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Inspection on 10/01/06 for 14 Marloes Walk

Also see our care home review for 14 Marloes Walk for more information

This inspection was carried out on 10th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service continues to provide a comfortable homely and spacious environment for people with profound physical and learning disabilities. Care is provided around a core group of staff who have worked with the people living in the home for a number of years, have a good knowledge of them, and who demonstrated a commitment to them having a good quality of life and good life experiences. Good individual care practice was observed, and staff spoken to had overwhelmingly positive things to say about the service.

What has improved since the last inspection?

The environmental shortcomings following the disruption of the essential work done on the home have now been largely addressed. The bathrooms have been much improved, and the home altogether has much more homely and well-cared for feel, which can only reflect positively for the people living at the home.

What the care home could do better:

Since the last inspection, there have been a number of incidents regarding errors in the administration and recording of medication, the last recorded one being in December. These must be kept to an absolute minimum, in order to safeguard the welfare of the very vulnerable people living at the home. To help ensure a more consistent and stable team, the home needs a much higher proportion of permanently contracted, as opposed to agency, staff. A number of current agency staff expressed the wish and anticipation of becoming permanent staff at the home. The organisation should ensure that all such suitable staff are able to do this without unnecessary delay.

CARE HOME ADULTS 18-65 14 Marloes Walk 14 Marloes Walk Sydenham Leamington Spa Warwickshire CV31 1PA Lead Inspector Martin Brown Unannounced Inspection 10th January 2006 10:15 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 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 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 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 Adults 18-65. 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. 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 14 Marloes Walk Address 14 Marloes Walk Sydenham Leamington Spa Warwickshire CV31 1PA 01926 452804 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) Turning Point Ms Sally Barlow Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th August 2005 Brief Description of the Service: 14 Marloes Walk is a care home with nursing for eight younger adults with severe learning disabilities and physical disabilities. The South Warwickshire Primary Care Trust owns the home and the service providers are Turning Point. The two bungalows were purpose built and the home was opened in 1994. Four service users are accommodated in each of the bungalows. The bungalows are connected and have a shared office, sensory room and laundry. The home is close to a small row of shops and is close to the town of Leamington Spa. All of the bedrooms are single without en-suite facilities. There are two adapted bathrooms and a sensory room. The home and gardens are suitable for wheelchair users. 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is of the second unannounced inspection of the year at this home, and should be read alongside the previous inspection report, for a fuller picture. Where key standards have been assessed on the previous inspection and have been met, these have not necessarily been inspected on this occasion. The inspection took place over five hours on a week day morning/afternoon. Staff were helpful and informative throughout. The manager was not present on this occasion. Of the seven service users, five were seen during this inspection, two being out at day services for the duration. What the service does well: What has improved since the last inspection? What they could do better: Since the last inspection, there have been a number of incidents regarding errors in the administration and recording of medication, the last recorded one being in December. These must be kept to an absolute minimum, in order to safeguard the welfare of the very vulnerable people living at the home. To help ensure a more consistent and stable team, the home needs a much higher proportion of permanently contracted, as opposed to agency, staff. A number of current agency staff expressed the wish and anticipation of becoming permanent staff at the home. The organisation should ensure that all such suitable staff are able to do this without unnecessary delay. 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 6 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. 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not fully assessed on this inspection. There have been no new service users admitted to the home since the last inspection. 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,9 Service users benefit from care plans and information clearly setting out their needs and wishes, and how these are met. Being fully be up-to-date will ensure that care and support is meeting current needs. EVIDENCE: A sample of individual care plans were looked at. Communication books continue to provide clear guidelines, illustrated with photographs, as to how individuals make their needs and wishes known. One of these looked at was in the process of being updated. Changes were added in pen; neither these nor the original were dated, making it difficult to tell when these were written, reviewed, or due to be reviewed. Individual Personal Plans are kept in individual bedrooms. One Individual Personal Plan could not be located at the time of the inspection. Individual risk assessments were seen; those looked at were being reviewed and updated as necessary. 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Staff continue to support service users in a variety of activities, and are making commendable efforts to ensure that their disabilities do not prevent them from experiencing as wide a range of activities as possible. EVIDENCE: These standards were seen to be met at the previous inspection, and were not fully assessed on this occasion, other than to note from discussions with staff, the variety of activities undertaken by people living at the home over the Christmas and New Year period. Staff were able to demonstrate, in discussion, a commitment to supporting service users to have a variety of enjoyable experiences. Two service users had recently been supported to go to a night club; an event apparently greatly enjoyed by all. 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 The home continues to provide a high level of support for a small group of vulnerable people with high support needs. Vigilance and care is needed to ensure that medication administration and recording is always correctly done. EVIDENCE: Staff continue to show a good knowledge and awareness of service users’ preferences and how to meet them. Nursing support was requested and provided by the qualified nurse on duty whenever needed during the inspection. Clear guidelines for medication administration and recording continue to be in evidence and staff were able to satisfactorily explain procedures, which were also observed to be carried out appropriately. There have been a number of notifications regarding the administration of medication, principally in the recording of it. Levels of stock all tallied with amounts recorded. All records were checked during the inspection, and were seen to be satisfactory, with the exception of the following: one medication was being administered twice daily, as on the chart, but the label on the medication stated ‘four times daily’. Staff were clear that the correct amount was twice daily, and will clarify this with the pharmacist. 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Staff work hard to that ensure service users’ views are wishes are understood and heeded. EVIDENCE: Staff were observed being very attentive to service users and were able to discuss knowledgably the signs and reactions they gave and what these were likely to indicate. These were confirmed in communication guides and personal care plans. Staff showed a commendable commitment to understanding and meeting service users’ needs and wishes, gained through working with them for, in some instances, many years. This was reflected in ‘comment cards’ received from relatives, who praised the care provided by the home, and only had reservations, in one instance, about the commitment of ‘temporary’ staff. 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Service users benefit from living in a much-improved environment. EVIDENCE: The environment is much improved following its refurbishment. The bathrooms have now been much improved, although the cupboards still require fixing or replacing. I was informed by staff that this is to be done next week. A stepladder had been left in one bathroom. A toilet seat worn to the bare wood needs replacing or refurbishing. The majority of curtains are now in place; there are blinds on every window. The remaining curtains, I was informed, are to be in place by next week. Temporary ramps, needed because of height differences created by the new flooring, have now been replaced by permanent ones. Bedrooms reflect individual needs and wishes; necessary hoists and mobility equipment is in place and a sample was seen to be working satisfactorily. Staff pointed out some minor squeaking in certain areas of the floor. They were advised to ensure that the management was aware of this, in case it was a problem that worsened and might need addressing. A bookcase in the hallway, opposite the office, is a potential obstruction. 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 14 The home was seen to be clean and hygienic throughout on this unannounced inspection. 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 The people living at Marloes Walk benefit from the support of experienced and competent staff who are familiar with their needs. The service should ensure that suitable and willing staff are employed on a permanent basis, rather than via agencies. EVIDENCE: There was sufficient staffing on duty to meet the needs of service users. Although half the staff on duty on the morning shift were agency staff, they were all experienced staff who were familiar with the needs of the service users. Agency staff spoken to were full of praise for the service, and wished to become permanent staff. Concern was expressed over the amount of time this could take. Staff were observed to be supporting service users in a positive, reassuring, and respectful manner throughout. Although qualifications as a whole were not thoroughly examined in the absence of the manager, staff were able to demonstrate, through discussion and observed practice, their competence and knowledge in working with the people living at Marloes Walk. 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 16 All staff have recently had training in Manual Handling, the subject of a previous requirement. 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,42 Service users benefit from a well-run home that promotes and protects their health, safety, and well-being. EVIDENCE: Staff were complimentary about the running of the home; morale amongst staff spoken to was high, with a general determination to ensure as high a quality of life as possible for the people living at the home. The manager was not present during the inspection; the senior person was an agency nurse. She was able to demonstrate her competence throughout the shift, supported by competent and able staff who ensured service users were well-supported, and that service user safety in all aspects of their care was given high regard. Records showed regular fire equipment and safety checks continue to take place, and a recent fire drill had taken place. Staff advised that fire safety training via computer was in progress. The completion of this will be checked at the next inspection. 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 x ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 x 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 x x 3 x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 4 15 x 16 x 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 2 x 3 x x x x 3 x 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 15 Requirement All information regarding the care and welfare of service users must be dated, to facilitate regular review and updating as necessary. Individual personal files must be readily available in the home. Medication instructions on pharmacy labels must be in accord with that being administered. Bathroom cupboards are to be replaced/repaired. All curtains are to be in place. The worn toilet seat is to be replaced/made good. The home must reduce the reliance on agency staff by recruiting more permanent staff.(This is an outstanding requirement from the previous inspection). The home must ensure that no new service users are admitted to the home until sufficient permanent staff are in place. (This is an outstanding requirement from the previous inspection). Timescale for action 11/02/06 2 3 YA6 YA20 15 13(2) 11/02/06 11/02/06 4 5 6 7 YA27 YA24 YA27 YA33 16,23 16,23 16,23 18 11/02/06 11/02/06 11/02/06 11/04/06 8 YA33 18 11/04/06 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 20 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 YA28 Good Practice Recommendations It is recommended that the bookcase in the hall be moved to somewhere less obstructive. 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 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 14 Marloes Walk DS0000058004.V277205.R01.S.doc Version 5.1 Page 22 - 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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