Inspection on 19/03/09 for Marden Court

This inspection was carried out on 19th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Marden Court 12/03/07

Marden Court 27/01/06

Marden Court 15/08/05

Marden Court 01/02/05

Marden Court 25/10/04

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Fairfields Country Rest Home

Poldhu

Queensmount

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Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Marden Court Quarr Barton Calne Wiltshire SN11 0EE     The quality rating for this care home is:   two star good 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: Sally Walker     Date: 1 9 0 3 2 0 0 9 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 34 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Marden Court Quarr Barton Calne Wiltshire SN11 0EE 01249813494 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): manager.mardencourt@osjctwilts.co.uk The Orders Of St John Care Trust Name of registered manager (if applicable) Tracy Ann Carash Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: No more than 2 service users with Dementia (DE(E)). No more than 4 service users over the age of 65 years with a mental disorder MD(E) may be admitted at any one time. The maximum number of service users who may be accommodated at any one time is 28. Date of last inspection Brief description of the care home Marden Court was built in the 1960s as a purpose built residential home offering accommodation and personal care to a total of 28 residents over the age of 65 who require care primarily through old age, although the home is also registered to Care Homes for Older People Page 4 of 34 care home 28 Over 65 2 4 28 0 0 0 Brief description of the care home accommodate four residents who have mental health needs and two with dementia needs. Two of the 28 beds are used for respite care. The home also provides day care facilities for up to 16 residents. The home is set in its own gardens, in a quiet residential area close to the centre and facilities of the market town of Calne. The home was originally opened in the 1960s as a local authority home and was taken over by the Orders of St Johns Care Trust in 2000. The registered manager is Miss Tracy Ann Carash. Residents are provided with their own bedrooms and these are located on the ground and first floor levels and are accessed by the use of a passenger lift. A call bell system is installed in each room, which can be used by residents to call for staff assistance. The home provides suitable communal space together with adequate bath and toilet facilities. The minimum care staffing levels are 3 with a care leader during the mornings, 2 and a care leader during the afternoons and evenings and three waking night staff. Care Homes for Older People Page 5 of 34 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: two star good 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: This unannounced inspection took place on 19th March 2009 between 9:15am and 6:00pm. Miss Tracy Carash, registered manager, was present during the inspection. Mrs Heather Mudie, care services manager, was present for the feedback. We looked at care plans, medication, risk assessments, menus, rotas, staff recruitment and training. We made a tour of the building. We spoke with people who use the service and staff. We asked the home to fill out their AQAA (Annual Quality Assurance Assessment). It was filled out in full and returned on time. Some of the information we received can be found in the body of this report. Care Homes for Older People Page 6 of 34 As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. Comments are found in the relevant part of this report. The last Key inspection was on 12th March 2007. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? A new care planning system has been implemented. Care plans are being more regularly reviewed. People have their risk of developing pressure damage regularly assessed. Care plans are in place for those people who are assessed as having a risk of developing pressure damage. Staff have been trained in tissue viability which has increased their awareness of identifying and monitoring those people who may be at risk of developing pressure damage. The organisations medication policy has been amended so that staff must check peoples medication with their GP when they are admitted. Care plans show details of why people are taking medication prescribed to be taken only when needed. Care plans identify what symptoms would prompt an administration. Body maps show where people have topical creams administered. Care Homes for Older People Page 8 of 34 Staff have been given more time for doing activities. There are some new activities available, some of which take place in the locality. Work to upgrade the building is well underway. Some of the bedrooms had been refurbished. There are new signs around the home, which means that people can find their way around the home more easily. The dining room has been refurbished with new carpets and furniture. A hair dressing salon had been provided and the conservatory upgraded. The laundry room has been upgraded. The toilets and bath hoists are being cleaned better. Miss Carash is nearing completion of the Registered Managers Award. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 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 10 of 34 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. Peoples care and support needs are known before people move into the home. Evidence: The organisation has produced new pre-admission assessment documents. Miss Carash or one of the care leaders carry out the pre-admission assessments. Information is gained from the person who is considering using the service, their relatives, care managers and healthcare professionals involved in their care. The home asks people about their social, as well as medical history during the assessment. The information is then included in their care plan which is in place when they move into to the home. Most of the people we spoke with told us they had not had the opportunity to view the home before they came to live there, mainly due to acute circumstances. They told us that a relative had made the arrangements. They all said they were satisfied with their Care Homes for Older People Page 11 of 34 Evidence: admission. None of them remembered having been given information about the home. One person told us My son probably has the information. They said staff had explained some of the daily routine information to them. In a survey form one of the people who use the service told us My family received letters and leaflets and dealt with it for me. Care Homes for Older People Page 12 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care and support needs are detailed in their care plans which are regularly reviewed. People can choose who provides their intimate personal care. People have good access to healthcare professionals. The arrangements for peoples medication are generally well managed. Evidence: Action had been taken to address the requirement we made that peoples care plans are reviewed and revised as needs change. We said that the care plans must detail how those needs are to be met, together with information about any associated risk or behaviour monitoring plans. The home has implemented the organisations new care planning documentation. We saw that care plans were in place on the day that new people moved in. One person we spoke with told us that their keyworker met with them regularly to discuss writing their care plan. Care plans were very detailed in identifying how peoples care needs are to be met and monitored. There was good information about Care Homes for Older People Page 13 of 34 Evidence: how people wanted their personal care to be carried out. Although there was no policy about the giving of intimate personal care by staff of a different gender, we saw that people had been consulted about who provided their care. We saw that any medical concerns were promptly referred to the relevant healthcare professional. Action had been taken to address the requirement we made that people have their risk of developing pressure damage assessed. We said that care plans must show how identified risks are to be minimised or managed. The new care planning documentation provides risk assessment forms. Miss Carash told us that training in tissue viability had increased awareness of the purpose of assessing peoples risk of developing pressure damage. We saw that pressure relieving equipment was in place where indicated. We saw evidence of the successful healing of one pressure wound. One persons care plan identified a wound with a body map to show its location. There was good detail about treatment of the wound, but no further record showing whether the wound had healed. We saw that another person was having a wound dressed by the district nurses. There was no record in the care plan about whether the wound was healing. We advised that the home should keep their own records and not rely on notes kept by the district nurses of treatments and progress of healing of wounds. We advised that the home should keep a record of the outcome of district nursing interventions. Another persons care plan contained photographs that the home had taken of a wound throughout the healing process. The person had given their permission for the photographs to be taken. We saw that where immediate care charts were in place, they were being filled out according to the information in the persons care plan. We looked at one persons fluid intake chart. We saw the medical intervention record that the GP has advised that the person was to have only six cups of fluid a day. This was recorded on the chart but the care plan made no record of this or why this course of action was advised. Two people we spoke with told us that the district nurse came regularly to dress their legs. One person told us they liked to have some bed rest after lunch to aid healing of their legs and staff encouraged them with this. People were weighed on admission and monthly thereafter. Any significant weight loss was reported to their GP. People had their nutritional needs risk assessed. We saw evidence of assessment of different risks to people who use the service. Some of these included: use of a hot water bottle, fire, going out unaccompanied, the use of bed rails (often referred to as cot sides) and moving and handling. Staff had been trained by the district nurse to take blood glucose levels for people who Care Homes for Older People Page 14 of 34 Evidence: had diabetes. We spoke with one of the visiting nurses. They told us that staff were very helpful when they visited. They said that staff were quick to tell them of any concerns and always acted upon any advice given. They described a situation where end of life care was given to someone at the home. They said staff regularly made the person comfortable in different positions to reduce pressure damage and monitored fluid intake. They said staff had also supported the family of the person. They told us that no one had pressure sores. We saw that staff had taken the trouble to make sure that people looked smart and well dressed and had clean glasses. One of the people we spoke with told us that they could make their own GP appointments but preferred staff to do it for them. They said that their GP visited them at the home and they could have staff present if they wanted to. Action had been taken to address the requirement we made that the revised medication procedure is further amended with regard to checking medication that is received from people who use the service, relatives or hospitals. We said that the wording should must be amended to must. We could not find reference to this in the medication procedure. We checked with our Pharmacy Inspector who made the original requirement. She confirmed that this requirement is now met. We saw that confirmation of current medication had been received from the GP of one person using the respite service. One of the care leaders and Miss Carash showed us the arrangements for medication administration. None of the people who use the service were currently administering their own medication. Miss Carash told us that people could administer their own medication following a risk assessment and consultation with their GP. The supplying pharmacist had carried out a check of peoples medication on the day before the inspection. Action has been taken to address the good practice recommendation we made that the rationale for medication prescribed to be taken only when required, is stated in the care plan. We saw that care plans identified symptoms which prompt an administration of painkillers. Miss Carash told us that a recognised pain assessment tool would be introduced to use with people who may not be able to talk about their pain. Separate medication charts were used to ensure that topical creams were administered. Body maps identified where the cream was to be administered. We saw that the home had downloaded information about some medication from the internet. One person was prescribed adhesive patches for administration of a controlled Care Homes for Older People Page 15 of 34 Evidence: medication. Their care plan did not give information about where the patches were to be applied. We advised that a body map should be used to identify the varying sites on the body where the patches are to be alternately administered. Miss Carash told us what she had done about two recent medication errors that she had notified us of. She had investigated the matter and was taking her conclusions to a staff meeting that week. Neither person had been affected by the errors. Advice had been immediately sought from the GPs and both families had been informed. There is a policy on action to take if maladministration occurs. All of the people we spoke with told us that staff administered their medication. They all told us they preferred that staff kept their medication. One person told us the times that staff would bring their medication. They said they always had their medication at the right time and no mistakes were made. They said they are very strict with pain killers. We asked them what this meant. They told us about only having a limited amount each day. They told us that staff always asked them if they needed painkillers. We saw staff ask certain people if they needed their pain killers during the administration of medication. All of the people we met with in their bedrooms had their call alarms within easy reach. In one room we noticed that the extension lead jack plug was not fully fitted into the unit. This bell would not operate until the lead was fully pressed in. We looked at other alarms in peoples rooms and found them to have the leads fully in place. We advised that the units should be regularly checked to ensure they are fully functioning. Miss Carash and four staff had recently attended end of life training at a local hospice. She told us that this training would be cascaded to other staff. She also said that she had discussed some issues at the residents meetings about remembering people who had died at the home. End of life care planning would be introduced. One of the visiting district nurses told us that Staff are very good at working with us in providing end of life care for residents. In a survey form one person told us Medication given promptly daily and appointments are dealt with on my behalf. One of the relatives told us The majority of the time my mother gets the care and support that the staff provide but on occasions staff could be more persistent i.e. hygiene. Recently my mother became ill I do not feel the doctor was contacted soon enough. One of the GPs told us Looks after elderly people with care needs who cannot cope in their own home with help. I am not aware of any areas where they need to improve within the limits they work in. On balance I think Marden Court provides above Care Homes for Older People Page 16 of 34 Evidence: average care in its class. Care Homes for Older People Page 17 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An increase in the staffing hours provided for activities means that people have more opportunity to engage in activities that they like to do. An improved range of activities takes place at the home and in the locality. People are offered a choice of meals from a menu that they contribute to. Evidence: All of those people we spoke with in their bedrooms told us they liked to spend time in their rooms and enjoyed their own company. Most of them told us they had all their meals in their bedrooms. One person told us staff encouraged them to have some of their meals in the dining room to socialise a bit more. We asked those people in their bedrooms whether they joined in with the activities. Although most of them said they did not necessarily join in with everything, they all knew what events were planned or had taken place. The hours for staff providing activities had been increased from sixteen to twenty five. The activities coordinator was due to attend a course at Swindon College about providing activities in care homes. Care Homes for Older People Page 18 of 34 Evidence: Miss Carash told us that various fund-raising events are held to provide different activities and excursions. The home uses local community transport for regular trips in the locality. One of the people we spoke with told us about a recent shopping trip. They also said there was a quiz at another home in the organisation. Most of the people we spoke with told us about their enjoyment of a fruit tasting session which had taken place the previous day. They also told us about a recent visit of exotic animals to the home. We saw photographs of these and other events that had taken place. Another person told us about someone bringing in a dog which they enjoyed. Another person told us about a visit to the canal locks in Devizes, wheelchair ice skating, Christmas shopping in Chippenham and a pub lunch. They said that two singers had come to entertain people. They also said they were invited to go to one of the organisations other homes in Devizes. The activities programme was displayed on the notice boards. There were two activities each day including the weekends. Miss Carash told us that care staff would provide activities when the co-ordinator was not working. One of the people we spoke with told us about the monthly Holy Communion provided at the home. They also said they regularly went to church on Sundays. Miss Carash showed us the two vegetable patches which had been dug over ready for people to plant vegetable and fruit. Many of the people we spoke with told us that they enjoyed sitting in the garden in the better weather. The home produces a regular newsletter publishing events and activities. One person told us they enjoyed the bingo. They said theres always something happening. Yesterday we had fruit tasting. You had to guess what they were. They told us that Communion was held once a month. They told us they also went to the local church. We asked them whether they had a key to the front door. They told us they had to ring the door bell as only staff know the code to the lock. They said they did not mind having to be let in. One of the district nurses had also told us that the home would not let them have the code to the front door. We asked Miss Carash about this. She told us that for matters of security, it was the organisations policy that the code was not given to anyone except staff. One persons care plan identified that they went out unaccompanied. Any risks had been assessed. The care plan stated that the person would tell staff when they were likely to return. We looked at the daily notes which did not always record when the person had returned each day. One person had shown an interest in attending the organisations annual event at an Care Homes for Older People Page 19 of 34 Evidence: activity centre in Devon. Another had shown an interest in the organisations planned trip to Lourdes. All of the people we spoke with told us that their relatives and friends could visit them at any time. One person told us their enjoyment in inviting a friend to a meal. We observed the lunch being served. We noted that nine people were left in a wheelchair at the dining tables. We saw that the arms on one persons wheelchair were too high for the chair to fit under the table. This meant that they were not near enough to the table to eat their meal with ease. We asked Miss Carash why people were not offered a dining chair to eat their meals. She told us that people were happy to stay in the wheelchairs, but would look into offering them dining room chairs. A member of staff went to those people who were having lunch in their rooms to offer them choice for the meal. People were offered a choice of juice with their meal. The lunch was liver and onions with carrots, sprouts and potatoes or sausage roll, baked beans and chips. The meal was well presented and people told us that they enjoyed it. People were offered support where needed with cutting up their food. Staff who were supporting some people to eat their meals did so at the persons pace. Staff talked to the person about the food and took time to sit with them while they were eating. People could help themselves to condiments on the tables. Staff also asked if people wanted different sauces which they brought from the kitchen. We spoke with the chef who showed us the menus. They told us they compile a winter and summer menu taking into consideration comments from people using the service. They said they had introduced more sandwiches for the evening meals following requests. The menus included dishes reflecting different celebrations during the year. One example was St Patricks Day. They said they used fresh ingredients and cooked meals from scratch. Cakes were made on the premises. They told us they were able to cater for different special diets, including diabetic and vegetarian. They told us they had received training in nutrition, particularly in relation to people with dementia and people who were at risk of, or had pressure damage. They also had Level 2 food hygiene certificate. We saw good stocks of fresh fruit and vegetables. One person told us The food is OK. They know I like small portions. They do all sorts of different puddings. I really like the puddings. One person told us There is an excellent menu and usually a choice. They put the menu up on the board. There is always a choice of sandwiches for tea and a cooked breakfast on Thursdays. I usually go down to breakfast. The pre-admission assessments showed that people are asked about their diet and food preferences at admission. A form with these details is given to the chef. Care Homes for Older People Page 20 of 34 Evidence: The visiting district nurse told us The food always looks good and smells nice. In a survey form one person told us They do have a good variety of activities but I dont always want to go on them. Meals very good. Care Homes for Older People Page 21 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place for people who use the service and their representatives to complain about the service. Complaints are taken seriously and fully investigated. Staff know about their responsibilities to report any observations or allegations of abuse to the local safeguarding procedure. Evidence: The homes complaints procedure was displayed on various notice boards around the home. There was also a pictorial, large print notice advising people of how to make a complaint. The complaints log showed that all complaints are investigated with a response given to the complainant, giving details of whether their complaint was upheld or not. Complainants are informed about any action taken to address their complaint. All of the people we spoke with told us that they did not know how to formally use the homes complaints process. Each person told us that they did not have anything to complain about. One person told us they would speak to their daughter. Another person told us they would talk to their keyworker. Another person told us about the questionnaires the manager had recently sent them about the food and about taking concerns to the regular residents meetings. One of the care leaders told us about the local safeguarding process for reporting Care Homes for Older People Page 22 of 34 Evidence: allegations or suspicions of abuse. They told us that they had had experience in the past of reporting their concerns using this process. They told us they had received training in the local procedure and showed us the booklet with contact details of the local safeguarding unit. Our record of notifications to us show that the home is prompt in referring any allegations or observations of serious concern. Miss Carash told us that potential staff are asked questions about reporting abuse at interview. Training in safeguarding vulnerable people is included in the induction of new staff. In a survey form one person told us Usually happy, no concerns. Would ask a carer. Care Homes for Older People Page 23 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from the recent and ongoing improvements to the environment. The home is cleaned to a good standard. Evidence: Significant improvements had been made to upgrade the environment. The dining room had been redecorated, re-carpeted and new furniture provided. A toilet had been converted into a sluice room. Two extra toilets had been provided in the main entrance area. People who use the service had been consulted about the colour schemes for new curtains which were on order. A new hairdressing salon had been created upstairs. The conservatory, previously used as a smoking room by only one person, had been redecorated and designated as a quiet room. We saw a group of people using the room. A covered area outside with seating was now used by people who smoked. The built in wardrobes and vanity units in peoples bedrooms are gradually being taken out and replaced with new vanity units, chests of drawers and wardrobes. This makes the usable space greater. People told us they liked their bedrooms. One person told us they liked to look out of their window and watch events at the front of the building. In the AQAA Miss Carash told us over the last year we have been undertaking Care Homes for Older People Page 24 of 34 Evidence: substantial redecoration works incorporating the residents ideas and choices of colour, furniture and fabrics. The home is much more homely and welcoming for all the residents and their families. A programme of bedroom refurbishments is being undertaken with Marden Court planning to redecorate at least six bedrooms this year. Since the inspection Miss Carash has provided us with the homes five year plan for upgrading the building. Pictorial and large print signs have been placed on toilet, bathrooms and other communal rooms. There was also signs with arrows at different points around the home to locate the way to nearest toilets or communal rooms. Each persons bedroom had their name on the door together with a picture of things that interested them. We asked one person who went out regularly into the town whether they had their own key to the front door. They told us about the keypad. They said they did not have the number but did not mind ring the door bell on their return. A visitor told us they wanted to know the keypad number. Miss Carash told us it was a security issue and the organisations policy that only employed staff know the number. Action had been taken to address the requirement we made that the undersides of toilet surrounds and bath hoists must be regularly cleaned. We found one toilet surround which had yellow drip marks underneath. All the other toilet surrounds and bath hoist seat were cleaned underneath. Miss Carash told us that the marks under the toilet surround were due to a sealant which discoloured the surface. We saw that a number of bedrooms had free standing heaters. One person told us that theirs was used because the radiator did not work. Miss Carash told us that the home had experienced problems with the heating since the supply to the adjacent empty flats had been disconnected. She told us that the organisations property management department were dealing with the issues. Since the inspection we have sent the home guidance from Wiltshire Fire and Rescue about the use of free standing heaters. Miss Carash also sought advice from the fire trainer who was providing staff training that day. She told us that the heaters would be fixed to the wall the next day to reduce any risks to people using the service. We saw that a risk assessment had been carried out which identified that the heaters must only be used when people were in their bedrooms. All of the radiators were guarded to reduce the risk of scalding should anyone fall against them. Following the inspection we were told that the freestanding radiators had been removed. The laundry room had been upgraded and redecorated. An additional tumble dryer had been purchased. There were arrangements for the disposal of clinical waste. There Care Homes for Older People Page 25 of 34 Evidence: were also arrangements in place for laundering soiled or infected linen. The laundry was well organised. One of the housekeepers is designated to do the laundry for three mornings a week. Care staff do the laundry at other times. There is a separate room where night staff do the ironing. People we spoke with told us they were satisfied with the laundry service. In a survey form one of the people who use the service told us It is always spotless and is a credit to the staff. Another person told us See the cleaners daily working around the home. Very clean. Care Homes for Older People Page 26 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels mean that people have the care and support that they need. Staff have good access to relevant training. A robust recruitment process means that people are protected from unsuitable staff. Evidence: The staffing rota showed that there was a care leader and three care staff during the mornings and a care leader and two care staff during the afternoons and evenings. At night there was three waking night staff. Miss Carash told us that she was currently recruiting more bank staff to reduce the use of agency workers. In the AQAA Miss Carash told us We continue to have an extra seven hours at a senior level which is off rota for senior care staff to complete administrative duties without compromising the care to residents. One of the staff told us they had received a good induction into their role. They told us about training they had undertaken including: health and safety, food hygiene, dementia care, infection control, abuse and fire safety. Another staff told us that they had recently received training in sensory deprivation, palliative care and dementia, nutrition and medication. They had also received training from a local undertaker in how they carry out their work. In the AQAA Miss Carash told us that all new staff commencing employment are given equality and diversity training within their Care Homes for Older People Page 27 of 34 Evidence: induction. We have a specific Trust module on equality and diversity. Staff training records are kept on the homes computer. Miss Carash also keeps a matrix of training that staff are expected to achieve. This matrix includes training undertaken via the organisations e-learning modules, in-house training and external training courses. Miss Carash told us that nearly all staff had attained at least NVQ Level 2. Miss Carash told us that training videos and DVDs in different subjects were available at the organisations local office. She told us that she had requested a national organisation for mental health to provide training. She went on to say that Age Concern had provided training in mental health in old age. Miss Carash was providing a resource library for staff consultation. This included information from the internet, books and pamphlets. In the AQAA Miss Carash told us that all staff had received in depth dementia training. We looked at the staff recruitment files. All the information and documents required by regulation were on file. No one commences duties without checks on their suitability to work with vulnerable people. Miss Carash told us that she intends that people who use the service will be included in the recruitment process. They will meet candidates and comment on their interactions. All of the people we spoke with made very positive comments about the staff. One person described the staff as wonderful. Everybody is so kind and helpful. If you ring the bell, no matter what time theyre here. They know that if I fall they must let my daughter know. Another person told us they are very, very kind. I have great faith in them. In a survey form one of the people who use the service told us the staff always answer any request made to them with a smile and make it happen. They really care and it shows. Marden Court is a great place to live with a dedicated staff to make sure it stays that way. Another person told us staff listen pretty good, to act on when you ask. Staff available but do understand that they are busy. One of the staff told us They gave me leaflets and all the information I needed. I was also shadowing a staff member who told me step by step what was done and how its done. I have had a number of training sessions for vision-call, which helped me to understand better how to help the residents that have hearing and visual difficulties. I have found all my training useful. Care Homes for Older People Page 28 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a manager who runs the home in their best interests. People are asked to comment on the service. Staff receive regular supervision. Systems are in place to ensure the health and safety of people who use the service, staff and others. Evidence: Miss Carash has managed the home for over three years. She has over four years experience in senior management and over twelve years experience working in social and nursing care. She holds NVQ Level 4 in management and care. She told us that she expected to complete the Registered Managers Award by the end of the month. She told us about different unforeseen barriers to her completing the Award earlier. Miss Carash keeps herself up to date with current good practice by attending courses provided by the organisation. She is clear about how she wants to home to develop. Staff told us that they received supervision at least six times a year. We saw the years programme for supervision on the staff notice board. One of the care leaders told us Care Homes for Older People Page 29 of 34 Evidence: about their providing supervision to other staff. As well as the organisation carrying out annual quality audits of the home, Miss Carash asks people to fill out questionnaires about different aspects of the service. People we spoke with told us about responding to the questionnaires and attending the regular residents meetings. We saw that the minutes of these meetings were displayed on the notice boards. Miss Carash told us that one of the people who use the service had agreed to take on the role of residents representative. They would talk to people and encourage them to talk about the service. In the AQAA Miss Carash told us we conduct an Annual Residents Survey each summer and from the feedback, we plan the ongoing developments for the home directly responding to the views of our residents, creating an action plan that is shared with them. We advise that staff are also included in the audit. Action has been taken to address the good practice recommendation we made that body maps should be used to record monitoring of any wounds. We found that body maps were being used to documents wounds. However we noted on one of the care plans that although photographs and body maps had been used to show healing of one wound, there was little information recorded since. Action has been taken to address the good practice recommendation we made that drinking vessels should be measured so that daily totals can be made of fluid intake to assist monitoring. We found that volumes were being recorded but daily totals were not always recorded. We advised that the form should indicate how much each person with a chart should achieve each day. Daily totalling of the consumption could then be monitored. The organisation contracts for servicing and maintenance of equipment. The handyman carries out day to day repairs. Risk assessments of the environment were being carried out annually. Individual risk assessment with people using the service were found in their care plans. Staff were receiving fire safety training on the afternoon that we visited. In a survey form one of the staff told us The manager is very helpful. I feel I can go to her at any point for help and advice or concerns. Care Homes for Older People Page 30 of 34 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 31 of 34 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 17 The home must keep its own 05/06/2009 notes on treatment and monitoring of wounds carried out by the district nurses. As evidence of healing. 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 2 7 9 Fluid charts should identify any quantities people are expected to consume each day Body maps should be used to identify which parts of the body medicated patches are placed each time they are administered. Consideration should be given to whether people would be able to eat their meals more easily if they sat in a dining room chair rather than the wheelchair used to transport them to the dining room. Regular checks should be carried out of peoples call alarm leads to ensure they are secured into the housing on the call box and fully function. Staff should be given the opportunity to contribute to the quality audit. Page 32 of 34 3 15 4 22 5 33 Care Homes for Older People Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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. 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