Inspection on 26/08/05 for 14 Marloes Walk

This inspection was carried out on 26th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

14 Marloes Walk 16/04/07

14 Marloes Walk 29/06/06

14 Marloes Walk 10/01/06

14 Marloes Walk 14/03/05

14 Marloes Walk 15/06/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 14 Marloes Walk 14 Marloes Walk Leamington Warwickshire CV31 1PA Lead Inspector Martin Brown Unannounced 26 August 2005 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 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 Stationary 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 E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 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 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 registration, with number of places 14 Marloes Walk E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 14 March 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 E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced, and took place on Friday 26th August between 10 a.m. and 2.30 p.m. The inspector was made welcome by the home. Staff and management were helpful and co-operative, and all service users were present at some point in the inspection. The service has recently undergone massive disruption, as a result of essential floor reconstruction, which meant the entire service being moved temporarily to a vacant hospital ward. This difficult period has been managed well by staff and service users, and all appear to be glad to be back at Marloes Walk. What the service does well: What has improved since the last inspection? What they could do better: 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 E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection 14 Marloes Walk E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 Page 7 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 standard(s) 5 The Service User’s Guide now contains more detail regarding expectations of contributions towards the costs of care. EVIDENCE: These standards were not fully assessed on this inspection, other than to note that information regarding terms and conditions for service users, as required from the previous inspection, is now included in the Service User’s Guide. There have been no new service users admitted to the home since the last inspection. 14 Marloes Walk E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 Page 8 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 standard(s) 6,7,9 Having all care plans and guidelines up-to-date and in line with best practice will greatly assist the meeting of service users’ needs and wishes. EVIDENCE: Individual daily records are kept and were seen to be up-to-date. Individual folders have clear, accessible ‘need to know’ information detailing care needs, and including clear information on service users’ methods of communication, assisting staff to interpret and understand expressions of needs and wishes. Not all of the guidelines are dated, and some are overdue for review. The fully up-to-date ones are of good quality. The manager advised that all individual guidelines affecting individual care, are being up-dated in turn. Staff were observed to be taking care and time to understand and heed service user wishes. Risk assessments are in place. The home recognises the need to update these to reflect any changes following the move back to Marloes Walk. One service user is able to exercise a degree of independent mobility within the home, assisted by a safe environment, the presence of staff and clear guidelines concerning his mobility. 14 Marloes Walk E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 Page 9 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 standard(s) 12,13,15,16,17 Service users are supported in activities, which may appear minimal in many cases, but which may require a great deal of planning and organisation. A higher staffing ratio may allow a greater scope for activities. EVIDENCE: Three service users currently attend day services outside the home; all service users have a variety of in-house activities, with physical and sensory activities such as footspas and massages, and social activities such as shopping. Staff advise that all service users have family contacts and that relationships are positive and supportive. Examples of this, in the form of written compliments, and a poem, were seen. Staff engage positively with service users, talking to them, explaining actions, singing and reading to them. Communication guides help staff interpret service users’ responses. Magazines, pictures, and favoured objects are all available for individual service users. 14 Marloes Walk E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 Page 10 The majority of service users rely on ‘peg’ feeds. A shift leader was able to satisfactorily explain how this operated safely and provided appropriate nutrition and how this was regularly checked with the support, as necessary, of outside professionals. The ‘feeds’ are at a regular time, but flexibility is allowed, to cater for activities and any other factors. A stock of fresh fruit is available along with a variety of food for service users not reliant on pre-prepared food. ‘Tasters’ are also provided for service users where a positive response has been noted to these. Staff, in discussion, demonstrated effort and commitment in encouraging service users to regain/maintain/improve skills in areas such as swallowing. 14 Marloes Walk E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 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 standard(s) 18,19,20 The service works hard to provide support to service users in line with their needs and preferences. There have been inconsistencies and mistakes in medication in recent months; improved guidelines and awareness now appear to have put a stop to these. The effectiveness of epilepsy medication may be compromised by the way in which it is currently stored. EVIDENCE: Staff showed good awareness of service users’ preferences in the way they worked with them, offering lots of physical contact where appropriate, as well as discussion, explanation, and encouragement. At one point, a service user was mobilising independently. Staff were able to ensure he did this safely, but were unable to fully support him in travelling as far as he wished at that point, because of other immediate commitments. Individual ‘Need to know’ folders gave a good outline of requirements and guidelines, promoting good, safe practices. Medication recording showed that medication was being administered in accordance with clear guidelines, with service user photographs, and evidence of consent being in place. Good control and recording of medication stock levels acts as a double check in the event of any perceived inaccuracies. 14 Marloes Walk E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 Page 12 Epilim is being administered in blister pack form. Epilim must usually be administered directly from its protective packaging. Staff advised that the recipient has had one epileptic seizure in the past two years. Discussion with staff and management, and examination of records, showed the involvement of outside professional support in identifying and meeting service users’ health and physical needs. 14 Marloes Walk E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 Page 13 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 standard(s) 23 The openness and ethos of the home, robust abuse policies and procedures, and the involvement of those independent of the home, helps protect the vulnerable people living in the home. The continued reliance on agency staff to cover many shifts is still a source of concern. EVIDENCE: Service user finances are recorded; receipts are available to account for individual expenditure. The manager explained that she audits finances weekly; these are then checked monthly by the service manager, and that Turning Point are now putting in place a system whereby regular auditing will be done by an outside auditor. The profound level of service users’ needs at Marloes Walk makes them potentially very vulnerable. All have relatives who maintain frequent contact, outside professional involvement is maintained, and the environment is an open one, notwithstanding issues of privacy and dignity. Appropriate abuse policies are in place; the home still relies on a large percentage of agency staff to provide full cover at times. The manager advised, and rotas confirmed, that the majority of these workers are regular, long term workers at the home. 14 Marloes Walk E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 Page 14 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 standard(s) 24,25,26,27,28 The home has benefited from its re-flooring and general refurbishment. Because of the tight time scales, some refurbishment, most notably one bathroom, is not yet adequately completed, and this seriously compromises the good work done. EVIDENCE: Service users had moved back into the home earlier in the week, following its renovation. Bedrooms were being returned to their previous condition, in that they were being personalised again with pictures and possessions, reflecting individual likings and personalities. The whole building now has a fresher, brighter feel. Where the re-flooring work had created some differences in floor levels between kitchens, laundry, bathrooms, and exits, wooden ramps have been installed, as a temporary measure, until more permanent ramps can be installed. 14 Marloes Walk E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 Page 15 The vibrating bed, used for therapeutic purposes by service users, had no cover on it. At present, blinds are in place at windows. The manager advised that new curtains are to be purchased and put up where needed. Chairs in communal areas are worn and in need of refurbishment or replacement. The bathroom in Bungalow ‘B’ is not yet fully refurbished; with paintwork incomplete, tiles painted over, and the water supply to the washbasin not working. Service users are currently not using this bathroom. Cupboards in the other bathroom are of poor quality. 14 Marloes Walk E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35,36 Service users benefit from the attention of experienced and well-motivated staff. The home is still having to place a heavy reliance on agency staff, which frustrate efforts to ensure consistent practice. EVIDENCE: There were sufficient staff on duty to meet service users’ general needs, but not sufficient to meet all one-to-one needs on demand, so that, for example, a service user who wished to mobilise could not immediately be supported to go where he wished, how he wished. Rotas show a heavy use of agency staff on occasions. Staff files were examined; those looked at for permanent staff included confirmation of satisfactory Criminal Record Bureau checks by the organisation’s human resources personnel. The proforma for agency staff used by Turning Point was examined; this includes confirmation that Criminal Records Bureau check has been undertaken, but does not clearly state that the check is satisfactory. Staff expressed some concerns at the slow responsiveness of the organisation in some issues, notably in correcting wage errors. Staff supervision and appraisal is recorded and takes place within required times. Staff who supervise others are now scheduled for training in this respect. A staff training matrix shows regular staff training and updating, but also shows that training in Manual Handling has not taken place for eighteen months. Person-Centred Planning training is scheduled for September. 14 Marloes Walk E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39,42 The home is working hard to try and ensure that service users’ views are understood and heeded. Health and safety within the home is promoted and maintained by adherence to policies and procedures. There appears to be some slowness in the organisation returning safety certificates to the home, where they belong. EVIDENCE: Guidelines for service user meetings recognised the role of staff in raising issues on behalf of service users. The guidelines demonstrate the commitment of the service to helping service users, and highlights the difficulties and imperfections in staff raising issues on their behalf. Correspondence showed the involvement of relatives in service user advocacy; the manager advised that regular ‘family forums’ are to be set up, and that Person Centred Plans are to be commenced. Quality surveys amongst relatives have previously been done. 14 Marloes Walk E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 Page 18 Up-to-date gas and electric certificates were seen, Portable Appliance testing was being done by outside contractors on the day of the inspection. Hoists are checked regularly, although the most recent check available was November 2004. The manager advised that these take place bi-annually but are sent first to HQ, and has not yet been passed on. The latest check will be examined at the next inspection. Regular fire safety checks take place; fire training for staff is due to be updated. 14 Marloes Walk E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x 3 Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 2 2 x x Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x 2 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 14 Marloes Walk Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 2 x E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 Page 20 yes 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 20 Regulation 13(2) Requirement The home is required to get satisfactory confirmation that it is acceptable for Epilim to be administered by blister pack, rather than directly from individual foil packaging, or cease this practice. All individual care plans and guidelines must be dated and reviewed six-monthly. One bathroom requires renovation to make it usable; the other bathroom requires new cupboards. Communal chairs require renovation/replacement Temporary ramps must be replaced by permanent ones. Updated training in Manual Handling and fire safety is required. 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 risk assessments reflect any changed cicumstances within the home. The home must ensure that no Timescale for action 5/10/05 2. 3. 6 27 15 16,23 5/10/05 5/10/05 4. 5. 6. 7. 28 24 35,42 33 16,23 16,23 18,13(4) 18 5/11/05 5/3/06 5/11/05 5/10/05 8. 9. 9 33 13 18 5/10/05 5/10/05 Page 21 14 Marloes Walk E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 new service users are admitted to the home until sufficient permanent staff are in place.(This is an outstanding requirement from the previous inspection). 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 34 Good Practice Recommendations It is recommended that the proforma used by the home for agency workers clearly indicates that a Criminal Bureau check is satisfactory. 14 Marloes Walk E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 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 E53 S58004 Marloes Walk V246172 260805 Stage 4.doc Version 1.40 Page 23 - 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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