Inspection on 16/08/07 for Maranatha Rest Home

This inspection was carried out on 16th August 2007.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Maranatha Rest Home 03/07/08

Maranatha Rest Home 17/01/08

Maranatha Rest Home 27/02/07

Maranatha Rest Home 20/10/05

Maranatha Rest Home 16/11/04

Maranatha Rest Home 13/07/04

Maranatha Rest Home 11/12/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Maranatha Rest Home 211 York Road Southend On Sea Essex SS1 2RU Lead Inspector Vicky Dutton Unannounced Inspection 16th August 2007 07:50 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 Maranatha Rest Home DS0000038290.V345065.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. Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maranatha Rest Home Address 211 York Road Southend On Sea Essex SS1 2RU 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) 01702 467675 01702 600884 Syed@smh.demon.co.uk AMA Generic Ltd Mrs Rosemary Gay Bodley Care Home 15 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (15) of places Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th February 2007 Brief Description of the Service: Maranatha Rest Home is an established private home providing personal care and accommodation for up to fifteen older people. Within this number the home is registered to care for up to five people who have a diagnosis of dementia. Maranatha is a detached property comprising of eleven single and two double bedrooms. There is a choice of two communal lounge areas, a dining area and a conservatory. Bedrooms are provided on the ground and first floor, with the first floor being accessed via the passenger lift. There is a small garden for the use of residents and on street parking for visitors. The home is situated close to Southend town centre and to the seafront. Maranatha has both a Statement of Purpose and Service Users Guide available. The previous inspection report was available to residents/other interested parties in the homes entrance area. It was confirmed that the current fees at the home are £378.00 to £460.00 There are additional charges for chiropody, hairdressing, taxis when required and newspapers/magazines. Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced ‘key’ site visit. The visit took place over an eight hour period. At this inspection all the key standards were considered. The home’s compliance with requirements made at the previous inspection was assessed. At the site visit a tour of the premises took place, care records, staff records, medication records and other documentation were selected and various elements of these assessed. Time was spent talking to, observing and interacting with residents at the home. Prior to the site visit the home had completed and sent in to CSCI their Annual Quality Assurance Assessment (AQAA). This outlined how the home feel they are performing against the National Minimum Standards, and how they can evidence this. Three weeks before the site visit a selection of ‘Have Your Say’ surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives and involved professionals. A further supply of relative’s surveys were left at the home by the visitors signing in book on the day of the site visit. Staff surveys were given out to individual staff on duty by the inspector. No ‘Have Your Say’ surveys were returned to CSCI prior to this report being finalised. At the site visit a notice was displayed advising people that an inspection was taking place, and with an open invitation to speak with the inspector at any time. During the site visit five visitors and staff on duty were spoken with. The views expressed at the site visit have been incorporated into this report. The inspector was assisted at the site visit by the registered manager and other members of the staff team. Feedback on findings provided throughout the inspection process. The opportunity for discussion or clarification was given. The inspector would like to thank the manager, staff team, residents, and relatives for their help throughout the inspection process. Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: In order that residents are cared for properly and safely the home urgently needs to improve how they plan for residents care, and show how peoples identified care, health and social needs are going to be met effectively. Residents, families and staff need to be involved in this process. Maranatha is registered to provide care for residents who have dementia. Therefore greater attention is needed to monitor and address potential health and safety hazards in/outside the building. The quality of décor furnishings and equipment at the premises needs to be reviewed. A plan for refurbishment, renewal and redecoration needs to be put in place so that the environment provided for residents is improved within a reasonable timescale. Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 7 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. Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 8 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 Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 9 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): 1, 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents cannot be sure that good records of their assessment of needs will be kept, or that these will be used to plan care and assist staff in meeting their needs when they first move into the home. EVIDENCE: The home has a Statement of Purpose and Service users Guide in place which was last updated in March 2007. The home also has a combined document which is in a larger print to assist residents. The manager said that one resident had been admitted to the home since the last inspection. It was not possible to assess the adequacy of the home’s preadmission assessment process. It was stated that the family had wished to see the documentation, had taken it away to view, and would be returning it at the end of the week. A copy had not been kept in the home. Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 10 A briefly completed social work assessment and some brief notes on a piece of paper were available. No initial care plan was in place. The manager said that she had told staff about the resident’s needs. Staff spoken with did appear to know about the resident, and the resident said that they were settling in well and being well cared for. Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 11 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 poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be sure that their health and care needs will be clearly assessed and planned for, so that staff meet their needs in the way that they would wish. EVIDENCE: Residents generally seem to feel that their care needs are met by the home. One family felt that care was not always good, and that things such as care of fingernails and feet were not always attended to properly. Poor planning of, and management of care has been an ongoing issue at the home (see previous inspection reports.) Care planning at the home is still poor, and does not provide an adequate basis for the delivery of holistic care to residents. This has the potential to place residents at risk. Although a new format for care planning has been developed this was only in place for a few residents. As previously stated, a new resident admitted six days prior to the site visit had no initial care plan in place, and no full assessment information available. One resident had recently returned from hospital. A new format care plan was completed and printed out during the site visit. This provided good Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 12 information. Prior to this however their care file was extremely jumbled and it was difficult to identify any consistent or clear previous care planning and review process. For another resident it was a similar story. There was a file full of bits of information but no clear or cohesive care planning and review system identifiable. One resident had a care plan in place dating from March 2007. Since that time an occupational therapist (OT) had completed an assessment and made recommendations for their safe moving and handling. The care plan still referred to the use of a specific piece of moving and handling equipment which the OT said was unsuitable. One resident had a new care plan in place. This was good in its style and level of detail, but lacked some specifics such as the fact that they were receiving district nursing input. Where risk assessments could be identified they had not been reviewed, for example one resident’s risk assessments dated from 2005, and had not been reviewed since that time. Those on another resident’s file were of a different format and, although they were good at identifying potential areas of risk, no remedial actions to reduce the risk were identified. Daily records are maintained separately from the care files and are recorded in individual residents’ diaries, (some also now on separate sheets in another file.) Care staff record three entries a day in these. Other information relating to residents, for example bath records and nutrition records are also kept separately. To try and get a picture of each individual resident’s care it was necessary for the inspector to access six different files/books. This is not good practice, and has the potential to compromise good resident care by increasing the risk that important information/developing issues will be missed and not acted upon. The practice also does not encourage care staff to make active use of care planning information. As at the previous inspection it was clear that where identifiable care plans are in place, they are not routinely used by care staff. The home relies on staff knowledge of residents, and verbal sharing of information at handovers. A proper assessment, care planning system and staff involvement needs to be developed in order that all residents’ care, health, social, and cultural needs are properly identified and met. The start of this process was seen, but the slow progress in this area means that residents are left at risk. The manager gave assurances that these matters would be addressed within a short timescale. From discussion and observation it was clear that residents’ health is monitored and any concerns acted upon. Files showed that referrals had been made to speech therapy, occupational therapy, and the falls prevention team. Again poor recording practice and care planning do not support this process and ensure that all staff are aware of what is happening, in order that they can deliver appropriate care. New recording sheets have just been put in place to try and address this. Good nutritional and fluid records are maintained, but residents’ weight is not currently being monitored. The manager thought that residents’ weight was monitored on a monthly basis, but when the record was found (relating to residents’ bathing, and commenced November 06) no Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 13 residents’ weights had been recorded. An OT assessment that took place in April 2007 for one resident had advised that the resident’s weight be measured so that staff were not put at risk, and a hoist assessment could be undertaken. This did not appear to have happened. District nurses attend some residents at the home. The manager said that the district nurses attended residents in their own rooms. It was noted that in one of the home’s bathrooms, a range of dressings and other items were stored. As well as posing a potential hazard to residents, this may not be an ideal storage area in terms of temperature and humidity. Staff training records showed that some staff had undertaken training in areas relevant to supporting residents with their needs such as incontinence and personal hygiene and pressure care. Medication at the home is managed mostly through a monitored dosage system. Records were generally well maintained, and staff confirmed that they had undertaken training in the administration of medication. Training records indicated though, that in many instances this training took place in 2004. The manager said that they monitor staffs’ competence on an ongoing basis, but this is not formally recorded. Since the previous inspection, protocols for the use of medicines prescribed to be used when necessary (PRN) have been put in place and were of a good standard. One resident self administers some of their medication. A risk assessment was found in relation to this that dated from October 2005. No reviews had taken place. It was seen that the resident was storing their medication in a drawer that could not be locked. The manager addressed this during the site visit. Although the situation relating to the management of creams had improved, some were still readily available in residents’ bedrooms. As the home is registered for dementia this could cause a potential hazard to some residents. Staff at the home were seen to treat residents with care and respect and some good interactions were observed. One shared room at the home did not have a dividing curtain in place to ensure residents’ privacy. It was understood that this had been taken down some weeks previously when the room was redecorated and had not been replaced. Neither the manager or staff had noticed this. Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 14 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents can be sure that they will have some opportunities for occupation and stimulation, but this may not be relevant to their individual needs and choices. Residents know that their visitors will be made welcome and that they will be encouraged to maintain contact. EVIDENCE: The home has no formal programme of activities in place. Activities are provided on an ad hoc basis. A resident said that an entertainer visits the home on a weekly basis, and that sometimes other activities such as bingo take place. They said that when the weather was good staff were sometimes able to take them to the park or seafront. The manager outlined what they hoped would be future developments, including key workers undertaking individual needs assessments for residents to identify their preferences, for example sketching and exercise (at a local college for one resident.) Some staff have undertaken training in ‘Activities in a Care Home.’ During the day of the site visit no activities took place. Residents sat in lounges with the television on, but were mostly not actively watching this. Lounges were frequently left for some time with no staff presence. Staff were kind and Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 15 attentive in their contacts with residents, but said that they ‘do not have much time’ to undertake activities with residents. One visually impaired resident spent the day in their room with little observed staff contact or stimulation, apart from managing their care needs. A member of staff said that this was because they tended to ‘call out a lot, ‘ but that they sometimes did spend time in the lounge.’ Their care plan said that they ‘like music and old songs.’ A music player was available in their room but this was not on. The resident had no access to a call bell. It was said that they would be unable to use this. On my arrival at the home before 08.00, the majority of residents were up, having been assisted up by night staff at the home, (day staff do not start until 08.00.) Residents who were able to express an opinion seemed happy with this arrangement and one said that ‘they liked to be up early.’ Visiting at the home is open with no restrictions, visitors were seen to come and go during the day and were observed to have a good rapport with staff and management at the home. A tour of the premises showed that residents at the home are able to bring in personal possessions. The manager said that information on advocacy services was still awaited, as the service was ‘just starting up again.’ Most residents at the home have relatives who advocate on their behalf. Lunch on the day of the site visit looked appetising and was enjoyed by residents. Menus are based on one main meal with alternative choices such as salad, omelette, soup or other items being available. Residents spoken with said that they were happy with the food provided at the home. Staff were observed to be offering residents choice about what they wanted. The home’s dining area does not provide sufficient seating for the number of residents living at the home. Some residents remained seated in lounge chairs and ate their lunch from small tables. Staff were able to explain the reasons behind this and said that it was in accordance with resident choice. It was also noticed that there were insufficient proper dining chairs available. Two folding chairs were being used to make up the shortfall. These may not be fully suitable or safe for some residents to use. Some residents at the home require assistance to eat. This was done in a sensitive and caring manner by staff. However two residents in one lounge, one clearly requiring assistance, were left with their meals in front of them for some time with no staff presence. Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents and their families know that they can raise concerns about the home, and that they will be listened to. Residents can be sure that that most staff are trained and have knowledge and understanding that will safeguard them from abuse. EVIDENCE: The home’s complaints process was on display on a notice board in the home. The manager was advised that, in line with current guidance, this should include contact details for the Local Authority. No complaints or concerns had been recorded by the home. However one family spoken with said that they often raised issues with the manager of the home. Given this, the home may need to consider their recording processes so that they capture these issues, and provide an accurate picture of complaints made and concerns raised. One person raised anonymous concerns with CSCI. These were discussed with the manager who was co-operative in providing information and documentation so that the concerns could be evaluated. Residents and relatives said that they would feel confident in raising any concerns with the staff or manager. The manager said that all care staff at the home have received training in safeguarding adults. Some newer staff however are not identified on the home’s training matrix so this was not confirmed. Information on safeguarding Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 17 adults was readily available in the home. One member of staff so far has received training in managing challenging behaviour. At the moment at least three residents at the home can present with challenging behaviour. Two of these residents did have some appropriate staff actions identified in their care plans. Maranatha Rest Home DS0000038290.V345065.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, 22, 24, 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents do not benefit from living in a home that is clean and well maintained. EVIDENCE: Maranatha generally provides a comfortable and homely environment for residents, but most areas of the home are in need of upgrading and refurbishing to a better standard for residents. Furnishings in many areas are in a poor condition and require replacement. Access to the main entrance of the home is via a flight of steps. Wheelchair access is to the side of the building. A pleasant small garden is available to residents at the back of the property. Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 19 Since the previous inspection the manager said that one bedroom and a corridor area at the home has been redecorated, one bedroom had been recarpeted and that some work had also taken place in the home’s kitchen. The redecorated bedroom was observed to have had the original wallpaper painted over (including the large central border which still showed through) and the paper was peeling off in one place. Call points in a number of areas were not fitted with cords. This could make it difficult for residents/staff to summon help if required. No programme of routine maintenance and renewal was in place to show that any improvements are planned. The home is registered to provide dementia care. This needs to be considered to a greater degree with issues such as signage, safety and things such as clocks saying the wrong time being addressed. On the day of the site visit there were odour control issues in some isolated areas, including the home’s main lounge. The home currently employs agency cleaning staff who clean residents’ rooms and some communal areas. The ability to keep the home fresh, clean and looking tidy is hampered by the poor fabric of the building, old furnishings and lack of adequate storage facilities. Some toilet seats are in poor condition, and toilet brushes were dirty and in need of replacement. One resident’s relatives were concerned about the poor state of chairs in the home and felt that this contributed to poor odour control. The manager said that chairs were regularly steam cleaned. The manager confirmed that there are no cleaning schedules in place. It was reported that the home’s lounges are cleaned by night staff. These areas were not clean and thick dust had accumulated around the television and fireplace areas. The manager said that they were aware of this problem. The home’s laundry area is in a poor condition. Suitable hand washing facilities to promote infection control were not available in this area. Laundry equipment provided is however adequate to meet the needs of the home. On the day of the site visit the tumble drier was broken and being repaired. Its malfunction had caused some of the home’s towels to be very hard and not suitable to be used. In spite of this, and the fact that a plentiful supply of other towels were available, hard towels had been given out to some residents. This was commented on by relatives, who said that they were not suitable for sensitive skins. Some staff said that they had received training in infection control, but the home’s training records showed that only a few of the home’s current staff have undertaken this. Maranatha Rest Home DS0000038290.V345065.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 poor. This judgement has been made using available evidence including a visit to this service. Residents are supported by staff who have limited relevant training to meet their needs, and may not always be available in sufficient numbers to provide them with holistic and person centred care. Residents cannot be sure that staff are recruited in a robust way so that they are fully protected. EVIDENCE: Staff rotas were viewed and showed that staffing levels are being maintained at three staff on duty during the day, with one being in charge, and one asleep and one awake staff at night. The sleeping in member of staff also works from 07.00 to 08.00 to assist in helping residents to get up. The manager’s hours are normally supernumerary to this. Ancillary staff are provided. One cook/member of staff in the kitchen, domestic staff and a part time handy person are employed. The manager said that there is only currently one full time care vacancy. Although there has been a recent turnover of staff and some longstanding members of staff have left, Maranatha generally benefits from having a relatively stable staff group with many staff having worked there for a number of years. This provides consistency for residents. Residents spoken with were positive about the staff at the home and said that they were ‘very kind and nice.’ Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 21 The manager felt that sufficient staff are provided to meet the needs of residents. Findings at this inspection however show that staffing levels need to be kept under review to ensure that residents’ holistic needs are met at all times. During the day residents were often left unattended in the home’s lounges. Some residents were not assisted with their lunch in a timely manner. Staff felt that there was not time to spend enough quality time with residents to undertake activities and so on. One resident requires three staff to meet their personal care needs. One family felt that there were insufficient staff provided to provide for attention to detail such as nail care and proper foot care. Out of thirteen staff at the home, (from the home’s rota,) one has a National Vocational Qualification (NVQ) at level three. Four further staff have a nursing qualification or degree. Further staff are about to start NVQ at level two. The home falls below the recommended standard of 50 of care staff at the home being trained to NVQ level two or above. The inspector was told that two new members of staff had been recruited since the previous inspection. The files of these staff were viewed. These indicated that recruitment procedures at the home have improved but that further improvements could be made to evidence that recruitment is carried out robustly to protect residents. The people identified as previous employers and referees on one application form were not identified in the person’s employment history. A note on this application form indicated that the referees given had been contacted by phone, but there was no record of the outcome of this. In spite of it now being over two months since employment commenced, there are still no proper references received from these sources. Further references were taken up, but these were from family members. A Criminal Records Bureau check was not yet in place and there was no evidence (in either case) that a POVA first check had been undertaken. The manager said that this had been done, but the email not printed off and put on file. It was advised that this always happens in the future. To help new staff to offer good care to residents the home is undertaking staff induction based on the Skills for Care common induction standards. As at the previous inspection the documentation relating to this could not be viewed, as it was said to be with the members of staff, neither of who were on duty that day. The manager said that no blank formats were available to be viewed. The home’ training matrix showed that the manager has undertaken recent training in the Common Induction Standards, and some staff are identified as having completed an induction course. Staff felt that the training opportunities offered by the home were very good, and identified a range of training that they had undertaken. A training matrix showed that staff at the home undertake some appropriate training for their role. The manager felt that training had fallen off a bit of late but that staff were starting to attend more courses again. The home has had a recent Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 22 turnover of staff. Many of the staff identified on the home’s training matrix no longer work at the home. The level of staff training in dementia care, for which the home is registered is poor. Of the current staff team only four members of staff are identified as having undertaken this training. Some of this training took place in 2004. Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 23 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, 33, 35, 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that they live in a home where health and safety is given a high priority and well managed. EVIDENCE: Maranatha has an experienced registered manager in post. The manager has recently completed their Registered Managers Award and NVQ level four in care. Staff, residents and relatives felt that the registered manager was approachable. As at the last inspection, and still evidenced at this site visit, management at the home needs to focus on developing and monitoring robust systems that promote well evidenced resident care, and provides for the health and safety of residents and staff. Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 24 Following the previous inspection of the home in February of this year the home was required to complete an improvement plan detailing how they intended to address the requirements made at that visit, and improve the standard of the home for the benefit of residents. Despite two reminder letters and a second copy of the improvement plan format being emailed to the home, a completed improvement plan was not received. The registered provider has strategies in place to monitor the quality of the service at Maranatha. A quality control exercise utilising questionnaires to seek resident’s views was undertaken last year and was reported that another batch of questionnaires had just been sent out for this year. The registered provider also conducts regular visits to the home to carry out visits that are required by Regulations. However given the findings of this and previous inspections the effectiveness of these visits in terms of monitoring that the home is being run in line with current standards may need to be considered. The home is part of the Investors in People scheme, the manager said that the home has recently been re-accredited. It was reported that residents meetings do not take place and that staff meetings are held on a periodic basis. The home does not hold any personal allowances for residents. Some health and safety issues were identified as part of this inspection. Some of the issues identified were also highlighted at the previous inspection of the home. The home is registered to provide care for those with dementia, so vigilance is needed to ensure that the environment is safe and secure for them. Gloves and other items were left available that could potentially harm residents. An external door was propped open giving residents free access to the front of the property, the laundry door was not kept locked as previously advised, allowing residents access to a potentially hazardous area. The home stores foodstuffs and dry stores in a shed in the garden. The door to this was observed to be left wide open for most of the day, allowing potential insect/animal contamination, or for dampness from the weather to affect the quality of the stored items. A wheelchair was being used with one resident without footplates being put in place, which has the potential to cause injury. A recent fire inspection identified that the home needed to review and improve their fire risk assessment and take remedial actions in the laundry area of the home. The home’s previous electrical safety certificate ran out in August 2006, but was not renewed by the provider until June of this year. The new certificate said that the system was ‘safe’ but did not comply with current regulations. Fifty six remedial actions were identified as necessary for the home to meet current regulations. The manager advised that none of the remedial actions Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 25 advised have so far been addressed. A further defects list was provided in relation to the home’s emergency lighting system. The home’s training matrix showed that staff training in core areas such as food hygiene, control of hazardous substances and fire safety has in the past been reasonable but due to the turnover of staff this is now not adequate. According to the home’s training matrix many current staff have not been trained in these areas. No staff were identified as having had first aid training. The manager said that the expectation is for staff to be trained/updated in moving and handling on an annual basis. For most staff this last took place in April 2006. Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 26 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 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X 2 X X X 1 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 1 Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15(1) Requirement So that residents receive proper care that is planned and carried out in a consistent manner, the home’s assessment and care planning systems must be improved. The home must consult with residents/their family, carry out a proper assessment of their health, care, social and occupational needs and identify how staff are going to meet these identified needs through a comprehensive care planning system. To assist this process documentation relating to care planning/recording must be clear and consistent. Previous timescales of 01/02/06 01/07/06 and 01/04/07 not met. 2. OP19 23 The premises must be suitable to 01/10/07 meet the aims and objectives of the home, and provide residents with a suitable place to live. This refers to the issues raised in the body of the report, including the need for a plan of DS0000038290.V345065.R01.S.doc Version 5.2 Page 28 Timescale for action 14/09/07 Maranatha Rest Home redecoration and renewal to be in place. This to be developed and a copy including timescales to be sent to CSCI 3. OP26 13 The home must be maintained in a clean and hygienic condition so that good infection control is maintained, and residents live in a clean and pleasant environment. This refers to the issues raised in the body of the report and includes the need to develop and adhere to robust cleaning schedules, and to ensure that staff are trained and competent in infection control procedures. 4. OP27 18 Management at the home must ensure that there are always sufficient staff on duty to meet residents care and social needs. The home must be able to demonstrate how they have assessed that staffing levels are appropriate to meet residents assessed needs. Staff recruitment procedures must be robust so that residents are properly protected. This refers to the issues raised in the body of the report including the need to obtain satisfactory written references and Criminal Records Bureau checks. This is a repeat requirement in relation to recruitment procedures at the home. 6. OP30 18 Staff must receive appropriate training to care for residents and meet their needs. In particular this refers to the need for all DS0000038290.V345065.R01.S.doc 01/10/07 01/10/07 5. OP29 19 01/10/07 01/12/07 Maranatha Rest Home Version 5.2 Page 29 staff to receive a good level of training in dementia care for which the home is registered. 7. OP38 12 Management at the home must make proper provision for the health and welfare of residents. This refers to the need to assess and monitor health and safety matters at the home, and address the health and safety issues identified in the report. These include maintaining a safe environment for residents by ensuring that items that have the potential to cause harm are stored securely, and that potentially hazardous areas are kept secure. 8. OP38 18 Management at the home must ensure that staff receive appropriate training and are kept up to date in core areas as identified in the report. This includes food hygiene, fire safety and moving and handling. The registered person(s) must ensure that the premises are properly maintained. This refers to the need for advice in relation to the homes electrical and emergency lighting system to be acted upon and remedial actions taken. 01/12/07 01/12/07 9. OP38 23 01/12/07 Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 30 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 OP7 Good Practice Recommendations Management at the home should review the practice of maintaining daily records, and other individual residents records, separate from care files. Care staff should be encouraged to be involved in the development and use of effective care planning at the home. Management at the home should review the storage arrangements for creams and topical applications to ensure that residents are kept safe. Management at the home should continue to develop appropriate activities and occupation in consultation with residents. In particular residents with dementia should have their needs properly assessed, appropriate occupation provided, and outcomes recorded. So that residents receive assistance in a safe and consistent manner, staff at the home should receive training in managing challenging behaviour. Management at the home should develop a suitable environment for residents who have dementia and consider the provision of appropriate directional and orientation signage. Management at the home should ensure that staff are encouraged and facilitated to achieve National Vocational Qualifications. 50 of care staff should achieve NVQ Level 2 or above. Management at the home should be able to evidence that staff starting work at the home receive a robust induction programme that is in line with current skills for Care standards. 2. OP9 3. OP12 4. OP18 5. OP22 6. OP28 7. OP30 Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Maranatha Rest Home DS0000038290.V345065.R01.S.doc Version 5.2 Page 32 - 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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