home: The Manor, Yealmpton

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What the care home does well The Manor is homely, comfortable and welcoming. The staff are trained and competent in their jobs and there was a calm atmosphere during the inspection with staff interacting well with the people living there. People living in the home who were spoken to and those who had completed surveys all praised the staff. They said that they were treated with respect, that they were cared for as an individual and that they were looked after very well. One person said that the staff were excellent, good fun, cheerful but still professional. A relative said that they were confident that the staff would notice any problems developing. When possible, prior to admission, the registered manager or one of the senior nurses visit the person in their current setting to complete a full needs assessment in addition to receiving care plans from other social and health care professionals. Once admitted to the home the person`s needs are set out in a care plan, the plans provide sufficient information for care staff to be able to meet the health, social and psychological needs identified. Individuals` preferences with regard to their daily routines, how they spend their time, the food they wish to eat and any other choices which are important to them are respected and recorded in their care plans. Staff said that they felt well supported and that they have good training. They also said that they work together well as a team. The home is clean and hygienic and is regularly maintained and redecorated. What has improved since the last inspection? There were no recommendations or requirements following the last inspection. New carpets, furniture and other equipment have been purchased. Refurbishment and redecoration are ongoing. What the care home could do better: All those living in the home should be given information about the programme of activities so that they can choose whether or not to participate. All staff should be made aware of the assistance each person requires to enable them to eat their meals. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Manor, Yealmpton Fore Street Yealmpton Plymouth Devon PL8 2JN     The quality rating for this care home is:   two star good 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: Susan Samways     Date: 1 1 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, Yealmpton Fore Street Yealmpton Plymouth Devon PL8 2JN 01752880510 F/P01752880510 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wells House Limited Name of registered manager (if applicable) Mrs Jean Thompson 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 physical disability Additional conditions: Physically Disabled (50 years and over) The Home is registered as a Care Home with Nursing for a maximum of 22 Service Users in the categories of PD(E) 22, TI(E) 22, OP 7, DE(E) 3 Date of last inspection Brief description of the care home The Manor is situated in the village of Yealmpton within the South Hams area of Devon. The home provides nursing and/or personal care to a maximum of 22 service users over the age of 65 years of either gender with physical frailty or physical disability or illness and up to 3 service users with dementia. 0 0 0 Over 65 3 7 22 care home 22 Care Homes for Older People Page 4 of 26 Brief description of the care home Accommodation is provided on 3 floors, a passenger lift provides access to the 1st floor, and a stair lift provides access to 4 bedrooms situated on the 2nd floor. Individual accommodation is currently available in 16 single rooms (five have en suite WC) and 3 double rooms. The communal areas are situated on the ground floor and comprise a lounge and conservatory. This facility offers a `homely? comfortable environment. The registered provider visits the home on a regular basis and shows a commitment and interest in the service users welfare. The last CSCI inspection report is displayed in the foyer at all times for people to read. The manager is due to review the Statement of Purpose and was advised to include information about how a person who cannot visit the home or does not have access to the internet can get a copy of the inspection report. The current fees are £375 - £575 (March 2009). The contracts examined clearly breakdown the make up of the fees charged and what is included in the fee. Contracts are issued to every Service User whether they are publicly or privately funded. Care Homes for Older People Page 5 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection for this service was completed on 21st March 2007. This was an unannounced inspection which lasted for seven hours. Since the last inspection the registered manager had changed. Unfortunately she had been off sick for several months and her role was being filled by the previous registered manager who is now the general manager for The Manor and another home owned by the same company. Time was spent in discussion with the general manager, examining care plans, staff files and other records and documentation and interviewing staff. Several people resident in the home were spoken to as well as some visitors in passing. A tour of the Care Homes for Older People Page 6 of 26 premises, including a visit to the kitchen, also took place. Surveys were completed by six people living in the home, some with assistance from relatives, and by seven staff. Prior to the inspection the Annual Quality Assurance Assessment, completed by the general manager, had been received. This provided information about how the national minimum standards had been met, what had improved since the last inspection and future plans for The Manor. 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 8 of 26 7535. Care Homes for Older People Page 9 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 10 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into The manor can be confident that they will have sufficient information about the home and that the home will have ensured that they can meet their needs. Evidence: A brochure that includes the Statement of Purpose is given or sent to every person wishing to move into the home. This provides information about the home, the accommodation and services provided and the registered provider, registered manager and the staff. The brochure is available at all times in the foyer along with the most recent inspection report. People living in the home who completed surveys all said that they had sufficient information about The Manor prior to moving in. The files for three people living in the home were examined. All had detailed assessments identifying the care they would require. Some had assessments Care Homes for Older People Page 11 of 26 Evidence: completed by social services or other professionals. The home has its own assessment which is used especially if the person is self funding. The general manager visits prospective residents where they are currently living to complete the assessment and ensure that the home can meet that persons needs. Any one considering moving into the home and /or their relatives can visit the home, stay for a meal if they wish and meet staff and other residents. A room in the home is offered on the basis of one months trial. The home is not registered to provide intermediate care. Care Homes for Older People Page 12 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 and, when appropriate, their relatives are involved in planning and reviewing their care. The medication procedure safeguards the people living in the home. Staff treat people with respect Evidence: The care plans for three people living in the home were examined. The care plans were clear and easy to understand and had been regularly reviewed. In some cases it was evident that the plans had been created and reviewed with input from the residents and/or their relatives. They included risk assessments regarding pressure care, manual handling, mobility and nutrition and other assessments relevant to a particular person or their condition. Records were seen to have been made for all visits to the home by social or health Care Homes for Older People Page 13 of 26 Evidence: care professionals, including the persons GP, and of all outpatient appointments attended. The medication system is well managed. The records were seen to have been completed correctly and medication is stored appropriately. Disposal of unused/ out of date medication is safe, well recorded and removed by a licensed contractor. A senior carer stated that if a new nurse or a nurse from an agency who is unfamiliar with the people living in the home is on duty she escorts them on the drug round to ensure that each person receives the correct medication. During the inspection staff were observed to treat the people they are caring for with respect and this was confirmed by those spoken to. They said that the staff usually listen to what they say and act on it and said that staff are usually available when they needed them. The general manager stated that each person has an end of life plan and two of the files had these. She also stated that when someone is coming to the end of their lives their wishes are respected. Relatives are able to stay with them for as long as they would like and are able to help with their care if they wish. Care Homes for Older People Page 14 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 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 a range of activities in which to participate if they choose. The meals provided are nutritious and varied. Evidence: The information submitted by the general manager prior to the inspection lists a range of activities that take place in the home and the local community including musical entertainment, slide shows, quizzes, reminiscence, hand massage and manicures and library services. Local school children and other community groups are invited to visit the home and those who are able are encouraged to attend local events. Peoples religious beliefs are respected and local ministers of religion attend the home and hold services as required. Those still able to go to church are enabled to do so. Some people who completed surveys said that they did not know about activities arranged by the home. This may be because they were too poorly to participate but the manager should ensure that everyone has easy access to information about events within the home so that they have choice about whether they wish to join in. Care Homes for Older People Page 15 of 26 Evidence: The menus are designed to meet the needs of the people living in the home. The general manager stated that they are regularly reviewed and suggestions for meals made by those living in the home are included. The chef was seen to have individual records for each person which include their likes and dislikes. He stated that there is a choice of food at every meal and that snacks and drinks are available 24 hours a day. Those completing surveys said that they usually liked the meals. One relative said that some staff do not ensure that their family member is in the right position to be able to eat their meal comfortably while others are very careful to get it right. The manager needs to address this. Care Homes for Older People Page 16 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 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 and their relatives have sufficient information to make a complaint should the need arise. People living in the home are safeguarded by staff being trained to recognise abuse. Evidence: The homes complaints procedure, which details who to complain to and the time scales for dealing with the complaint, is included in the homes brochure and is on display in the home. The general manager stated that they have had no complaints in the last 12 months and the Commission for Social Care Inspection have had no complaints about this service since the last inspection. All those completing surveys said that they knew how to make a complaint should the need arise. The general manager stated that all staff have had training regarding the protection of vulnerable adults which raises their awareness of what constitutes abuse and the action they should take if they suspect abuse to have taken place. Staff spoken to were aware of these issues. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manor provides a clean, comfortable and homely environment in which to live. The manor is equipped to meet the needs of the people living there. Evidence: The inspection included a tour of the premises. The home was found to be clean, hygienic and free from offensive odours. Rooms were seen to have been personalised by the occupants using items of their own furniture, ornaments and pictures. Communal space is limited but it meets the needs of those currently living in the home. There is also easy access to pleasant outdoor space including a patio which the general manager said is well used when the weather permits. The home is furnished and decorated in a homely way. There are chairs of varying heights and some recliner chairs. There is also specialist equipment to aid the care of those living in the home. This includes adjustable height beds, pressure relieving mattresses and manual handling equipment. There is a call bell system throughout the home. The laundry and kitchen are adequate to meet the needs of the people living there. The home appeared to be well maintained and the general manager said that there is Care Homes for Older People Page 18 of 26 Evidence: a rolling programme of redecoration and refurbishment. During the last year several carpets, beds and chairs have been replaced. A new cooker and dishwasher have been purchased. Infection control policies and procedures are in place and staff are provided with adequate supplies of gloves and aprons. 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. There are sufficient numbers of staff with appropriate skills and knowledge to meet the needs of the people living in the home. The homes recruitment procedures protect people from being placed at risk of harm or abuse. Evidence: The manor is a home which also provides nursing care. A registered nurse is therefore on duty at all times including during the night. They are supported by a team of carers the majority of whom are qualified to at least NVQ Level 2 in Care. On the day of the inspection there appeared to be sufficient staff on duty and those completing surveys said that this was usually the case. Staff interviewed during the inspection and those who completed surveys said that The Manor was a good place to work and that everyone worked together as a team. They also said that training was good. Examples of training they had recently undertaken were dementia care, manual handling, strokes, eye problems and the Liverpool Care Pathway. They also said that the induction training for new staff covered what they needed to know very well. Care Homes for Older People Page 20 of 26 Evidence: People living in the home were complimentary about the staff. One said that they care for people as individuals and another said that they were excellent, good fun, cheerful but still professional. A relative said that they had confidence that the staff would notice any problems developing. The files for four staff were examined. All contained the required documentation including application form, at least two references and police checks. Checks had also been made against the register of those barred from working with vulnerable adults before employment commenced. One file also had a risk assessment for when the member of staff was pregnant. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management style is open and receptive to the views of the residents and others involved with the home. The policies, procedures and safe working practices provide protection for both the people living in the home and staff. Evidence: Since the last inspection there has been a change of registered manager. The previous manager has been promoted to general manager and oversees the running of The Manor and another home owned by the same company. A new manager has been recruited and registered with the Commission for Social Care Inspection. Unfortunately, at the time of the inspection, the registered manager had been off sick for several months and the general manager had been managing the home in her place. Care Homes for Older People Page 22 of 26 Evidence: The general manager stated and staff contacted confirmed that there is an open door style of management. The general manager was seen to be approached by staff, visitors and the people living there with confidence and were well received. Staff said that they feel well supported although formal staff supervision is reported to be irregular. Staff feel that they are usually kept informed about what is going on in the home and any changes made. The views of the people living in the home and of their relatives are sought annually through the use of questionnaires. Changes have been made in the home as a result of suggestions made e.g. improved lighting in the conservatory. Most people living in the home manage their own money or their families assist them to do this. Lockable storage is provided in bedrooms for the safe keeping of items of value. General spending money for eight people is looked after by the home. Money is provided by relatives who regularly top up the fund. The home was seen to have kept accurate records of all transactions. Only the general manager and registered manager have access to these funds thus reducing the risk of any inaccuracies occurring. The general manager stated that they endeavour to ensure that the home is safe and that safe working practices are employed at all times. Radiators are covered, water temperatures regulated and window openings restricted. Hazardous substances are stored correctly and antibacterial soap and alcohol hand gel is available for all to use. Staff are trained in fire safety, manual handling, first aid and infection control. Information provided by the general manager prior to the inspection shows that safety checks and regular servicing of equipment and services is carried out at the required intervals. Any accidents or incidents are recorded and reported to the appropriate authorities as required. 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 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 12 The registered manager should ensure that everyone living in the home is aware of the activities available for them to participate in. The registered manager should ensure that all staff are aware of the assistance required by each person living in the home to eat their meals. 2 15 Care Homes for Older People Page 25 of 26 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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