Inspection on 17/01/08 for Maranatha Rest Home

This inspection was carried out on 17th January 2008.

CSCI found this care home to be providing an Poor service.

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 16/08/07

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 Ms Vicky Dutton Unannounced Inspection 17th January 2008 08:20 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.V358219.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.V358219.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.V358219.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th August 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 or 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.V358219.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced ‘key’ site visit. At this visit we considered how well the home meets the needs of residents, how staff and management work to provide good outcomes for people, and how people are facilitated to have a lifestyle that is acceptable to them. The level of compliance with requirements made at the previous inspection was assessed. At the site visit a partial 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 people living at Maranatha, and talking to staff and visitors. Last July the manager 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. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to people living at the home, relatives involved professionals and staff. There was a low response rate to these with only one person living at the home and two relatives surveys being returned to CSCI. 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. The views expressed at the site visit and in survey responses have been incorporated into this report. The manager and other members of the staff team gave assistance at the site visit. Feedback on findings was provided throughout the inspection. 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.V358219.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: People need to know that their care is provided in a way that is consistent and safe. So that this happens, any risks such as the use of bed rails/wedges need to be assessed, and where possible people’s consent sought. It has been difficult to get a full and accurate picture of staff training. Staff files do not always contain certificates for training identified as having taken place. Training lists do not always marry up with a training matrix supplied. Management need to keep accurate records and demonstrate that staff are skilled and competent to meet the needs of people. Staff should access the training needed to enable them to meet the assessed needs of people living at the home, and their own development needs. Management need to urgently address staffs’ understanding of fire procedures and safety. Information at this site visit showed that staff recruitment is still not being carried out to a satisfactory standard. People living at the home should be Maranatha Rest Home DS0000038290.V358219.R01.S.doc Version 5.2 Page 7 protected by staff recruitment always being undertaken in a consistent and robust way with appropriate checks being carried out. This is not happening. When staff start work at the home they need to be given the initial training that will help them to work safely, care for people well, and understand basic policies and procedures. Although works to improve the environment for people are ongoing, an unmet requirement from the previous inspection is that a written plan of renewal and redecoration should be in place and a copy sent to CSCI. The plan should include when the improvements are to take place by, so that people can be assured that improvements will be seen within a reasonable timescale. 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.V358219.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.V358219.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): 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can be sure that the home has a process in place to assess their needs and make sure that the home will be suitable for them. EVIDENCE: As at the previous inspection it was not possible to fully assess the effectiveness of the home’s pre-admission assessment procedures, and confirm that people have the opportunity to take part in an assessment process that will help them to decide whether the home will be suitable for them or not. This is because since the previous inspection only one person has moved into the home. This person was well known to staff at the home, and had used the service in another capacity for a long time. A ‘Resident PreAdmission Record’ had been completed. This was dated after the stated date of admission and did not cover all areas that an assessment of need should cover as indicated in the National Minimum Standards. ‘Assessment’ sheets Maranatha Rest Home DS0000038290.V358219.R01.S.doc Version 5.2 Page 10 that better covered some of these areas had been completed by the family, rather than being completed as part of an assessment process by staff. Information was available from the social services department funding the admission. Another ‘Resident Pre-Admission Record’ sheet provided a brief write up and confirmation that the home was able to meet the person’s needs. An ‘admission checklist’ to show that appropriate procedures had been followed and the person helped to settle in had only been partially completed. On the AQAA completed by management last July it was stated under ‘what we could do better’ that ‘Allocate a member of staff to give information and special attention to make the prospective resident feel comfortable in their surroundings and enable them to ask questions.’ The poorly completed ‘admission checklist’ shows that this may not yet be happening. Intermediate care is not provided at Maranatha Rest Home. Maranatha Rest Home DS0000038290.V358219.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 adequate. This judgement has been made using available evidence including a visit to this service. People can generally be sure that their care needs will be planned for, however risks associated with care may not always be fully appreciated or assessed. People will be supported to maintain good healthcare, and their medication will generally be managed safely. EVIDENCE: Comments on the care provided at Maranatha Rest Home were varied but generally positive. Some comments were: ‘The residents are well fed and kept clean,’ ‘I feel that they feed my relative regularly with a well balanced diet, and treat the bedsores and minor abrasions caused by their delicate skin regularly and efficiently,’ ‘sometimes care is good and sometimes not.’ A person living at the home said ‘I couldn’t ask for more.’ Care records viewed indicated that personal care might sometimes be lacking. According to bathing records none of the three people being ‘tracked’ as part of this site visit had had been offered a bath in the previous ten days. One person’s care plan said Maranatha Rest Home DS0000038290.V358219.R01.S.doc Version 5.2 Page 12 that they should be weighed monthly. There was no record that this had happened. Since the previous inspection staff and management have worked hard to improve the assessment and care planning processes. A new format has been put in place that generally provides a satisfactory basis for staff to know about peoples needs, and offer them appropriate care. Care plans aim to be person centred. As part of this site visit three care plans were viewed in detail. Two were generally satisfactory, although one was dated over one month after the person moved in, showing that care plans may not always be put in place in a timely manner. There was also no evidence to show that care plans are reviewed on a monthly basis or more frequently as required. One person still had an older style care plan in place that did not reflect all their current needs. The care plan indicated that the person would require ‘full personal care with washing and dressing,’ but there was no guidance for staff as to how this should be carried out in ways preferred by them. The manager said that a new format had been previously completed, but this could not be found. A new one was written and put in place during the site visit. Some elements of individual risks such as moving and handling are assessed, but others are not. Two people at the home were using a system of wedges to prevent them from falling out of bed. These had been put in place without any multidisciplinary risk assessment process being carried out to assess the need for or the appropriateness of the system. There was also no risk assessment or care plans in place to ensure staff understanding and safe use. Training records available did not indicate that any staff had undertaken training in the risk assessments or use of bedrails. The risk was potentially more complex for one person where the system was being used on a bed where a pressure relieving air mattress was also in place. The manager said that the air mattress belonged to a previous occupant of the room and should have been removed. The manager said that one person using the wedge system would be able to give their consent to this form of restraint, and although a relative had been consulted, there was no evidence that they had been consulted or their consent sought. Risk assessments for both people were written during the site visit. Although kept separate from individual care plans, it was seen that good daily records are maintained. Care records, observations and discussions during the day indicated that people are offered a good level of healthcare to meet their needs. They can access all appropriate services, and when health issues arise staff are proactive in ensuring these are managed with appropriate referrals being made. As part of care planning people’s nutritional and tissue viability needs are assessed. Good nutritional and fluid records are maintained. Medication is managed mostly through a monitored dosage system. Records were generally well maintained, and suitable procedures were in place to make sure that people’s medication is managed safely. It was difficult to assess the level of staff training in administering and managing medication to assess if Maranatha Rest Home DS0000038290.V358219.R01.S.doc Version 5.2 Page 13 there was a good level of competence in the staff team to ensure that this important aspect of care is managed effectively. This was because training records were not well or consistently maintained at the home. The AQAA completed by the home last July said that ‘four more staff have attended medication training. Staff are involved in learning the side effects and reasons for prescribing various medication.’ A training list for the last year showed that one person had undertaken medication training during that time. Four staff files viewed did not identify that any medication training had taken place for these staff. It was acknowledged that one member of staff is a trained nurse and would have knowledge of medication. The manager undertook to supply a full and up to date staff training matrix. When this was received it showed that only four current staff have had medication training. The manager and one other member of staff had undertaken recent training. The deputy manager last undertook training in 2004, and another member of staff in 2005. Policies and procedures were available, and it was good to note that a copy of the recently revised Royal Pharmaceutical Society’s guidelines relating to care homes was also available. When the system was viewed it was found to be generally satisfactory. Some minor practice issues were identified. This included improving how people’s medicines are stored in the home’s general food refrigerator, and the need to record on medication administration records if someone is self administering their medication. Although the management of creams has improved, in one shared room two pots of unlabelled aqueous cream were found with an expiry dates of 2004 and 2005. In an unlocked bathroom cupboard there was a wound cleaning spay dating from 2005 and for someone no longer at the home. As at the previous inspection it was noted in one of the home’s bathrooms, a range of dressings and other items were stored. As well as posing a potential hazard to people, this may not be an ideal storage area in terms of temperature and humidity. The manager said that these would be moved. During the site visit staff treated people with care and respect and some good interactions were observed. One shared room did not have a dividing curtain in place to ensure people’s privacy. In a bathroom cupboard some toiletries such as shaving foam and shampoo were noted. It was not clear if these were being used communally. If so this would be poor practice. Maranatha Rest Home DS0000038290.V358219.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. People will have some opportunities for occupation and stimulation, but this may not be relevant to their individual needs and choices. People know that their visitors will be made welcome and that they will be offered food that they enjoy. EVIDENCE: There is no formal programme of activities in place. Activities are provided on an ad hoc basis by care staff, one of who was identified to have undertaken training in activities provision. During the site visit some people played a game of skittles with staff in the morning and enjoyed a brief piano session. Throughout the day some people enjoyed going to have their hair done by a visiting hairdresser. It was confirmed that an entertainer still visits the home on a weekly basis. During the site visit staff interacted with people in a friendly and caring way, but they were frequently left to their own devices with the television on, many dozed frequently during the day. In the afternoon only one person was awake in one lounge. The television was on showing snooker; the person said that they did not like this. Another person said that they were often bored. On a survey a relative said that there were ‘Very few activities available.’ Care plans are better at identifying individuals preferred activities, Maranatha Rest Home DS0000038290.V358219.R01.S.doc Version 5.2 Page 15 but often identify things like ‘going out for walks,’ which rarely seems to happen. When activities take place these are not recorded or targeted to individuals’ assessed needs. Therefore, particularly for people who have dementia and may not be able to say what they enjoy, the home has no way of identifying what works, or building up a suitable individual programme of occupation. People’s preferred routines are recorded in care planning information. From observations during the site visit it was clear that staff were aware of people’s preferred routines, and respected these. The AQAA completed last July recognised some of the above issues and under ‘what we could do better’ said ‘Record the residents’ participation. Improve on activities for persons with dementia.’ Visiting is open with no restrictions, visitors were seen to come and go during the day. In a recent compliment made the home was praised for its care for relatives and ‘the endless supply of cups of tea and coffee.’ A tour of the premises showed that people living there are able to bring in personal possessions. As at the previous site visit the manager said that information on advocacy services that could be put on display for people was still awaited. Most residents have relatives who advocate on their behalf. Information about a carers support line was available. On the day of the site visit the kitchen was being refurbished so fish and chips (or alternatives) had been ordered. People spoken with said that they were happy with the food provided and made comments such as ‘very tasty,’ and ‘Food is good on the whole.’ Maranatha Rest Home DS0000038290.V358219.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. People know that they can raise concerns, and that they will be listened to. However they cannot be sure that all staff are trained and have the knowledge and understanding that will fully safeguard them from abuse. EVIDENCE: A complaints procedure is in place and on surveys people indicated that they were aware of how to raise any concerns. Since the previous inspection no complaints have been recorded by the home. A new book has been placed in the home’s entrance hall for people to record any compliments, complaints or issues that they might have. No items had so far been recorded. This practice raises issues relating to maintaining confidentiality. These were discussed with the manager. Since the previous site visit two families have raised concerns about the home through CSCI. Issues raised related to the premises, personal care and the future of the home and were considered as part of this inspection process. From training information available it would appear that most staff at the home have completed training in safeguarding vulnerable adults. Two new members of staff confirmed that they had attended training in safeguarding adults, but were not aware the term whistle blowing or appropriate procedures. Training information showed that only one member of staff has done any training relating to managing challenging behaviour, although it was identified that some people living at the home can be challenging. Maranatha Rest Home DS0000038290.V358219.R01.S.doc Version 5.2 Page 17 Maranatha Rest Home DS0000038290.V358219.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, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a homely environment, where there is a generally improving picture of cleanliness and safety. EVIDENCE: Maranatha generally provides a comfortable and homely environment for people, but some areas are in need of upgrading and refurbishing to a better standard. Two comments from different relatives were: ‘The lounge and dining room are quite shabby and badly need re-decorating,’ and ‘bedroom furniture is very poor and broken and needs replacing.’ Another relative said that the home ‘was not a palace.’ The home’s AQAA completed last July under ‘what we could do better’ said ‘new schedule for repairs, renovations.’ A requirement from the last site visit undertaken in August 2007 was the need for a plan of redecoration and Maranatha Rest Home DS0000038290.V358219.R01.S.doc Version 5.2 Page 19 renewal to be developed and a copy including timescales to be sent to CSCI. This was not received. At a meeting with CSCI held in November 2007 the manager said that some new furnishings were awaiting delivery. No new furnishings were noted or pointed out at this site visit. 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 people at the back of the property. On the day of the site visit a new kitchen was being installed so this area could not be fully used, the conservatory was out of use as being used by workmen for the storage of tools etc. and the lift was out of order. Staff were coping with these issues and ensuring that people were not unduly inconvenienced. There was some evidence that management are now being more proactive in providing an environment that is safe and suitable for the people living there. Two bedrooms have been redecorated, an issue of damp addressed, and comments such as ‘that room is next on the list to be done’ were made by the manager. At the last inspection issues relating to making the environment suitable to meet the needs of people with dementia were discussed. The manager said that signage had been discussed with residents, who did not feel it was necessary at this time. One person was noted to have their name on their bedroom door to assist their orientation. The laundry area is now kept locked so that it is secure and people are kept safe. Hand washing facilities are now available. Cleaning schedules have been put in place, and in general the home seemed cleaner and tidier. The cleaning schedule did not cover the laundry area, the manager agreed to incorporate this to ensure that this important area is kept clean and hygienic, as it did not appear so on the day of the site visit. However it was recognised that this may in part be due to the poor decorative state of the area. Isolated areas of odour and poor deep cleaning were identified to the manager. Attention is also needed to ensure that moving and handling equipment used by people is kept clean. The manager felt that infection control had been improved at the home by the provision of soap dispensers in all rooms and alcohol gel dispensers in appropriate areas. From training information available only two members of current staff were identified as having undertaken training in infection control. The manager and deputy have undertaken an infection control for managers course. Maranatha Rest Home DS0000038290.V358219.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. People are supported by staff that have some relevant training, and are generally available and able to meet their care needs. However they cannot be sure that staff are recruited in a robust way so that they are fully protected. EVIDENCE: On the day of the site visit eleven people were being accommodated. Two care staff and the manager were on duty and the deputy manager came on duty later in the morning. A cleaner was on duty and another member of staff worked in the kitchen. Rotas viewed showed that generally staffing levels are 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 people to get up. The manager’s hours are recorded as 0800 to 17.00 Monday to Friday and are normally supernumerary. Comments on staffing were varied, and not always positive. One person said that ‘the staff are lovely.’ A relative said ‘most of the staff are excellent very kind and caring,’ but then went on to qualify this with a less positive comment about the experience their relative in relation to some staffs’ attitude. Relatives did not always feel that staff had the appropriate skills to support people. One said ‘I feel that sometimes mainly at night the staff on duty lack the necessary experience to deal with awkward situations.’ Another commented on the poor communication skills of some staff. During the site Maranatha Rest Home DS0000038290.V358219.R01.S.doc Version 5.2 Page 21 visit staff were attentive to people and interacted and communicated well. People living at the home felt that there were sufficient staff to meet their needs. Only one had completed a survey and they felt that staff were ‘usually’ available. The number of staff having completed or currently undertaking National Vocational Qualification (NVQ) training that will improve their skills and enhance peoples care were confirmed with the manager. Currently two members of staff have NVQ at level 3 and one at level 2. Two further members of staff are undertaking NVQ training, and the manager said that a further four staff will be commencing training soon. One member of staff is a qualified nurse. With a care staff group identified of eleven the home falls below the recommended standard of 50 of care staff at the home being trained to NVQ level two or above. Two new members of staff had been recruited since the previous inspection. The files of these staff were viewed. These indicated that recruitment procedures have continued to improve in some ways. However in spite of previous advice and requirements being made the home can still not fully evidence that robust recruitment procedures that will protect people are maintained. Notes on both application forms indicated that referees had been contacted by phone but no note was made of the discussion or outcome. For one, written references were in place but these were dated some time after the start of employment. No POVA first check had been undertaken. Only a Criminal Records Bureau check from a previous employer was in place. The manager said that they thought this was satisfactory. For the other member of staff a reference was still not in place from a given referee. Two references were in place but both from relatives, one of who works at the home. No CRB was in place, and the POVA 1st check was sent for and received back dated after the person had commenced work at the home. It was stated that both staff started work at the home on 08/10/07 but other information was not consistent with this, for example one application form dated 26/10 with a note that the given referees were also phoned on this day. Management recognised that recruitment procedures were lacking, and on the AQAA completed last July said that they needed to ‘improve on recruitment processes.’ There was no evidence that either member of staff had gone through a structured and recorded induction process. Staff said that they had attended the home for a day, seen around the home, met the people living there, undertaken moving and handling training and looked at lots of paperwork. They were also able to identify other training undertaken. As at the last inspection the manager said that it was not possible to see a completed induction programme as staff were working on them. At this site visit a blank copy of Skills for Care ‘Progress Log of Standards with Glossary and Certificate of Successful Completion’ was presented to show what the new staff were working on. However on speaking to the new members of staff they Maranatha Rest Home DS0000038290.V358219.R01.S.doc Version 5.2 Page 22 had not heard of Skills for Care and had not previously seen the above identified document. As seen from training lists, a good level of training opportunities have been provided, but many staff who completed this training have since left. It was however positive to see that in 2007 a good number of existing staff completed training in dementia care, and some staff in other conditions and areas relevant to older people. This will increase their skills in caring for people. One member of staff spoken with had found the training in dementia care very good and said that it was ‘very thought provoking.’ The manager feels that a strength of the home is that it tries to develop staff and provide them with knowledge and understanding. An example was given of a recent initiative. However there is no evidence to show that staff development is planned and carried out in a consistent way and in line with individual staff members’ training and development needs. Maranatha Rest Home DS0000038290.V358219.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, 37, 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People cannot be assured that they live in a home that is robustly managed with clear strategies in place for ensuring their health and safety. EVIDENCE: Maranatha has an experienced registered manager in post. The manager has recently completed their Registered Managers Award and NVQ level four in care. In spite of the manager’s experience and qualifications, findings at this and previous inspections raise concerns about the management of the home. Often poor, jumbled or inconsistent recording practices, and inadequate monitoring of staff practice leave people living there at potential risk. At a meeting held with CSCI in November 2007 the manager agreed to send in a full improvement plan as required from the inspection that took place in August 2007. This was not received. Maranatha Rest Home DS0000038290.V358219.R01.S.doc Version 5.2 Page 24 The last recorded staff meeting seen dated from 01/01/07. Formal residents or relatives meetings are not held. A brief note had been made in relation to a discussion with people on signage. This was dated 12/12/07, and did not include details of those involved. This does not demonstrate that people involved with the home have regular opportunities to express their views or feelings, and to influence the running of the home. Management has strategies in place to monitor the quality of the service at Maranatha. A quality control exercise utilising questionnaires to seek residents’ and others’ views was undertaken last year. Some of these were briefly viewed and showed a positive response. It was stated 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. These visits are supposed to be carried out on a monthly basis and the manager said that this is the case. However at the site visit the most recent report available dated from August 2007. Following the site visit reports dating from 30/11/07 and 15/12/07 were sent in to CSCI. It was confirmed by the manager that people’s personal monies are not held or managed by the home. Information provided on the AQAA completed by the home in July last year showed that the majority of the home’s policies and procedures stated to be in place had not been reviewed since 2003 or 2004. The needs of people with dementia and health and safety were discussed, in relation to such issues as storage of disposable gloves, which were accessible, and could pose a potential hazard, and the security of the building, which was raised by a relative in relation to security and the potential for residents to wander out. The manager felt that any issues would be dealt with on an individual basis as they arose to ensure safety, and that the home would not admit people with a severe level of dementia. During the site visit electricians were on the premises. They confirmed that all the remedial works required were now being undertaken, and when complete the home will be issued with a new electrical safety certificate. From the training information available at the site visit (training lists and staff files) levels of core training such as food safety, first aid and moving and handling amongst the current staff group are very low. This may reflect inadequate recording of training courses that are stated to have taken place ‘in house.’ This particularly in relation to moving and handling where the deputy manager in 2004 and another member of staff in 2006 have undertaken training to train carers. On a matrix sent in following the site visit the situation appeared better. Training was only identified by year rather than specific date, but all staff were identified as having undertaken moving and handling training in 2007. From the new matrix five staff have not yet Maranatha Rest Home DS0000038290.V358219.R01.S.doc Version 5.2 Page 25 undertaken training in food safety. A number of staff are not identified as having completed health and safety training. The fire service last visited in July last year, and advised that the fire risk assessment needed to be improved. It was seen that this was completed in August 2007. Records seen showed that regular checks are made of fire systems and equipment to make sure that they are in good working order. Training records for recent years available at the site visit identified that only two current staff have attended formal fire training. Information received following the visit showed a better picture. With two members of staff having undertaken training last year and one in 2006. The deputy manager last undertook training in 2003 and no training was identified for the manager. Induction records are not maintained to show that staff are instructed in fire procedures. The last recorded fire drill that could be found was 14/01/07. Staff told the inspector about a recent incident at night when the fire alarms had gone off. These had been silenced, and then the building checked by the staff on duty. Staff on duty included a new member of staff on sleep in duty for who no induction process could be evidenced, and an experienced night carer. This was in direct contravention of the home’s stated fire policy that the fire brigade is to be called whenever the alarms sound unexpectedly. The manager was unaware that this incident had taken place. The incident had been recorded in a logbook but not in fire records. Maranatha Rest Home DS0000038290.V358219.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 3 X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 3 X 2 1 Maranatha Rest Home DS0000038290.V358219.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 12(1) Requirement So that people receive proper care that is safe, planned and carried out in a consistent manner, any risks associated with their care must always be robustly assessed. Staff training and ongoing competence monitoring in relation to medication management must be clear so that it can be demonstrated that staff are competent to manage this aspect of peoples care. Timescale for action 01/03/08 2. OP9 13(2) 01/04/08 3. OP18 13(6) So that people are cared for 01/03/08 safely and protected, staff must have a full understanding of safeguarding and whistle blowing procedures and practice. The premises must be suitable to 01/04/08 meet the aims and objectives of the home, and provide people with suitable private and communal accommodation. This refers to the need to continue to refurbish the premises in a timely manner DS0000038290.V358219.R01.S.doc Version 5.2 Page 28 4. OP19 23 Maranatha Rest Home with a plan of redecoration and renewal to be in place. This to be developed and a copy including timescales to be sent to CSCI 5. OP29 19 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 before people start work. This is a repeat requirement in relation to recruitment procedures at the home. 6. OP30 18(1) So that people are cared for by staff who have good initial training to be competent and confident in their role, the home must be able to evidence that robust induction procedures are in place. So that people know that they will be cared for safely, staff fire awareness and practice must be improved through training and regular drills. Management at the home must ensure that staff receive appropriate training and are kept up to date in core areas. This includes food hygiene and infection control. This is a repeat requirement with a previous compliance date of 01/12/07. 01/03/08 01/03/08 7. OP38 23(4) 14/02/08 8. OP38 18 01/04/08 Maranatha Rest Home DS0000038290.V358219.R01.S.doc Version 5.2 Page 29 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 Records associated with peoples care must continue to be improved so that they provide a consistent and accurate record of care given in accordance with people’s wishes and their care plan. The best practice issues relating to medication practice identified at the site visit should be actioned, and the management of creams improved. Management at the home should enable people living in shared rooms to have privacy, by the use of suitable curtaining/room dividers. Management at the home should continue to develop appropriate activities and occupation in consultation with people. In particular people with dementia should have their needs properly assessed, appropriate occupation provided, and outcomes recorded. So that people receive assistance in a safe and consistent manner, staff at the home should receive training in managing challenging behaviour. So that staff are aware of best practice and work safely they should receive training in infection control. 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. Policies and procedures relating to practice and running of DS0000038290.V358219.R01.S.doc Version 5.2 Page 30 2. OP9 3. OP10 4. OP12 5. OP18 6. 7. OP26 OP28 8. OP30 9. OP37 Maranatha Rest Home the home should be kept under regular review. Maranatha Rest Home DS0000038290.V358219.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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.V358219.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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