Care Home: The Manse

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What the care home does well What has improved since the last inspection? The registered manager has complied with all the previous requirements identified at the last inspection. This has meant that care plans are now being regularly reviewed and documented. All staff have attended some form of adult protection training, and the registered manager and some staff have attended Cornwall`s Multi disciplinary training so all staff are aware of how to respond if an allegation of abuse is made. With the current number of residents in the home on the day of inspection there was sufficient trained staff on duty. The registered manager is aware that if the numbers of people who use the service rise and if dependency levels rise then a review of staffing must be undertaken to ensure that at all times sufficient trained competent staff are on duty. People who use the service and staff all expressed that currently there is sufficient staff on duty. It is recommended that this be reviewed on a continual base. The recruitment, selection and vetting arrangements are robust to ensure that all relevant checks are made and are satisfactory before employing a person at the home to ensure the safety of people who use the service. In respect of the recommendations identified at the previous inspection care plans do now incorporate a personal history, where possible, of each person who lives at the home. The medication returns system is robust. The registered manager discussed with people who use the service when they wished to have their breakfast and all spoken with are satisfied with when breakfasts are provided. The registered manager informed us and was seen, that new documentation has been introduced in the areas of pre admission assessments, care planning and their subsequent reviews. These documents ensure that all care needs are identified. The care plans guide and inform staff in specifying what caring interventions are needed, this then allows consistent care to be provided. Care plans are regularly reviewed to make sure they are up to date and appropriately reflect the individual`s needs, preferences and choices. Staff acknowledge that as the documentation is new they are still learning how to complete the forms. Risk assessments are more `in-depth` and a monthly audit of all falls in the home is undertaken and any actions to prevent further falls are addressed. People who use the service and the registered manager felt that the activities have improved and there are now sufficient activities in the home. Carpets have been replaced to ensure that the environment remains to a good standard and the registered manager is aware of any maintenance work that needs completing. The registered manager has more dedicated management time, which is reflected in this report, as she has been able to address all the requirements and recommendations from the last inspection, plus implement new paperwork and procedures into the home, ensuring that staff are also aware of what is expected of them. Staff meetings and residents meetings now occur on more regular bases, as does supervision of staff. The registered manager also felt that the support from the Responsible Individual has benefited the running of the home. What the care home could do better: The home is managed to a good standard but there are some recommendations to further improve the standards in the home. These are that the home`s assessment does not make clear who was present at the assessment. This would provide evidence that the prospective resident and their family, or representatives, were involved in the assessment to ensure that their diverse needs were recorded. The persons contract or a statement regarding the terms and conditions of residency is being reviewed and we will contact the registered provider to discuss this further. The homes medication policy and procedure needs to be updated to include for example the administration and storage of oxygen and insulin and accurately reflect current practices The home uses the Monitored Dose System of medication. However medication had not been entered onto the MAR sheet when received at the home and therefore for PRN and medication that can not be blister packed, a audit of these medicines was not possible and did not tally with the MAR sheets. It is recommended that when transcribing (writing entries on medication sheets) that two staff members witness this to ensure that the entry is written accurately. The registered manager agreed to review the homes adult protection policy and procedure o specify what actions need to occur if there is a suspicion/ allegation of abuse. The Manse has a whistle-blowing policy, it is recommended that this is expanded further as to what actions will occur if a allegation against a member of staff has been made so that staff are clear of the homes procedure. The registered manager was not aware of a policy and procedure in the management of people who use the service monies and this is recommended. The registered manager must ensure that all notifications under regulation 37 of the care Standard Act are sent to the commission.The inspector would like to thank people who use the service, relatives, staff and the Responsible Individual for their kind assistance and cooperation during this inspection process. CARE HOMES FOR OLDER PEOPLE The Manse Cargoll Road St Newlyn East Newquay Cornwall TR8 5LB Lead Inspector Lynda Kirtland Key Unannounced Inspection 18th June 2008 11:00 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Manse Address Cargoll Road St Newlyn East Newquay Cornwall TR8 5LB 01872 510844 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) louisejewell@fsmail.net Underhill Care Ltd Mrs Philippa Louise Jewell Care Home 23 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (23) of places The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th July 2007 Brief Description of the Service: The Manse provides care for up to 23 elderly people. This includes up to 16 people who may have dementia. The home is in the village of St. Newlyn East, which is situated between Truro and Newquay. The Manse has 21 bedrooms of which 19 are single bedrooms. All bedrooms have an en-suite toilet and washbasin facilities. The home has a garden and parking for visitors. There are two shared lounges and a dining room. The home is well maintained with good quality furnishings. Respite care is offered. Some day care is also provided. A copy of the inspection report is available in the hallway, and it is suggested a copy is requested from management if required. The range of fees at the time of the inspection is £370.65 to £388.50 per week. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The unannounced key inspection took place on 18 June 2008 and lasted for approximately seven hours. The purpose of the inspection was to ensure that people who use the service needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that people’s placements in the home result in good outcomes for them. Information received from and about the home since the previous inspection has also been taken into consideration in making judgements about the quality of outcomes for the people living there. The inspection included meeting with some of the people currently living at The Manse plus taking into account the surveys completed by them (6). On the day of inspection eighteen people were resident in the home. A survey by relatives was also received. Members of staff were interviewed plus there were opportunities to directly observe aspects of people’s daily lives in the home and staff interaction with them. Other activities included an inspection of the premises, examination of care, safety and employment records and discussion with the registered manager. The principle method of inspection was “case tracking”. This involves interviews with a select number of people who use the service, staff caring for them and examination of records relating to their care. This provides a useful impression of how the home is working for people who use the service overall. Three people were case tracked in detail at this inspection. The Annual Quality Assurance Assessment, which is a questionnaire that the registered manager completes, was received. The AQAA describes the services and facilities that The Manse provide and identifies what areas they do well in and where they want to make further improvements What the service does well: New people to the home confirmed that their introduction to the home was positive and felt that staff listened to them and understood what care they needed, and have since met. People who use the service commented this was done in a ‘sensitive’ and ‘informative’ manner and did not feel this area could be improved upon. From inspection of case records it was evident that the registered manager undertakes their own assessment plus gains the views and The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 6 opinions of any specialist workers involved with the individual. From this an individual plan of care that identifies the person’s needs is implemented. The care plan forms the basis of the care and support provided. The plans are regularly reviewed to make sure the person’s needs are met at all times. Each person admitted to the care home is provided with a contract or terms and conditions of residency People who use the service were positive about the care and support provided by the staff and said the staff was flexible and responsive to their needs. Some comments include ‘I get personal help from kind staff’ and ‘staff are so helpful’. People who use the service also stated they were always treated with dignity and respect. Good arrangements are in place to meet individual’s health needs and people who use the service were confident that medical services are promptly accessed when required. Flexible visiting arrangements are in place. People who use the service are positive about the varied and nutritional menu that reflects their preferences and choices. Some saying the food is ‘good’ and we get ‘plenty of it’. The kitchen is suitably equipped and good standards of cleanliness are maintained. People who use the service and relatives said that if they had any concerns they felt able to discuss them with their family, via the residents meetings and some said with the registered manager. They felt confident that the registered manager would listen to them and act upon any issues raised. The environment is homely, clean and comfortable and the people who use the service said they were satisfied with the accommodation provided. There is a lounge and dining area on the ground floor, which people who use the service were seen to be socialising in. There is a lounge/dining area on the first floor but people who use the service said they prefer to spend time in their rooms, which was observed. All said they were satisfied with their bedrooms, cleanliness and the décor of the home. People who use the service said they were satisfied with the care provided and that staff are ‘kind’, ‘supportive’ and ‘helpful’. It is clear that positive and trusting relationships have been established between the staff and people who use the service. The care home is well managed by an experienced, qualified, registered manager who has the confidence of the people who use the service, relatives and staff. The Responsible Individual provides support to the registered manager. Suitable arrangements are in place to review the quality of the services and facilities each year. The home is maintained to a good standard ensuring that all health and safety and fire checks are carried out as per legislation. The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? The registered manager has complied with all the previous requirements identified at the last inspection. This has meant that care plans are now being regularly reviewed and documented. All staff have attended some form of adult protection training, and the registered manager and some staff have attended Cornwall’s Multi disciplinary training so all staff are aware of how to respond if an allegation of abuse is made. With the current number of residents in the home on the day of inspection there was sufficient trained staff on duty. The registered manager is aware that if the numbers of people who use the service rise and if dependency levels rise then a review of staffing must be undertaken to ensure that at all times sufficient trained competent staff are on duty. People who use the service and staff all expressed that currently there is sufficient staff on duty. It is recommended that this be reviewed on a continual base. The recruitment, selection and vetting arrangements are robust to ensure that all relevant checks are made and are satisfactory before employing a person at the home to ensure the safety of people who use the service. In respect of the recommendations identified at the previous inspection care plans do now incorporate a personal history, where possible, of each person who lives at the home. The medication returns system is robust. The registered manager discussed with people who use the service when they wished to have their breakfast and all spoken with are satisfied with when breakfasts are provided. The registered manager informed us and was seen, that new documentation has been introduced in the areas of pre admission assessments, care planning and their subsequent reviews. These documents ensure that all care needs are identified. The care plans guide and inform staff in specifying what caring interventions are needed, this then allows consistent care to be provided. Care plans are regularly reviewed to make sure they are up to date and appropriately reflect the individual’s needs, preferences and choices. Staff acknowledge that as the documentation is new they are still learning how to complete the forms. Risk assessments are more ‘in-depth’ and a monthly audit of all falls in the home is undertaken and any actions to prevent further falls are addressed. People who use the service and the registered manager felt that the activities have improved and there are now sufficient activities in the home. Carpets have been replaced to ensure that the environment remains to a good standard and the registered manager is aware of any maintenance work that needs completing. The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 8 The registered manager has more dedicated management time, which is reflected in this report, as she has been able to address all the requirements and recommendations from the last inspection, plus implement new paperwork and procedures into the home, ensuring that staff are also aware of what is expected of them. Staff meetings and residents meetings now occur on more regular bases, as does supervision of staff. The registered manager also felt that the support from the Responsible Individual has benefited the running of the home. What they could do better: The home is managed to a good standard but there are some recommendations to further improve the standards in the home. These are that the home’s assessment does not make clear who was present at the assessment. This would provide evidence that the prospective resident and their family, or representatives, were involved in the assessment to ensure that their diverse needs were recorded. The persons contract or a statement regarding the terms and conditions of residency is being reviewed and we will contact the registered provider to discuss this further. The homes medication policy and procedure needs to be updated to include for example the administration and storage of oxygen and insulin and accurately reflect current practices The home uses the Monitored Dose System of medication. However medication had not been entered onto the MAR sheet when received at the home and therefore for PRN and medication that can not be blister packed, a audit of these medicines was not possible and did not tally with the MAR sheets. It is recommended that when transcribing (writing entries on medication sheets) that two staff members witness this to ensure that the entry is written accurately. The registered manager agreed to review the homes adult protection policy and procedure o specify what actions need to occur if there is a suspicion/ allegation of abuse. The Manse has a whistle-blowing policy, it is recommended that this is expanded further as to what actions will occur if a allegation against a member of staff has been made so that staff are clear of the homes procedure. The registered manager was not aware of a policy and procedure in the management of people who use the service monies and this is recommended. The registered manager must ensure that all notifications under regulation 37 of the care Standard Act are sent to the commission. The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 9 The inspector would like to thank people who use the service, relatives, staff and the Responsible Individual for their kind assistance and cooperation during this inspection process. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are assessed so that they can be assured that the home can provide adequate care EVIDENCE: From discussions with people who have recently come to live at the Manse they said that they were welcomed to the home by staff and were emotionally supported as they settled into their new surroundings. The Manse policy is that managers from the home meet with prospective residents prior to admission to discuss their care needs. Documentation evidenced an assessment had occurred taking into account prospective residents physical, emotional, social and diverse needs. The home’s assessment does not make clear who was present at the assessment. This would provide evidence that the prospective resident and their family, or representatives, were involved in the assessment to ensure that their diverse needs were recorded. People who use the service however, feel that the home involved them in their care arrangements. The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 12 The Manse is using new pre admission documentation that ensures that all care needs are discussed prior to admission so that the home, plus the prospective resident is aware what an individuals care needs are and how The Manse will provide appropriate care to meet them. Staff acknowledge that as the documentation is new they are still learning how to complete the forms. The persons contract or a statement regarding the terms and conditions of residency is being reviewed and we will contact the registered provider to discuss this further. The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Written care plans direct and inform staff about peoples health and personal care needs so that these can be consistently met. The healthcare needs of people are monitored and addressed so that their needs are met. Action must be taken to ensure that all medication is accounted for so that the risk of medication errors is minimised. People who use the service stated they are treated respectfully at all times so that they retain their dignity and enjoy a good quality of life in the home. EVIDENCE: Each person who uses the service has a care plan that covers the individuals physical, emotional, and diverse care needs. The care plans guide and inform staff in specifying what caring interventions are needed, this then allows consistent care to be provided. Care plans are regularly reviewed to make sure they are up to date and appropriately reflect the individual’s needs, preferences and choices. Some people who use the service stated they participate in the reviewing of their care plans. People who use the service were satisfied with the care and support they receive and many were positive about the manner in which the staff undertakes their duties and responsibilities The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 14 Risk assessments in respect of mobility are completed when an issue of mobility has arisen and identify what equipment if any, is needed to assist in the moving of an individual. The daily records for people who use the service summarised if care had been provided that day and reflect for example when visitors or participation in activities occurred. People who use the service are registered with local GP practices. They felt that their health care needs were monitored and attention obtained promptly when needed. This was also documented in the individuals care records. The homes medication policy and procedure needs to be updated to include for example the administration and storage of oxygen and insulin and accurately reflect current practices. General and surplus medicines are stored in a secure facility and each person has a lockable facility in their room to store their individual medication. The Pharmacist safely disposes of any medicines that are no longer required. A medication round was observed and staff were competent in the administering medication and it’s recording. Staff responsible for administering medication has been suitably trained and clear records are maintained. The home uses the Monitored Dose System of medication. However medication had not been entered onto the MAR sheet when received at the home and therefore for PRN and medication that cannot be blister packed, an audit of medicines was not possible as a tablet count did not tally with records kept. This was observed in four rooms. After discussion with the senior carer who has been delegated responsibility for medication within the home, and with the registered manager both stated that this would be addressed immediately. In addition, medication that has been handwritten on to MAR sheets (transcribing), should be witnessed by two staff members to ensure that the entry is written accurately. Due to the registered manager ensuring that all actions identified at the last inspection were addressed and as she has given a undertaking to address this issue immediately this section has been rated as ‘good’ as previous experience has shown that she will address this issue. People who use the service made positive comments on the skills and caring qualities of staff. People who use the service felt well cared for and reported that staff delivered care sensitively, respected their privacy and dignity and listened to their concerns. People who use the service said that staff were “lovely” and “kind”. Examples of staff providing skilled and sensitive care were observed during the inspection. People who use the service found it difficult to identify any area where the home could improve. The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are supported in a lifestyle, which accords as far as possible with their own expectations and preferences. A range of activities takes place that meets peoples’ social, religious and recreational interests. The diet provided is varied and nutritious with attention to individual preferences. EVIDENCE: People who use the service felt that they had control over their daily lives and were supported to make choices about their routines and activities. Individual care plans detail their social and activity interests. The home provides a range of planned activities on a minimum of two days of the week, which people who use the service said was ‘enough’ and did not want it expanded further. The planned activities include outings, music, bingo, arts and crafts and entertainers coming to the home. People who use the service were observed during the inspection to, read the paper, listen to radio, watch TV, do jigsaws and generally socialising. People who use the service said that they found the visiting arrangements open and flexible. They felt that visitors were made welcome and could choose where they meet their guests. The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 16 People who use the service confirmed they have a lockable facility for small items of value or can ask the registered manager to look after items for them. They are able to bring possessions and furniture at admission by agreement with the provider. People who use the service were aware that they could lock their rooms if wished, but have chosen not too. People who use the service were complimentary about the quality and quantity of food provided, comments such as ‘good’, ‘very tasty’ and ‘plenty to eat’ were given. Some were aware of the meal to be provided for that day, and a menu was on display. Each person’s preferences and choices of food are recorded. People who use the service are encouraged at the residents meeting to provide ideas for the menus. Breakfast can be taken in the dining area or in their own room. A mealtime was observed to be a relaxed and unrushed occasion with staff providing sensitive support in a pleasant manner. Staff knew residents’ likes and dislikes. Hot and cold drinks are served between meals. Kitchen staff are aware of individual dietary requirements and cater for this. Kitchen staff have relevant qualifications in food hygiene including intermediate food hygiene certificate. Staff are aware when their need to attend a refresher course and will arrange this with the registered manager. Kitchen staff are available daily and therefore undertake the preparation of the main meal and tea in the home. Kitchen staff demonstrated an awareness of a person’s likes/ dislikes of food and any special dietary requirements. The environmental health inspection occurred 25 May 2008 and recommendations identified have been addressed. The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable arrangements are in pace to deal with any concerns or complaints positively. Staff are aware of the importance of ensuring that People who use the service are protected from abuse and have received training in this area. EVIDENCE: The complaints procedure is appropriate. People who use the service and surveys, said that if they had any issues of concerns, or ideas for improving the service that they were able to approach the management team and felt that they would be listened too. People who use the service also said that their residents meetings are a venue for expressing any worries or ideas for improvement and had confidence that their views would be listened too and where possible action taken to address them. Six concerns have been investigated by the home and ideas for improvements have been listened too and acted upon. The registered manager agreed to review the homes adult protection policy and procedure and was aware of what procedure needs to occur if there is a suspicion/ allegation of abuse as was staff. The registered manager and some staff have attended the multi disciplinary safeguarding course and all staff have attended the in house adult protection training. The Manse has a whistleblowing policy, it is recommended that this is expanded further as to what actions will occur if a allegation against a member of staff has been made so that staff are clear of the homes procedure. The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is accessible, well maintained and safe. A homely, clean and comfortable environment is provided that is maintained to the required standard. EVIDENCE: The environment is furnished and maintained to a satisfactory standard. People who use the service describe the accommodation as comfortable and many have personalised their own bedrooms. People said they ‘liked and ‘were happy’ with their rooms. The majority felt that there could be no improvements made to the environment. There are two lounges. The ground floor has a separate lounge and dining room. The first floor has a lounge/ dining area. People who use the service in particular use the ground floor lounge and some were seen to have their meals in the dining area. This was observed to be a social, relaxed occasion with music playing. On the first floor some people who use the service use the The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 19 dining area for lunch but choose to stay in their own rooms for meals and said they preferred to spend time in their rooms rather than use the lounge. Bedrooms are individualised and comfortable. A stair lift is provided to assist people to go upstairs. Decorations are to a good standard. Bathroom and shower facilities are to a suitable standard and are distributed throughout the home that is within a reasonable distance from people’s bedrooms and the communal areas. There are a number of bedrooms that have their own en-suite facilities. The registered manager was aware that some pipes needed blocking in in one of the bathrooms and assured us that the bathroom that is carpeted is not used, as she was aware of the infection control risks in this area. A range of aids and adaptations are provided at the home to assist people to be as independent as possible. In additional individual people are provided with disability equipment when this is required and following a specialist assessment. The registered manager has completed her own internal audit of the home and is aware of the maintenance work and redecoration that is needed throughout the home. Some carpets have been replaced and areas redecorated. Good standards of health and hygiene are maintained at all times and people who use the service are very satisfied with the cleanliness of the environment. The housekeeper and care staff were aware of the importance of cleanliness, promoting infection control and COSHH. Suitable kitchen and laundry facilities are provided. Domestic staff are employed, and felt that they had sufficient support and training to assist them in their work. They demonstrated knowledge in the areas of infection control and COSHH. The home was clean and hygienic at the time of inspection. The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient qualified, competent staff are on duty at all times to meet people’s needs safely. Staff are qualified and competent to work with the people who use the service. They are recruited on the basis of fair, safe and effective recruitment and selection policies and practices. They have good access to ongoing training to maintain their knowledge and skills. EVIDENCE: From surveys completed plus discussion with people who use the service, their relatives and staff it was noted that all felt that there were sufficient staff on duty at all times. People who use the service commented that staff respond ‘quickly’ when they press their call bell, and some acknowledged that at times there is a ‘little wait but that is because staff are dealing with someone else’. No one found this to be an issue. Currently there is three care staff on duty in the morning, from 3 – 4 pm this reduces to two but then increases till the evening to three care staff. There is two waking night staff, at all times there is management support and during the day housekeeping/catering/maintenance support. People who use the service were very positive about the staff and it is clear that positive and trusting relationships have been established. People who use the service said they felt in control of the care and support provided which they viewed as sensitive, positive, reliable and flexible. The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 21 The majority of care staff has achieved a minimum of NVQ at level 2 and some are in the process of completing it. Fifty percent of the staff team have achieved a minimum of NVQ level 2. Some staff are working towards achieving qualifications at NVQ level 3 in care, so that residents can be confident of the competency of the people looking after them. Recently recruited staff spoke positively about their appointment seeing it as a fair process. They felt their induction programme was appropriate to their work. An induction programme by Mulberry was seen. Staff records showed that all staff has completed application forms and a satisfactory POVA and CRB had been gained along with references. Interview notes are kept Staff at the home said they were well supported and were clear about their roles and responsibilities. It is clear the staff group are committed to helping people maintain their independence as far as possible. Staff confirmed that there has been recent training and the registered manager has booked future courses for staff to attend in the area of infection control, first aid, Mental Capacity Act, manual handling, health and safety and food hygiene. There is a staff-training plan for the home, which sets out training staff have had and are expected to undertake, so that they maintain their knowledge and skills. The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32,33, 35, 36,37 and 38 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home has an experienced and qualified management team who have a sound understanding of their responsibilities. The home is well run and managed for the benefit of the residents. Quality assurance processes demonstrate that service users their representatives, and staff are consulted about the service that the home provides. Records are maintained and handled in accordance with good practice, for the welfare and safety of the people who use the service. EVIDENCE: The registered manager has been in post for four years and ensures that her training in elder persons care is kept updated. She is a competent manager in the daily running of the home and is viewed positively by staff and people who use the service. The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 23 The registered manager is in the process to annually review and monitor the quality of the service and facilities that The Manse provides and has agreed to send these findings to the Commission. The surveys demonstrated that people who use the service and a relative plus discussion with them and staff all felt positively about the care that The Manse provide. In addition resident and staff meetings are held which is another avenue to express ideas on how to improve the service further. From inspection of residents monies kept at the home, the amount of money, and receipts tailed with what was kept in the home and records. Records off money deposited, withdrawn are signed for by the individual or their family plus staff. The registered manager was not aware of a policy and procedure in this area and this is recommended. A range of measures has been put in place to promote safe working practices and the equipment and services to the care home are regularly maintained and serviced. The risk assessment and risk management arrangements for individual people is satisfactory and a monthly monitoring audit of falls in particular is undertaken so that any issues can be highlighted and addressed quickly. The registered manager was advised when to notify the Commission under Regulation 37 of incidents that occur in the home. The registered manager agreed to act on this immediately. There is an established policy and procedure for fire detection and prevention. This has been reviewed by the fire authority that was satisfied with the documentation, which also evidence that equipment is regularly serviced and monitored. The staff at the home are appropriately trained and a regular programme of refresher training is in place. A fire drill occurred on the day of inspection and staff demonstrated a confidence when dealing with the fire alarm. Formal supervision is occurring a minimum of 6 times a year, and records of this were seen. The registered manager stated that the record of supervision is currently being reviewed to ensure that it records what actions have been agreed from the session. Staff annual appraisals also occur and documentation of them was seen. Records reviewed at this inspection indicate that they are appropriately maintained and held, to ensure the welfare and safety of people who use the service. There are suitable storage facilities and records are kept in ways that protect their confidentiality. The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 2 3 3 3 The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 17 (1)(a) Sch 3 (i) 13 (2) Requirement All medication received into the home must be recorded so that all medication held by the home is accounted for to prevent medication errors. Timescale for action 01/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The home’s assessment should record who was present at the assessment. This would provide evidence that the prospective resident and their family, or representatives, were involved in the assessment to ensure that their diverse needs were recorded. Medication that has been handwritten on to MAR sheets (transcribing) should be witnessed by two staff members to ensure that the entry is written accurately The homes medication policy and procedure should be updated to include for example the administration and storage of oxygen and insulin and accurately reflect current practices DS0000046439.V363982.R01.S.doc Version 5.2 Page 26 2 3. OP9 OP9 The Manse 4. OP18 The home’s adult protection policy and procedure should be reviewed so that all staff are aware of what procedure needs to occur if there is a suspicion/ allegation of abuse. The Manse whistle-blowing policy should be expanded further as to what actions will occur if a allegation against a member of staff has been made so that staff are clear of the homes procedure. A policy and procedure in the management of people who use the service monies should be implemented All incidents under Regulation 37 must be notified to the commission without delay as per the Care Standards Act. 5 6 OP35 OP38 The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Manse DS0000046439.V363982.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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