CARE HOMES FOR OLDER PEOPLE
Marbury House Marbury Road Heaton Chapel Stockport Cheshire SK4 5NU Lead Inspector
Jacqueline Kelly Unannounced Inspection 12th June 2007 10:35 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 Marbury House DS0000008565.V339594.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. Marbury House DS0000008565.V339594.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Marbury House Address Marbury Road Heaton Chapel Stockport Cheshire SK4 5NU 0161-432 2825 0161 947 9687 marburyhouse@boroughcare.co.uk 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) Borough Care Limited Mrs. Yvonne Nixon Care Home 40 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (40) of places Marbury House DS0000008565.V339594.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 40 OP and up to 4 DE(E). Date of last inspection 24th January 2006 Brief Description of the Service: Marbury House is owned by Borough Care Limited; a not for profit organisation who also manage a number of homes in the Stockport area. The home is registered for up to 40 residents. The home was purpose built approximately forty-five years ago and is situated on a small housing estate in the Heaton Chapel area of Stockport. An extension has been added so that all bedrooms are single occupancy with some having an en-suite toilet with wash hand basin. To the rear of the house there is a reasonably sized garden with shrubs and patio. Marbury House is situated opposite a bus stop, which is a direct route into Stockport town centre. There is also a train station approximately a thirtyminute walk with a direct line through from Buxton to Manchester. The motorway network is within easy reach. The fees range from £339:00 to £398:00. These prices include a £6.00 ‘topup’ charged by Borough Care Ltd for those people who are being funded by a local authority. There is also an additional charge of £12 each week for the ensuite rooms. The home has a statement of purpose and information pack, which includes the service user guide. A notice was pinned to the front door stating that a copy of the latest inspection report was available. The organisation has achieved the Investors in People Award and is a registered charity. Marbury House DS0000008565.V339594.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection, which included a site visit. The manager was not told beforehand that the inspection was to take place; this is called an unannounced inspection. The care home is registered to provide accommodation and care to people within the category of old age and to those who have a dementia type illness. There are also six beds allocated for intermediate care for the rehabilitation of people to go back to their home within the community. Time was spent talking with the manager Mrs Yvonne Nixon and the deputy manager, Mrs Julie Veritiero. Residents, General Practitioner, nurse Care Manager and other staff were also spoken with; the majority said that they were happy with the care provided and had no complaints. Care plans, risk assessments, and drug administration records were looked at all of which showed that the residents’ health and personal care needs were being met. Ten survey forms with free post envelopes were sent to the home for distribution amongst the residents and/or relatives. At the time of writing this report eight had been returned. All who completed the form said that; ‘the staff listened and acted on what they said’ and had no complaints. However it should be noted that seven of the survey forms had been completed with the support of others including staff and relatives. One direct comment was received; ‘Marbury House is a very nice home and I am happy to live here.’ The staff who were interviewed felt that the staff team was supportive and that the organisation provided opportunities for training and advancement. The Commission for Social Care inspection had received no complaints but had received notification of two safe guarding adult referrals both of which were unsubstantiated. Over the past twelve months nine complaints had been recorded by the home; five had been substantiated and three partially substantiated; all had been dealt with in a satisfactory manner. What the service does well:
The home is well maintained, with a number of different areas for people to sit and eat. There was a reasonably sized garden with patio area and garden furniture for residents to use during the better weather. The home was clean Marbury House DS0000008565.V339594.R01.S.doc Version 5.2 Page 6 and free from offensive odours. their bedrooms. Residents were encouraged to personalise The manager carried out an assessment of prospective residents and provided people with information to help them make a positive choice. However a small number of people did not feel that they had been given enough information. There was a key worker system in place where care workers were allocated three residents who they were particularly responsible for. Care plans were kept in residents’ rooms, which gave residents, relatives and other care professionals instant access to information. The intermediate care service had been quite successful over the past twelve months with eighty-two percent returning to at home in the community. The home had a stable staff team of care workers, many of whom had worked at the home for a number of years. The inspector received favourable comments from the residents who were spoken with or completed a questionnaire regarding the staff group. All residents had a personal profile, which, although short, was very informative and gave a picture of the resident’s past life. All but two of the residents who were spoken with or completed a questionnaire said that they enjoyed the food. A menu was provided for the inspection, which showed that there was a choice of meals. Daily activities included: bingo, carpet bowls, movement to music and fish and chip suppers. Residents meetings take place regularly where they are able to express their views and opinions. The staff spoken with were particularly pleased with the training offered by the organisation. Training consisted of dementia care; induction; pressure area care; loss grief and bereavement; first aid; safe guarding adults; medication and moving and handling. National Vocational Qualifications were ongoing. Staff and resident meetings were held every three months to enable people to express their views and opinions. What has improved since the last inspection?
The daily recordings in the care plans had improved and contained more information about the general well being of the residents. The main upstairs lounge had been completely refurbished. Marbury House DS0000008565.V339594.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Marbury House DS0000008565.V339594.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 Marbury House DS0000008565.V339594.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): Standards 1,3,6 Quality in this outcome area is good. For the most part sufficient information is provided to help people make a choice. The assessment process ensured prospective residents’ needs could be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five out of the eight people who completed a survey form said that they had received enough information to help them make a decision before they moved into the home. It is recommended that the organisation look at how and what information is provided to ensure that all people are satisfied. All prospective residents had a care needs assessment before being offered a place in the home. Marbury House DS0000008565.V339594.R01.S.doc Version 5.2 Page 10 As part of the assessment process people were able to visit the home prior to accepting the offer. The first six weeks were on a trial basis after which a review took place. The purpose of the review was to ensure that the resident was happy with the care being received and that the home could meet their needs. The home had six intermediate care beds to which people were admitted for rehabilitation with a view to going home. A physiotherapist and occupational therapist from the community were attached to the home to work with the residents and staff. Marbury House DS0000008565.V339594.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): Standards 7,8,9,10 Quality in this outcome area is good. The manager and the staff team met the health and personal care needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the residents had a care plan which was kept in their bedroom. This allowed residents, relatives and other professionals to look at the needs and care that was being provided. Residents had access to GP support, district nursing services, optician and chiropody services when required. Those residents who were admitted into the intermediate care beds had physiotherapy and occupational therapy as part of the rehabilitation service to help them live independently in the community. One resident was not happy with some of the routines of the home. The inspector spoke with the manager who said that the routines could be adjusted to meet individual needs.
Marbury House DS0000008565.V339594.R01.S.doc Version 5.2 Page 12 The home was in the process of changing the pharmacist. A pre-dispensed monitored dosage system was in place. All the senior staff who administer medication had been trained however the new pharmacist was also going to provide some training. The care workers were observed to be treating the residents well and the majority of those who were spoken with or completed a questionnaire were satisfied with the care they received. The brochure contained statements about the rights of residents to expect their privacy, dignity, independence and choice to be respected. Marbury House DS0000008565.V339594.R01.S.doc Version 5.2 Page 13 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): Standards 12,13,14,15 Quality in this outcome area is good. The residents’ daily life and social activities are catered for. The food is good and the residents have a choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents who completed a questionnaire said that activities were arranged in which they could take part. A small number of the residents said that they chose not to be involved. The inspector saw the record of activities that had taken place for instance; bingo, movement to music, carpet bowls and entertainers. Residents’ meetings were held where people were able to put their views and opinions forward. The majority of those people who were spoken with or completed a survey form said that they were happy with the food provided in the home. The menu showed that a choice was offered.
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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): Standards 16,18 Quality in this outcome area is good. Residents and relatives were able to express their views and make a complaint should they wish to do so. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home reported that nine complaints had been received over the past 12 months; five of which were substantiated with three partially substantiated. All the complaints had been dealt with in a satisfactory manner and recorded. No further action was necessary. However, it is recommended that the complaints, which are included with the compliments, be kept separate. This would allow for easier monitoring and inclusion in quality assurance reports. A summary of the complaints and safe guarding adult referrals and investigations should be included in the annual care audit report. The report should contain an account of the action taken and what could be learnt to improve the service. Marbury House DS0000008565.V339594.R01.S.doc Version 5.2 Page 16 The Commission for Social Care Inspection had received no complaints; there had been two safe guarding adults referrals both of which were unsubstantiated. The majority of the residents who were spoken with or completed a questionnaire said that they knew how to complain but that they had none. Care workers had received training in safeguarding adults, which was ongoing. Marbury House DS0000008565.V339594.R01.S.doc Version 5.2 Page 17 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): Standards 19,26 Quality in this outcome area is good. The home is well maintained, clean and free from offensive odours. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean, tidy and maintained to a reasonable standard. A small number of bedrooms were seen during the inspection; all had been personalised. The garden to the rear of the property is a reasonable size and was well kept with plants and a patio area for residents to sit out on. The upstairs lounge had been completely refurbished. The home complied with the fire safety regulations and Environmental Health standards.
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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): Standards 27,28,29,30 Quality in this outcome area is good. The staff were skilled and trained to meet the needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was sufficient staff employed to ensure that the residents’ health and personal care needs were met in a clean and comfortable home. The staff had received training in core skills, such as adult protection, medication administration, moving and handling and health and safety. Many had completed a National Vocational Qualification (NVQ) Level 2 and/or Level 3. A small number of staff files were looked at which contained a record of training received and supervision notes. It was recommended that the files be better organised to make information more easily accessible. The application form was discussed with the manager where it was suggested that the ‘employment history’ section be amended to include the statement: ‘from leaving school or full time education and explain any gaps’. Staff that have left and returned must be asked to supply information that relates to
Marbury House DS0000008565.V339594.R01.S.doc Version 5.2 Page 20 work activity (including references) within the interim period and re-affirm previous information supplied. All staff had received a Criminal Record Bureau disclosure, which were seen by the inspector. Marbury House DS0000008565.V339594.R01.S.doc Version 5.2 Page 21 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): Standards 31,33,35,38 Quality in this outcome area is good. The residents were kept safe through procedures and staff training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The organisation produces an annual review of the service; a copy for 2005/2006 was given to the inspector. However the information highlights where performance was considered ‘good’ or ‘very good’ in four areas it does not included the number of returns and it does not make any mention of where the organisation needs to improve performance. Marbury House DS0000008565.V339594.R01.S.doc Version 5.2 Page 22 A Care Audit report for 2006 had been completed. The report should contain information about complaints (as stated previously), include the analysis of completed questionnaires and state how the home is to act on any negative responses received to improve the service. The requirement to write a quality assurance report, which is sent to the Commission and made available to residents, was discussed with the manager and the quality assurance officer. Neither the organisation nor the manager was responsible for any of the residents’ finances. Formal staff supervision and annual appraisal took place on a regular basis and was recorded. Marbury House DS0000008565.V339594.R01.S.doc Version 5.2 Page 23 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 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 3 Marbury House DS0000008565.V339594.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP1 OP16 OP29 Good Practice Recommendations The way in which information is provided should be looked at to ensure that all residents feel that they are able to make a fully informed choice. The complaints should be separated from the compliments to enable easy monitoring of complaints. The application form should include a statement asking for more information about employment history. When a person is seeking re-employment the information required should be thorough to ensure that nothing has taken place within the period of absence that would affect their suitability. The annual Care Audit report would be suitable as the quality assurance report required by the Commission for Social Care Inspection. This document will require three additions; to include a summary of complaints, analysis of questionnaires and staff qualifications. The report should be sent on each anniversary to the Commission for Social
DS0000008565.V339594.R01.S.doc Version 5.2 Page 25 4. OP33 Marbury House Care Inspection and made available to residents and relatives. Marbury House DS0000008565.V339594.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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
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