Inspection on 01/12/05 for Essex Care Consortium Marks Tey

This inspection was carried out on 1st December 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Essex Care Consortium Marks Tey 03/05/07

Essex Care Consortium Marks Tey 12/07/05

Essex Care Consortium Marks Tey 25/01/05

Essex Care Consortium Marks Tey 17/08/04

Essex Care Consortium Marks Tey 15/03/04

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Coopers Mill Ltd

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Paradise Lodge

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Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Essex Care Consortium: Marks Tey Station Road Marks Tey Colchester Essex CO6 1EE Lead Inspector Tim Thornton-Jones Final Unannounced Inspection 1st December 10:30 Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 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 Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 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. Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Essex Care Consortium: Marks Tey Address Station Road Marks Tey Colchester Essex CO6 1EE 01206 211825 01206 211825 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) Ms Bethan Jess Oliver Ms Gillian Oliver Patricia Owen Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 13 persons) 12th July 2005 Date of last inspection Brief Description of the Service: The service is comprised of three dwellings occupying the same site. The largest dwelling provides for eight younger adults, who have a learning disability. The bungalow accommodation enables each person to have their own bedroom and to share other communal spaces. The second dwelling is a smaller bungalow accommodating four adults with similar disabilities, although persons within this bungalow have more complex needs. This dwelling is selfcontained and provides each person with separate facilities. The remaining dwelling consists of a self-contained studio flat on the ground floor, which provides for one person. Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This service has continued to demonstrate good commitment to achieving National Minimum Standards and, based upon the findings of this inspection, has maintained this standard at a high level. This inspection sampled seventeen standards across the range of compliance groups and evidence was available to demonstrate that all were being complied with, one rated as commendable. This continues to be a positive achievement. The recommendation regarding the completion of the Manager’s qualification by December 2005 remains. At this inspection one service user was briefly spoken with. The Manager and Deputy Manager were spoken with at length and the Inspector met four other care workers. No visitors or relatives were available during the inspection. Overall, based upon the standards assessed, the service continues to achieve a good outcome for service users. What the service does well: What has improved since the last inspection? • All National Minimum Standards assessed on this occasion have been suitably maintained. Some further developments regarding quality assurance and staff training were also noted. Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 Page 6 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. Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 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 Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 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): 4 Service users benefit from a planned transition approach by the service. EVIDENCE: No admissions have taken place since the previous inspection. The admission policy and procedure remains unchanged and meets with National Minimum Standards. Service users are able to contribute to the admission procedure and include a three-month trial period. Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 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): 9 • Service users, as appropriate, have opportunities to contribute to the home in a variety of ways. EVIDENCE: On the day of inspection one service user, under the guidance and support of an employee, was assisting with the task of replacing the dining room and kitchen flooring. The service user was demonstrably engaged in the activity at a level and contribution commensurate with levels of knowledge and skill. This was, for this service user, a very appropriate activity and provided self-esteem and a sense of achievement. Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 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): 11, 12 • • EVIDENCE: All service users, with the exception of one, were following individual activities off site, either following planned day services or within the community with support. The activities for one service user remaining on site have been described previously within this report. No case tracking approach was used on this occasion regarding care management, although resulting from discussion with the Manager and Deputy Manager the arrangements found at the previous inspection remain in place. Service users have appropriate opportunities for development and to take part in appropriate activities. both personal Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 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 • Service users benefit from a well managed system of medicines administration. EVIDENCE: The service system for the security and administration of medicines was sampled. The system used is a monitored dosage type, provided by a large high street pharmacy chain. Medicines were secure and well recorded. Staff who administer medicines have received appropriate training from the Provider, although the Manager advised that discussions are ongoing regarding the expansion of this training. The records included information on the individual medicines, including the main side effects for staff to be alerted too. Matters associated with consent for medicines, to be administered by the service, were stated by the Manager to be maintained within the individual care planning documentation, although these were not examined on this occasion. Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 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 • Service users benefit from a comprehensive complaints procedure. EVIDENCE: The service maintains a complaints policy and practice procedure that meets with National Minimum Standards. A version continues to be maintained in alternative formats that some service users find able to more easily understand. The Registered Person has not investigated any complaints regarding the service during the period since the last inspection. The CSCI have received no complaints regarding this service during the same period. Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 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, 28 & 30 • Service users benefit from living in a safe, homely and comfortable environment. EVIDENCE: The premises were observed, although not all rooms were visited. All of the communal areas were visited. All areas were well furnished, clean and decorated to a good standard. Of the individual bedrooms visited, all were reflective of the person’s gender and personality. Those bedrooms visited indicated that service users used the rooms for private time as well as sleeping and were equipped with music systems and TV equipment. At the time of inspection a fault had occurred with the hot water and central heating system within the Vines dwelling. The Manager had already contacted the engineer and the fault had been repaired before the end of the inspection. Within the Laurels dwelling, as previously mentioned, a new hardwood floor was being fitted within the dining area and kitchen. Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 Page 14 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): 34, 35 • Service users benefit from a well managed recruitment strategy and well trained staff. EVIDENCE: A full discussion was undertaken with the Manager and Deputy around recruitment practice. The care worker turnover had been relatively low since the previous inspection, although some recruitment had been undertaken. The service policy and practice procedure remains unchanged since the previous inspection and the same well managed approach remains in practice. Care staff are subject to periodic training relevant to the needs of service users and the outcome of the service. Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 Page 15 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, 38, 39, 40 • • The management arrangements are well maintained with an ethos and management style being reflective of good practice. Service users benefit from the developing quality assurance systems and the well developed approach to policy development and procedure. EVIDENCE: The Registered Manager is well established in post and has maintained periodic training. During the last 12 months the Manager has been following a course of study leading to an NVQ at level 4 in both care practice and management. This is in the final stages of completion. See recommendation. The overall ethos of the home is open management whereby all employees are well informed of their individual role and responsibility. This is supported by a well defined and comprehensive structure of policies and procedures. The environment was friendly and relaxed. Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 Page 16 The service has recently been awarded a continuation of the Investors In People Award, of which the home is proud. The Inspector was advised that consideration is now being given to following a standardised quality assurance and quality monitoring system within ISO9000. The Inspector discussed this with both the Manager and Deputy Manager in terms of the service objectives and methodologies of monitoring. Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 Page 17 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 3 X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 4 3 3 X 3 X 3 LIFESTYLES Standard No Score 11 3 12 3 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X 3 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Essex Care Consortium: Marks Tey Score X X 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X X X DS0000017967.V271007.R01.S.doc Version 5.0 Page 18 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. Standard Regulation Requirement Timescale for action 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 YA37 Good Practice Recommendations The Registered Person is recommended to ensure that the Manager is qualified to NVQ level 4 in care and Management by December 2005. Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Essex Care Consortium: Marks Tey DS0000017967.V271007.R01.S.doc Version 5.0 Page 20 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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