Inspection on 03/12/08 for Marcris House

This inspection was carried out on 3rd December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Marcris House Coopersale Lane Theydon Bois Essex CM16 7JH     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diane Roberts     Date: 0 3 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Marcris House Coopersale Lane Theydon Bois Essex CM16 7JH 01992814276 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Chigwell Homes Limited Name of registered manager (if applicable) Hayley Marion Dawkins Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 32. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Marcris house is a large detached house with a purpose built extension that provides accommodation for up to 32 older people and older people with dementia. The house is set in its own large gardens, which are partially accessible to wheelchairs. The house is located just outside Theydon Bois in Essex on the way to Abridge. The home provides 26 single rooms, 20 being en-suite, and 3 double rooms. There is a passenger lift to the upper floor. There are good public transport links to the home and visitor Care Homes for Older People Page 4 of 33 care home 32 Over 65 0 32 32 0 Brief description of the care home parking. Information for prospective service users including inspection reports can be obtained via the manager of the home. The weekly fees range from £500.00 - £575.00. Additional costs apply for hairdressing, newspapers and chiropody. This information was provided to the CSCI on 7th July 2008. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home over one day and met with the proprietor, regional manager, who had been covering the home, and the new manager. During our time at the home we talked with four residents, four members of staff and one district nurse. We sampled and reviewed records that related to, for example, care provision, medication administration, staff recruitment and training, activities, meals, complaints and the building itself. In addition to this the covering manager had completed a self-assessment prior to the inspection called an Annual Quality Assurance Assessment (AQAA). This tells us how the manager thinks the home is running and what they do well and what they could do better. This assessment is referred to through the report. Care Homes for Older People Page 6 of 33 Prior to the inspection we sent feedback surveys to the home for residents and relatives to complete to give us their views, and 6 residents and 6 relatives responded. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their needs will be assessed prior to admission and that they will have sufficient information on which to base a decision. Evidence: The manager has a pre-admission assessment system in place for prospective residents. Two recent assessments were checked at random and were found to be comprehensive and contained sufficient detail to enable an informed decision to be made as to whether a persons needs could be met at the home. The assessments contained person centered information and evidence of involvement from key people. In addition to the managers own assessment, information was also seen from referring authorities where appropriate. The covering managers AQAA said that we aim to provide a brochure to interested parties. Our service users guide allows prospective service users to make a more Care Homes for Older People Page 10 of 33 Evidence: informed choice. We have a pre admission procedure and residents have contracts. A review of the service users guide is recommended to ensure that it is in a format appropriate for the resident groups in the home, including the size of the print. Residents who commented in surveys all said that they had sufficient information on the home prior to admission and that they had a contract in place. Relatives who commented on surveys said that, on the whole, they had the information they needed. Residents spoken to about their admission to the home said that staff helped me settle in and they were kind, there is a service users guide in my room but I have not looked at it and the manager visited me before I moved in and I came to look around. Care Homes for Older People Page 11 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can not be assured at the current time, that all their care needs would be identified and met in full or in a way they they would wish. Evidence: Since the new owners have taken over the home, they have been updating the care planning system in place at the home. As the new, up to date, care plans have not been introduced in a systematic way, this has left residents, many with complex needs, without care plans in place to guide and inform staff and to further assess needs and evaluate care. Three care plans were reviewed and other care records used to cross reference. The new system being put in place is suitable but we found that many of the assessments and records had not been completed or completed in full. For example, one resident had a good comprehensive assessment in place, which also identified preferences and gave person centered information but all the required care plans, linked to identified needs, were not in place and those in place were basic and did not Care Homes for Older People Page 12 of 33 Evidence: fully reflect the assessment. The care plans seen were also not person centered. Another resident had care plans in place, updated in July 2008, which although basic were acceptable, but from the daily notes and district nurse involvement, the assessments and care plans did not reflect the current needs. These related to medication and pain relief, dietary intake, respiratory disease and continence. This resident also had no nutritional risk assessment in place and was not being weighed despite having needs around dietary intake. It was also noted that there was no manual handling assessment in place and from discussion the staff and the management team were disagreeing as to the level of support this resident needed. One resident did not have any care plans in place at all despite having an assessment. From the records and discussions with staff this resident had complex needs around diet, wound management, pressure relief, pain relief, chest care and required full support with all personal care needs. From discussion with the care staff, it was clear that, to a point, they generally knew the basic needs of the residents but did not have the care plans and management input to provide other than intuitive care. From discussion, some staff had made the effort to find out about their residents so that they could appreciate them as a person. The completion and standard of risk assessments was variable, but overall the shortfall was significant with residents, for example, having no manual handling assessments, nutritional risk assessment and general risk assessments for issues such as the use of bed rails or the management of challenging behavior. The management team reported that some residents had been weighed but they were unable to locate these records and individual care plans did not reflect that regular weighing had taken place. The covering managers AQAA stated that that they do not carry out nutritional screening on everyone admitted to the home. The AQAA also asks do you take actions to meet the needs of people at risk of malnutrition ? the answer given was - No. A set of stand on scales is available. Consideration should be given to providing sit on scales to improve the weighing system within the home and the overall approach to residents nutritional needs. Residents have developed pressure sores whilst being cared for in the home and relatives have raised this concern with us. No care plans were in place for residents with or at risk of developing pressure sores. During the inspection it was possible to speak to one of the district nursing team members who felt that the home was gradually getting organised, things were stricter for staff and some were unhappy with the changes. She felt referrals were quite prompt. Daily records showed quite prompt referral to the GP but subsequently records were inconsistent regarding what the GP had said and there was no evidence of any changes to care plans. It was noted that there were two systems in place for recording GP visits and this could cause omissions. Records did not evidence that residents were receiving appropriate input from chiropodists and other health care specialists. Care Homes for Older People Page 13 of 33 Evidence: The shortfalls in care assessments and care planning means that residents are at risk of not having their care needs met in the way that they would wish and not having them met in full. The covering managers AQAA said that we deliver a high standard of care for each individual service user using a comprehensive plan of care to ensure that all aspects of their health, personal and social care needs are being met. The evidence would not concur with this statement. Residents who commented said that they do what is best for me, I have been given all the medication and treatment required and the staff are good at explaining things and they are helpful. Residents observed during the lunchtime period were noted to have unbrushed hair and to look generally unkempt. Gentlemen who were reported to have been shaved had not been shaved properly. The administration of medication was reviewed at the home and shortfalls were noted. A blister pack system is in use and the medicines were seen to be checked in correctly. The administration sheets showed some omissions in signing and also that residents had not had their medication due to being out of the building. A more person centered approach needs to be taken to this, to ensure residents are receiving the medication they need. It was also noted that some residents are regularly refusing medication but upon checking there were no records to evidence that this had been raised with their GP for review. Staff need to ensure, where prescriptions change regularly, for example with anticoagulant therapy, that the prescriptions are clear and that they do not keep making the changes on one prescription box, as it makes them unclear and the risk of mistakes being made is increased. Some staff were noted to be using the omissions code system well and others were not. Residents were not having medication and the code system was not always evidencing as to why this was the case. More effort needs to be given to supporting residents with dementia take their prescribed medication. Care Homes for Older People Page 14 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can not be fully assured that their social care needs will be met in a person centered way. The meals service in the home is acceptable to residents. Evidence: From discussion with residents and staff and review of records, the routines of the day are not generally resident led. Staff said that we have to follow a set routine and because of that I could not start to help to wash people until 10 a.m and we have a printed routine to follow which tells us what times we have to do things - I carry one with me. Residents said staff come and tell you when to get up, it would be nice to lie in bed but you cant, night staff get me up early. Records show that the night staff get 9/10 residents up per day and give some of those residents, 3-4 per day, showers. The printed set routines of the care shift were reviewed and whilst positive in some aspects, showed a limited approach to resident choice, being very prescriptive with timings and care such as toileting, showering etc. This does not prompt staff to have a person centered approach to providing care. The covering managers AQAA said that we listen to residents about the routine of the day. Care staff provide the social activities in the home. The staff shift structure allows Care Homes for Older People Page 15 of 33 Evidence: them to provide activities between 3 and 4 p.m. This does not create a flexible and person centered approach to meeting an individuals social care needs, especially for people with dementia. Residents did not have social care plans in place that identified their needs, interests or past social and work history. There was no plan that promoted their independance, self worth or the retention of skills. Posters were seen around the home for group activities that included music, foot massages, trip out to Harlow garden centre, nail care, baking fairy cakes, bingo, sewing, chats, quizzes. A pie and mash evening was recently held. Records were inconsistent and showed that residents group needs may be met on occasions but individual needs are generally not met. Records show that some church services do take place. On the day of the inspection the activities poster said that in the morning reminiscence was taking place and in the afternoon karaoke/sing along. Neither inspection officers saw any evidence of this taking place although bingo was played during the afternoon. A residents meeting held in September showed that residents had been consulted on activities and comments included more quizzes and skittles and bingo, residents would like more reminiscence, they all like listening to music and to have more entertainment in the afternoon and trips out to the shops. Residents and relatives who commented on surveys said that that always try to take me outside if the weather is good for a walk, I take part in the occasional sing song and I read the papers every day. Daily news papers and magazines were available in the lounges for residents. Relatives said more stimulation is needed for those who are able and they are making efforts to introduce activities. The covering managers AQAA said that following residents meetings we are planning to improve the activities programme to what service users wishes are. We are also in the process of changing the menus. We can evidence of good range of activities and we hope to train more staff in activities. The meal service was reviewed. The menu looked varied and nutritionally sound. Management said that they plan to make changes to the meal service including having the chef dishing up meals in the dining room so he/she can get feedback from residents directly. Menu records show residents had choice at mealtimes. Some records were inconsistent with what residents had actually eaten. Condiments and place mats were noted to be dirty as well as the fridge in the dining room. Lunch is usually served at 12:30. People were sitting in the lounge from 12:45 when they were joined by an inspector and their meal finally arrived at 13:30 hours. Residents who commented said that the food is very nice, there is plenty of it, There Care Homes for Older People Page 16 of 33 Evidence: are choices and there is always a drink available, you only have to ask, the meals change every day, very good cook delicious and good food. There was evidence in residents meeting minutes that they had been consulted about the food in the home. Care Homes for Older People Page 17 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were able to raise concerns about the service however cannot be confident that complaints raised verbally will be dealt with in accordance with the homes policies and procedures. People living at Marcris House cannot be confident that staff have the skills and knowledge to safeguard them from harm or abuse. Evidence: The manager has a complaints procedure that was included in the Statement of Purpose and Service User Guide. This document gave clear information of what steps would be taken and the timescales for action. The document was not available in a format that could be easily used by residents, the print was light grey and the font was small. The managers AQAA that was sent to us in September told us that the home had not received any complaints since the previous inspection visit. We looked at the records of complaints held in the home and found that there was one complaint under investigation at this time. All appropriate actions had been taken including corresponding with the complainant to keep them informed. Complaints received by CSCI were reported to have been raised verbally with the management at the home. There was no evidence of these issues in the complaints Care Homes for Older People Page 18 of 33 Evidence: records of the home. This tells us that complaints that residents or their families raise verbally with staff and management are not always being recognised as such and therefore not being dealt with in accordance with the homes policies and procedures. We looked at records of staff meetings and noted that staff had received the instruction if any complaints are received ensure to inform management immediately. Completed surveys from people living at the home and their relatives told us that people were confident to approach staff or management if they wished to make a complaint. Comments included never had a complaint but would go to the office and I am always able to see the manager whenever I want to make a complaint and feel free to speak out and Under both ownerships they have always acted immediately over any issues I have raised. The manager advised that not all staff have had training on safeguarding however a course had been arranged. This was confirmed on the training matrix, which showed us that thirteen staff were to attend training on this topic in January 2009. It was noted that staff members not yet booked to attend training in the Safeguarding of Vulnerable Adults were 3 catering staff members, 1 laundry person and 2 domestic staff. The managers AQAA stated We feel that our recruitment procedure is now robust, to ensure that service users are safe guarded from abuse. Whilst looking at staff files we noted one occasion where a referee had refused to provide comment about a person who was being recruited to work at Marcris House. There was no evidence available to show us that the manager had followed up this information, the applicant had provided a further referee who provided a positive reference. Care Homes for Older People Page 19 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are not currently living in a home that can meet all their needs and keep them safe. Evidence: As part of this inspection site visit we undertook a physical tour of the home where various issues were noted. These included some loose radiator covers, the lighting on the galleried landing was quite dim and could be a potential hazard to people with already impaired vision and one bedroom had an internal door leading down some steps into a storage area that had been left unlocked creating a hazard for residents. Some substances that could pose a potential threat to the safety and well being of the people living at the home were in the laundry, accessible to anyone entering this room as there were no lockable facilities. We also noted that a hoist used to assist people transferring from bed to chairs etc. was unstable despite having an up to date safety certificate. It is clear that the proprietors have undertaken some refurbishment work, including a ramp to the front of the home and painting and decorating of corridors and bedrooms etc., but there is still some significant work to do. During the course of the inspection it became clear that there was no working bath in the home and only one usable shower room. The management team were aware of this but had no plan in place to Care Homes for Older People Page 20 of 33 Evidence: address such a significant shortfall. Many of the carpets in the home are in a poor state and many items of furniture are tired/broken and need replacement. A prioritised structured plan with timescales for refurbishment is needed. The covering managers AQAA states 15 bedrooms have been repainted and 3 re carpeted. communal areas repainted. We plan to replace more carpets, purchase new furniture and secure the garden. The AQAA sates that they plan to bring the home up to the minimum standard. Bedrooms were seen to be personalised in many cases and the home benefits from two homely lounge areas, for which new curtains have been ordered. The standard of much of the bedlinen and towels was poor with items being worn and/or stained. Environmental risk assessments were available for such areas as the entrance hall, use of zimmer frames, the laundry, use of hoist, use of gloves/aprons, slippery floors, wheelchair footplates and many more. All these assessments were undertaken in bulk in Feb 2003. All contained dates to indicate that annual reviews had taken place with the latest review being in February 2008. The manager reported she was aware of these risk assessments and equally aware that all needed to be robustly reviewed and evaluated under the new management. As covered in Standard 30, training records did not confirm that the staff team are trained and have all the skills necessary to perform safe working practices. The covering managers AQAA told us that policies and procedures relating to safe working practices had been reviewed in July 2008. Residents told us they felt cold. 3 people were seen wearing their outdoor coats in the lounge and dining room and the radiators in some bedrooms required attention as they were not completely hot when the heating was on. Night staff had also recorded that residents had complained of being cold during the night. This was raised with the management at the time of the inspection. The home has the services of a handyman shared with another group home. The person attends Marcris House 3 days per week and is responsible for undertaking routine hot water temperature testing. Records were available to confirm testing in November 2008. Overall the home was noted to be odour free apart from some specific rooms and this, it was felt, related to the cleanliness of mattresses rather than carpets and this was discussed with the manager. Some parts of the home are clean whilst others require more attention or deep cleaning. Overall the home does not look clean and fresh. Care Homes for Older People Page 21 of 33 Evidence: Residents who commented said that my room is clean and comfy, I cannot fault it and there are cleaners everyday. Relatives who commented said that physically the building needs a lot of work which is currently being undertaken. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Marcris House cannot be confident that they are supported by a staff team that have all the training necessary to promote the health, safety and well being of residents. Evidence: The staffing rota was inspected and showed us that daytime staffing levels varied between three and four carers for day time shifts and two carers at night. The rotas were not always updated to include the names of agency staff therefore we could not be confident of the numbers of staff that rotas indicated were on duty. For example on one day the rota indicated one carer on the night shift with a senior on duty 20:00hrs to 21:30hrs, presumably to administer medication. There was no evidence available to show us that the senior staff member was replaced when they went off duty at 21:30hrs. The covering managers AQAA stated We ensure the rota clearly shows how many staff are on shift at any one time, alterations dealt with immediately to show rota is correct at all times. Residents told us that staffing levels had been a problem for the new owners. The manager had left for a new position and 5 care staff had left at the same time. The number of agency staff working at the home had increased for a while however the residents told us that the same agency staff came back time after time so they got to Care Homes for Older People Page 23 of 33 Evidence: know them well. One person said Staff are settling down now, the home has been very short staffed and we had a lot of agency. Surveys returned to us by residents and family members as part of this inspection indicated that people were generally satisfied with the numbers and skills of the staff at Marcris House. Comments included Marcris has just been taken over, and to their credit they are upgrading the training of staff and they have had to use a number of agency staff but are now on the way to being fully staffed. There were 19 staff members working at the home, including the manager, care staff, domestic and catering staff. There were 9 care staff that had achieved minimum NVQ level 2 in care, 6 of these also had achieved NVQ level 3, there were 2 staff with overseas nursing qualifications and 1 person working towards NVQ level 3. An up to date training matrix was not available on the day of this visit however was provided subsequently. This showed us that there were many gaps in the basic core training provided for care staff such as first aid, fire awareness, infection control and health and safety. The training matrix showed that there were significant gaps in staff training in relation to adult safeguarding training. Staff were aware that it had been arranged and information provided subsequent to this visit told us that 13 staff members were to attend training in Adult safeguarding in January 2009. The manager reported that Common Induction Standards training was underway for all staff employed that had not already achieved the NVQ level 2 in care. A manager from another home within the group verified the induction training which is completed within 6 weeks of employment. There were no records available to confirm the induction training and evidence was not included in the matrix provided subsequent to the visit. We looked at recruitment documents for two recently recruited care staff. On the whole these had the information necessary to keep people safe however, one file sampled did not include a photo of the carer and previous employment dates solely indicated the year ie 2006 - 2008, not providing sufficient information for gaps in employment to be discussed at interview. Another file included a reference that had been returned to the home marked I do not wish to comment on this person. There was no evidence that this had been followed up, the carer had supplied another referee for the home to contact. On both files sampled there was evidence to confirm that checks had been made Care Homes for Older People Page 24 of 33 Evidence: against the Protection of Vulnerable Adults register and completed references were received before any person started to work at the home. Both files included enhanced Criminal Record Bureau Checks, written records of interviews and identification documents. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in management arrangements, staff training and health and safety in the home, could adversely affect outcomes for residents. Evidence: The manager at Marcris House had been in post for 5 weeks at the time of this visit. She had been previously registered with the Commission to manage a registered care establishment. Residents and family members we spoke with at this visit had good and positive comments to make about the current management. Comments included Any problems the manager or the area manager will deal with things immediately, It has become more professional in the last year and I cant praise the place enough. The manager is currently working towards achieving the NVQ level 4 in management and is an NVQ assessor. The registered provider, who was present throughout this visit, reported that the manager would be applying for registration with the Commission imminently. Care Homes for Older People Page 26 of 33 Evidence: Also present throughout this inspection was the area manager of 8 homes within the group, this person line manages and supervises the manager of Marcris House. It is clear that the manager, the provider and the area manager have all been working hard to move the home forward and drive the quality of care up, however this has been in a reactive and unstructured manner. From discussion with all three managers, there are currently blurred areas of responsibility with no clear boundaries of accountability. This has resulted in aspects of care management and premises issues not being progressed in a timely manner. Meetings have been held by the covering manager regularly with the staff team and minutes are available. The new manager has yet to formally meet with staff. The area manager reported that surveys relating to the quality of the service provided at Marcris House were distributed to residents, relatives, staff and healthcare professionals in June 2008. It was reported that a summary of the responses would be produced identifying any areas of shortfall in the quality of the service provision. An action plan would then be produced and implemented to address these areas, a copy of which would be sent to the Commission. The management of the home met with residents in September 2008 and consulted with them on menus, activities and the staff team. A chart on the office wall told us that 4 staff members had received formal supervision in July 08 and 3 staff in November 08. Manager and Area manager then remembered that 2 sessions had not been recorded on the matrix and amended the November tally to read 5 supervisions in November. The manager acknowledged that the system for staff supervision is not robust and needs work. Records relating to maintenance of equipment such as lifts, fire equipment, nurse call systems and electrical supplies were examined and were accurate and up to date. From records and discussion, staff need to ensure that they complete accident/incident records in a timely manner so that they can be investigated and/or followed up where required. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Residents must have a care plan in place which has a current assessment of their needs and the appropriate care plans. These must be evaluated and kept up to date. So that residents can be assured that their care needs will be met in full in a way that they would wish. 14/02/2009 2 8 12 The health and welfare of 14/02/2009 residents must be addressed by the use of appropriate risk assessments, subsequent management and the use of healthcare professionals where appropriate. So that residents can be assured that their health needs are being met and their welfare is paramount. 3 9 13 Residents must have their medication administered safely and as they require. 31/01/2009 Care Homes for Older People Page 29 of 33 So their health needs are met. 4 12 16 Provide social activities on an individual and group basis in a person centered way. So that residents are able to have a good social life in the home that promotes their independance and wellbeing. 5 12 12 Ensure that, as far as possible, the routines of the day are led by the needs of the residents. So they receive the care they need in the way that they would like 6 16 22 All complaints received, including verbal complaints must be logged and attended to as outlined in the complaints procedure. So that residents and relatives can be assured that their concerns will be looked into. 7 18 13 Train all staff in the home in adult safeguarding matters and ensure that the recruitment system is robust. So that residents are protected as far as possible. 8 19 16 Rooms used by residents must have adeqaute furniture and bedlinen, including towels. 28/02/2009 14/02/2009 14/02/2009 14/02/2009 28/02/2009 Care Homes for Older People Page 30 of 33 To give residents a good quality of life. 9 19 23 All parts of the home used for residents must be maintained in a good decorative order and be safe. A prioritised refurbishment plan with timescales must be submitted to the Commission. So that residents live in an environment that meets their needs and does not put them at risk. 10 26 16 All parts of the home must be kept clean and free from odours. So that residents live in a pleasant and safe environment. 11 29 18 Ensure that staff recruitment 19/01/2009 procedures are robust. So that residents are protected as far as possible. 12 30 18 Staff must be trained and competent to undertake the duties and responsibilities that they have. Residents are cared for by an skilled and competent staff team 13 31 12 The management team at the home, by working together in an accountable way, must promote and make proper provision for 31/01/2009 14/03/2009 31/01/2009 31/01/2009 Care Homes for Older People Page 31 of 33 the health and welfare of residents. To ensure that residents needs are met and that they are safe. 14 36 18 Ensure that the planned 14/02/2009 staff supervision programme is completed. So that the staff team are supported and developed to meet the needs of the residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The service users guide should be reviewed to ensure that the format is appropriate for the resident group, especially in relation to font size and for residents with dementia. Develop a more person centered approach to care planning, reflecting the individual more, with their preferences and choices identified. Provide a clean and pleasant environment for residents to eat in. Review the format of the complaints procedure to ensure that it is user friendly for the resident group. Keep a clear copy of the working rota to evidence all the staff working on a shift including agency staff. Ensure that accident/incident reports are completed in a timely manner so they can be appropriately followed up where needed. 2 10 3 4 5 6 15 16 27 38 Care Homes for Older People Page 32 of 33 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!