Inspection on 20/08/07 for Marian House Nursing Home

This inspection was carried out on 20th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Marian House Nursing Home 24/10/06

Marian House Nursing Home 06/01/06

Marian House Nursing Home 01/06/05

Marian House Nursing Home 18/11/04

Marian House Nursing Home 25/05/04

Marian House Nursing Home 25/02/04

Marian House Nursing Home 28/08/03

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

CARE HOMES FOR OLDER PEOPLE Marian House Nursing Home 32 Walmley Ash Road Walmley Sutton Coldfield West Midlands B76 1JA Lead Inspector Amanda Lyndon Unannounced Inspection 20th August 2007 09:10 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marian House Nursing Home Address 32 Walmley Ash Road Walmley Sutton Coldfield West Midlands B76 1JA 0121 240 8000 0121 240 8039 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Currently under development Walmley Care Home Limited Miss Josephine Louise Stinton Care Home 41 Category(ies) of Physical disability (35), Physical disability over registration, with number 65 years of age (35) of places Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: currently under review 1. 2. 41 places - over 50 years general nursing care for physically disabled service users where disablement began before pensionable age. That the home can accommodate 1 named service user who is 35 years of age for general nursing care. 24 October 2006 Date of last inspection Brief Description of the Service: Marian House Nursing Home is privately owned by Walmley Care Homes Limited, and provides 24 hour nursing care for up to 41 older people. It is able to offer care to adults over 50 years of age with a physical disability. It is situated in a residential area of Sutton Coldfield and public transport is easily accessible. Marian House Nursing Home is a purpose built Home with single accommodation on both floors, many of which have en suite facilities. There are ample assisted bathing and toilet facilities and staff are available to provide assistance in these areas as required. There are lounge/dining areas situated on both floors. There is a range of aids and adaptations designed to accommodate residents with limited mobility, such as hoists, grab rails, a passenger lift and nurse call system. The internal and external environment is suitable for wheelchair users. There is adequate off road parking to the front and side of the property and a well maintained garden at the rear for residents’ use. There are notice boards located throughout the Home displaying information of interest to residents, visitors and staff. Information about CSCI was on display and a copy of the most recent CSCI report was on display for anyone interested to refer to. The weekly fee to live at Marian House is between £615 and £650 (including the nursing care contribution). Items not included within this fee include hairdressing, staff escorts for routine medical appointments, chiropody and toiletries. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the Home and their views of the service provided. This process considers the Care Home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Information obtained and used in the planning of this field work visit included Regulation 37 notification reports of any accidents or incidents involving people using the service and one complaint made about an intermittent fault on the passenger lift. The Registered Manager had completed a self- assessment document, giving some information about the Home, residents and staff which was also taken into consideration. Prior to the visit four completed questionnaires were returned to CSCI from residents and their relatives. These included positive comments about the service provided at Marian House: “They keep the Home clean and tidy” “The staff are very friendly and caring. The nursing staff listen carefully to concerns and respond appropriately by dealing with issues raised or referring them to line manager”. Negative comments were received from residents and visitors about the number of staff on duty and lack of activities provided for a number of residents including: “They could improve by employing more staff” “I sometimes have to wait before someone comes to see what I want”. “More time needed to just spend time chatting with residents” “There are no activities for someone who is bedridden but is mentally alert, staff have no time to do this as well as their other duties”. “Activities are not suitable for me at the moment”. “It would be good if my Father was given a wider breadth of interests”. The field work visit referred to in this report was undertaken over one day by two Inspectors when there were forty one residents living at Marian House. The Home was not aware that we were visiting. Information was gathered by speaking with eight residents, two visitors, the management team and two staff members. An additional method of obtaining information was “case tracking” four residents in order to establish their individual experiences of living in the Care Home. This involved meeting and observing them, discussing their care with staff, looking at care files and focussing on their outcomes. A partial tour of the Home relevant for these people was also undertaken. Tracking residents’ care helps us understand the experiences of people who use the service. No immediate requirements were made on the day of the visit Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 6 What the service does well: Prior to coming to stay at the Home prospective residents are encouraged to sample what life would be like to live there. Following an assessment of prospective residents’ care needs a letter is sent out to residents or their families confirming whether their care needs could be met at Marian House. Staff have the necessary skills and knowledge in order to care for people with sore skin and the appropriate equipment was available for residents deemed to be at risk of sore skin to use whilst in bed and whilst sitting in their chair. All nursing staff are competent to take blood samples, syringe ears and change male urinary catheters so that residents do not have the upheaval of going outside of the Home for these type of nursing interventions to be carried out. Residents are generally cared for in a respectful manner by staff working at the Home and this ensures that their self- esteem and dignity are maintained The staff team have a good knowledge about residents’ individual care needs and staff approach residents in an understanding and sensitive manner so that residents feel calm, confident and relaxed. Details of forthcoming events are on display in the Home so that residents can choose which activities they want to participate in. Residents are able to exercise control over their daily lives and this promotes their independence and individuality. There are no rigid rules or routines at the Home and residents can choose where they spend their day and where they are served their meals. One resident said “I have my meals in my room or I go to the dining room”. Residents are supported to form friendships with each other so that they can share their experiences. Residents and staff are involved in producing an interesting newsletter. Visitors are made to feel welcome at the Home and are encouraged to spend time there. Residents are supported to continue to practice their chosen religions and this ensures that their beliefs and individuality are respected. Complaints are investigated in an appropriate and timely manner so that people are confident that their views are listened to. One resident met during Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 7 the visit said “There is nothing that I can think of to improve it here. I would have to think for a long time to find something I dislike”. Aids and adaptations are provided so that the independence, choice and dignity of residents are promoted whilst maintaining their safety. Regular maintenance checks of this equipment ensure that they are safe to use. The gender mix of care staff reflects the gender mix of residents so that care is provided in an understanding manner. Comprehensive staff training is provided so that staff have the appropriate skills and knowledge to work safely and effectively in order to provide a good standard of care to residents. The Registered Manager has a good understanding of individual residents’ care needs and positive comments were received about her management style. She ensures that staff feel supported within their job roles. What has improved since the last inspection? Care plans include detail of the care required by staff in order to monitor residents’ short and long- term health care needs. Additional equipment has been purchased in order to reduce the risk of residents developing sore skin. Wound dressing records identify that residents receive a good standard of care in this area. Residents have access to a wide range of health and social care professionals and written records regarding these visits are well maintained for ease of auditing. Social care assessments have been introduced in order to determine residents’ individual interests in this area. Residents are offered a choice of healthy and fresh meals which are served at the right temperature for residents to enjoy. One resident said “ The food is really good here. The menu is done over a four week period”. Another resident said “We all have different personal choices. If we ask for a small dinner, we get one”. Staff training has been provided about “Whistle blowing” so that they should have the confidence to raise any concerns about residents’ care in a timely manner. New garden furniture and a DVD player had recently been purchased for residents’ use. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 8 Additional manual handling equipment and an additional bath hoist have been purchased for residents who are not able to walk or stand on their own. This promotes the safety of both residents and staff. Action has been taken following the most recent environmental health inspection so that food is prepared in a hygienic environment. There is a robust system in place for the safekeeping of small amounts of residents’ money should they choose to use this facility. Maintenance checks are undertaken on equipment so that it is safe to use. What they could do better: The statement of purpose and service user guides should be further amended to reflect the current services provided at the Home so that residents can make an informed choice about whether they would like to live there. Care plans should be reviewed thoroughly in order to ensure that residents’ receive the care that they require. A small number of improvements are required to ensure that residents receive their medication in a safe manner. Activities arranged at the Home do not meet the expectations of all residents and opportunities for residents to participate in trips outside of the Home are limited. Menus should identify hot option alternatives to the main lunch time meal so that residents can choose what they would like to eat. The presentation of pureed meals should improve so that residents are served appetising meals. All incidents of a possible adult protection nature must be reported to the appropriate authorities without delay in order to protect residents. Suitable mechanical sluice disinfecting equipment must be provided so that commode pots can be cleaned in a hygienic manner so that the risk of the spread of infection is reduced. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 9 Staffing levels must be reviewed so that residents are confident that they can receive support from the staff team at the times that they require. One resident said “ The staff do whatever I ask them to do. I think that they are overworked”. Lapses in recruitment procedures on two occasions may not safeguard residents. Not all residents were able to use the nurse call system whilst in their bedrooms and lounges and ways to ensure that residents can summons assistance from staff should be explored. Cleaning products must be stored securely at all times so that vulnerable residents do not come into contact with these. Staff welcoming visitors in to the Home must ensure that they ask all visitors what the purpose of their visit is, in order to protect residents. Staff must undertake further training about fire safety and how to use wheelchairs safely so that residents’ health and safety are protected. Arrangements should be made to ensure that any shortfalls identified regarding staff performance are monitored in a timely manner. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission processes are thorough and prospective residents know before admission that their care needs could be met whilst living at the Home. EVIDENCE: The statement of purpose and service user guides have recently been amended to reflect the current services provided at the Home incorporating the principles of the Mental Capacity Act. These included excellent detail of the services provided and the views of residents and visitors to the Home. Both documents identify the age ranges of residents living at the Home however did not identify that a number of residents currently living there had dementia. A number of residents have additional dementia care needs however the general nursing care needs of these people outweighed their dementia care needs at Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 12 the point of admission to the Home. This may prevent prospective residents from having all information required in order to make an informed decision about whether they would like to live there. These documents were available in residents’ bedrooms for them to read at their leisure and were in the reception area of the Home in a large print format for ease of reading for people with poor eyesight. Prior to admission senior staff undertake comprehensive assessments of prospective residents’ care needs in order to determine whether these needs could be met living at the Home. This includes a recently implemented social history assessment so that this information can be included in the planning of the care to be provided to individual residents. Following assessment the management team send a letter to prospective residents or their families confirming that their care needs could be met living at the Home. Prospective residents are encouraged to visit the Home and have a hot drink with other residents in order to sample what it would be like to live there. Intermediate care is not provided at Marian House Nursing Home. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning and health provision are generally good so that residents should receive person centred care tailored to suit their needs and preferences. Residents generally receive their medication in a safe manner. Residents receive care in a respectful manner however a lapse in this on one occasion does not promote residents’ dignity or self esteem. EVIDENCE: Comprehensive assessments of residents’ care needs are undertaken on admission to the Home and detailed care plans are derived from this information. These are individual plans identifying residents’ individual care needs and outline the specific support required by staff in order to meet these needs. Care plans were written and reviewed with the involvement of residents and their relatives so that their preferred routines could be maintained whilst Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 14 living at the Home. Care plan evaluations were repetitive at times and did not always reflect the good care provided. Clear guidelines identifying residents’ preferences regarding the care and support that they receive were on display in residents’ bedrooms for staff to refer to. Care plans relating to the management of residents’ short and long term health care needs included good detail of the support required by staff in these areas. These evidenced that residents received nursing care at the times that they required. Care plans relating to the management of pressure area care (sore skin) were well maintained and evidenced that residents received a good standard of care in this area. Staff had the necessary skills and knowledge in order to care for people with sore skin and the appropriate equipment was available for residents deemed to be at risk of sore skin to use whilst in bed and whilst sitting in their chair. In addition other pressure relieving equipment is loaned from the Primary Care Trust so that such equipment is provided for all residents in need of it. A good rapport had built up with the tissue viability nurse team (skin care nurse specialist team) and it was evident that the Home’s staff followed any advice given by this team. Personal risk assessments had been undertaken including the risk of residents’ falling. Comprehensive moving and handling assessments had been undertaken identifying the choice of equipment to be used in order to meet each residents’ individual care needs thus maintain their safety and dignity. Residents have access to a range of Health and Social Care Professionals and they can retain their own General Practitioner on admission to the Home (if the GP is in agreement). Detailed written records of the outcomes of visits from these people were kept and identified that residents were supported to maintain their health and well- being. All nursing staff are competent to take blood samples, syringe ears and change male urinary catheters so that residents do not have the upheaval of going outside of the Home for these type of nursing interventions to be carried out. Copies of codes of practice regarding the roles and responsibilities of the nursing staff are available for staff to refer to so that residents are safeguarded. Each member of the nursing staff team takes the lead and has the responsibility for staff training and supervision regarding a variety of elements of care. For example one nurse is responsible for ensuring that all residents receive a nutritious diet and that the staff team are aware of the importance of their role regarding this. Nutritional screening, including the regular weighing of residents is comprehensive in order to determine whether each resident receives a healthy diet. Nutritional supplements were prescribed and given to residents in need of extra nutrition. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 15 One resident stated that following removal of her urinary catheter she would prefer to use a commode or toilet facility instead of relying on incontinence pads. This was brought to the attention of the clinical manager who sought advice from the continence advisor without delay and plans were being drawn up to identify the support required by staff in this area. This will ensure that the residents’ dignity is maintained whilst promoting her independence. Residents appeared to be well supported to choose clothing, make up and jewellery suitable for their age, gender and culture. Residents’ personal hygiene needs appeared to be well met, ladies nails were manicured and painted (if residents chose to have their nails painted), hair styles were neat and spectacles and clothes were clean. It was pleasing that there was evidence that staff had taken time to talk with one resident about recent fashions as she had an interest in this. Care plans identified whether residents had any preferences regarding the gender of staff assisting with their personal hygiene needs so that care could be provided in a way that they preferred. Systems in place for the management of medication were generally good so that residents should receive their medication as prescribed. Clear administration instructions were identified on the medication administration charts (MAR) and stock balances of medicines sampled during the visit were correct. A procedure had been written providing staff with instructions about when to administer an “as required” medication to a resident. One resident had not received his medication for eight days due to a manufacturing problem however the Home’s staff had discussed this with the residents’ Doctor to ensure that the resident will not have any ill effects as a result of this. MAR charts were generally well maintained however there were a few gaps in which it was unclear whether residents had received their medication and not all prescription creams had been dated on opening so that staff were aware of when to discard the product. Staff were assisting residents in a respectful manner throughout the visit and residents and visitors confirmed that this was always the case. A number of residents had chosen to have a private telephone line in their bedrooms and there was a portable phone available for residents to make and receive calls in private. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities provided meet the needs and expectations of the majority of residents living at the Home however further social opportunities for residents unable to participate in group activities should be sought. Residents have control over their daily lives and are provided with healthy meals that meet any special dietary requirements. EVIDENCE: Since the last visit an activities person has been employed at the Home for thirty hours per week. During the visit she appeared to be enthusiastic within her job role and it was evident that she had liaised with residents in order to find out their interests and hobbies. In addition activity surveys had been sent to residents in order to find out their preferences in respect of activities provided and an activity programme had been derived from this information. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 17 Details of forthcoming events were on display so that residents could decide which activities they wanted to participate in. Residents had a variety of activities that they could choose to participate in including gardening, board games, bingo and coffee morning social events. A selection of newspapers and magazines were available for anyone interested to read. External entertainers visit the Home each month and a singing group was providing entertainment for a large number of residents on the day of the visit. Shopping trips, pub visits and trips to the library are arranged for small groups of residents however staffing levels do not permit regular opportunities for residents to participate in larger group outings. This was brought to the attention of the registered manager who stated that due to the frailty of the majority of residents living at the Home past outings had not been successful and this was discussed with residents during group meetings. Despite improvements being made in this area, further development of the activity programme is required in order to meet the needs and interests of all residents living at the Home. In particular for residents who are unable to join in with the group activities arranged due to health problems of for other reasons. Opportunities for these people to pursue their leisure/social interests should be explored in order to improve the quality of their lives. It was noted however that there was a comprehensive daily social record maintained for one resident who was unable to participate in group activities and this identified that she had received good social contact from the staff team and her family. It was pleasing that music of her choice was being played in her bedroom and it was evident that she was enjoying this. A number of residents go outside of the Home on a regular basis with their families and friends and a number of residents attend a lunch club at a local church so that they have the opportunity to meet with people of similar ages and interests. It was evident that friendships had formed between residents and this promotes a family atmosphere within the Home. A Summer Edition of the Home’s Newsletter was on display for residents, their visitors and staff to refer to. This included an abundance of information of interest covering a wide range of topics. For example, the success of recent social events arranged for residents, short stories, residents’ life histories and significant life events and plenty of humour. This was produced in a large print format for ease of reading for people with poor eyesight. A Church of England Minister visits the Home each week and Holy Communion is available regularly both on an individual and group basis. Opportunities for worship for residents of non- Christian faiths can be arranged as required. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 18 There is an open visiting policy and visitors confirmed that they were made to feel welcome at the Home. Communication between the Home’s staff and relatives was good and both visitors and written records confirmed this. There are no rigid rules or routines at the Home and residents can choose where they spend their day and where they are served their meals. One resident said “I have my meals in my room or I go to the dining room”. Menus were available for residents to refer to and included a variety of nutritionally balanced traditional British meals, reflecting the cultural backgrounds of residents and identified that salads were available on a daily basis if residents did not like the main meal choice of the day. The menus did not identify that hot meal alternatives were available at lunchtime however identified that vegetarian options were available. Special diets can be prepared for reasons of health, religious/cultural preferences and taste and diabetic diets are currently being prepared. The Chef stated that eleven pureed diets are currently being prepared and serving moulds were available to improve the presentation of these meals but were yet to be used. Snacks are available at all times so that residents are not hungry and hot and cold drinks are available between meals, served in residents’ own cups. The main meal option for lunch on the day of the visit was Shepherds’ Pie and sausages were available for residents who did not like this. Meals were served at the correct temperatures however residents were not encouraged to serve their own portions of vegetables. This prevents residents from having control over portion sizes. Alcoholic and soft drinks were served with the lunch. Dining tables were laid attractively, dining furniture was of a good quality and salt and pepper was available for residents to add to their meals if they preferred. One resident said “ The food is really good here. The menu is done over a four week period”. Another resident said “We all have different personal choices. If we ask for a small dinner, we get one”. Dietietic and speech therapy advice is sought for residents who are deemed to be at risk of a poor nutritional intake so that they receive a healthy diet. The daily food record for one resident identified that her diet was very limited and this was brought to the attention of the registered manager who stated that this was her choice and dietetic advice had been sought about this. Staff were aware of residents likes and dislikes regarding food preferences so that they were served food that they enjoyed. One resident stated that she was happy that fresh fruit was available. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are confident that any concerns raised will be acted upon in a timely and appropriate manner however written documentation regarding actions taken is poor. Systems are in place that should protect residents from harm however a lapse in procedure on one occasion may have potentially placed residents at risk. EVIDENCE: In the reception area of the Home there was a folder displaying a number of “thank you” cards and letters complimenting the Home’s staff on their care and support. One resident met during the visit said “There is nothing that I can think of to improve it here. I would have to think for a long time to find something I dislike”. Since the last visit CSCI have received one complaint about Marian House and this was regarding an intermittent fault on the passenger lift and the negative impact that this was having on residents and the staff team. This was referred to the Provider for investigation and remedial action was promptly undertaken for the benefit of residents and staff. Records held at the Home confirmed that the lift was now in good working order and regular serving of this was being Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 20 undertaken. We had not been informed about the intermittent fault on the lift as per regulation 37 notifications. The “comments” register contained a number of positive comments made by health professionals and visitors about the services and care provided by the Home. There were also a number of negative comments recorded in the register since the last visit and this identifies that residents and their relatives feel confident to raise any issues about the services provided with the staff and management team. These included issues regarding personal care afforded, the cleanliness of a residents’ room, the failure of a staff member to check a PEG (stomach tube feed) of a resident as often as required and a missing item of personal clothing. The management team were able to advise about the actions taken in response to the issues raised, including staff disciplinary proceedings and work practices being revised for the benefit of the residents living at the Home. It was noted however that a written record of this was not always available. Audits of complaints received are undertaken so that any trends/patterns regarding these can be detected and to ensure that remedial action has been taken. A copy of the comments and complaints procedure is on display in the Home, included within the statement of purpose and service user guides and a “suggestions box” is available. This provides residents and visitors with the information that they require in order to raise any concerns. Since the last visit staff had undertaken training about adult protection and the importance of “whistle blowing”. Information regarding this was available in the Home for residents, staff and visitors to refer to so that they should be confident to raise any concerns in a timely manner. Since the last visit there had been one allegation of a possible adult protection nature involving a resident and following an investigation by the management team this had been concluded to the satisfaction of the resident and their family. Measures had been implemented to minimise the risk of a further incident of a similar nature occurring again. The registered manager stated that this incident had not been referred to Social Care and Health as adult protection from the onset as the resident concerned had not made a formal complaint and there were conflicting accounts of the incident. However as a result of this the registered manager stated that she would inform Social Care and Health of any future allegations of a possible adult protection nature in order to safeguard residents. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a homely and clean living environment in which they are safe and secure and their privacy is maintained. Aids and adaptations provided promote residents’ independence and choice whilst maintaining their safety. The absence of suitable mechanical sluice disinfecting equipment may result in the spread of infection at the Home. EVIDENCE: The external appearance of the Home is attractive and well maintained. There is a beautiful secure garden to the rear of the Home that is accessed via a ramp and is suitable for wheelchair users. New garden furniture had recently been purchased for residents’ use. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 22 The reception area of the Home is welcoming and homely in appearance. There is a CCTV intercom system installed on the front door so that staff should be aware of who is entering the Home. It was of concern however that on arrival at the Home we were not asked who we were or the purpose of our visit and was left alone after entering the Home. This was brought to the attention of the registered manager who stated that action would be taken to reinforce the importance of this to the staff team in order to safeguard residents. Residents have a choice of lounges in which to spend their time and a quiet room is available for residents to meet with their visitors in private and hold private celebrations if they wish. There is a spacious separate dining room and this is a pleasant area in which residents can enjoy their meals. Communal areas are decorated to a high standard and furnishings and fittings are attractive and of a good quality. A DVD player has recently been purchased for residents’ use and enjoyment. Residents have a choice of assisted bathing and shower facilities and whilst one bath was old in appearance, it was clean and popular with residents. Plans are in place to install a hydrotherapy bath facility for residents’ use. Aids and adaptations provided meet the needs of residents living at the Home, including raised toilet seats and handrails in corridors and near to toilets. Following an occupational therapy assessment a reclining chair had been purchased for the individual use of one resident in order to improve her quality of life and comfort whilst maintaining her safety. Since the last visit additional manual handling equipment has been purchased for residents who are not able to walk or stand on their own. This promotes the safety of both residents and staff. Residents’ bedrooms contained personal items to reflect their tastes, interests, age, gender and culture so that they were comfortable within their surroundings. Bed linen, curtains and floor coverings were of a good quality so that residents are provided with an attractive environment. All residents have a lockable facility provided in their bedroom for the safekeeping of private and valuable items. The Home was clean and fresh and visitors confirmed their satisfaction about this. There was a hygienic system in place for the cleaning of residents’ personal clothing and bed linen, with the exception that hand paper towels were required in this area. Since the last visit infection control audits have been introduced in order to monitor the standard of cleanliness within the Home. It was of concern however that, as identified during the last visit, the Home is in need of mechanical sluice disinfector equipment so that commode pots can be cleaned in a hygienic manner. This will protect both residents and staff and minimise the risk of the spread of infection within the Home. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 23 An environmental health inspection had not been undertaken recently however the kitchen had recently been audited by the health and safety executive. The management team stated that remedial action had been taken to address the requirements made by the environmental health department so that food continued to be prepared in a hygienic environment. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are concerned that they are not supported by an adequate number of staff and this has resulted in them having to wait for staff assistance for unacceptable periods of time on occasions. Current arrangements may not enable all residents to summons assistance from staff at the times that they require. Residents are supported by appropriately trained staff so that they should receive a good standard of care. A lapse in recruitment procedures on two occasions may not safeguard residents. EVIDENCE: It was evident that the staff team had a good knowledge of residents’ individual care needs, in particular regarding residents who had limited communication skills. A good rapport had built up between residents, staff and their visitors so that communications were good for the benefit of residents living there. One visitor said “The staff do listen to us”. Prior to and during the visit concerns were raised by residents and visitors about care staffing levels provided at the Home. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 25 One resident said “ The staff do whatever I ask them to do. I think that they are overworked”. These issues were also raised during the last visit to the Home. Residents stated that they had to wait for long periods of time for staff to answer their call bells and comments were received that there were not enough staff on duty to take residents on outings. One resident and her visitor voiced their concerns that there was not always enough staff on duty to encourage her to mobilise as per Physiotherapy instructions. This was brought to the attention of the clinical manager who advised that a programme of exercise for this person was being re introduced following a recent knee injury. The minutes of the last staff meeting identified that some staff members had voiced their concerns about the staffing levels and not having adequate time to carry out their responsibilities. The management team stated that they were confident that the current staffing levels were adequate however this must be reviewed in light of the most recent comments received. Since the last visit a new nurse call system has been installed and this included a facility to check staff response times regarding the answering of calls. On the morning of the visit it was evident that the care staff were very busy answering call bells. A nurse call facility was provided in each bedroom however a number of residents were not able to use this. Ways to resolve this were not always recorded within residents’ care plans. The administrator stated that one resident calls out for help, however staff may not be in the vicinity of her room at the times that she requires. Residents using the lounge were not able to access the nurse call button and during the visit staff were not always present in this room. Further consideration should be given regarding these issues so that residents can summons assistance from staff as required. The cultural mix of staff did not reflect that of residents and concerns were raised about the communication skills of a few staff members, their writing skills and understanding within their job roles. The management team stated that they were aware of this and issues raised were being addressed. There were two male staff members employed at the Home providing care for five male residents so that care could be given in an understanding manner. Staffing rotas identified that there are two registered nurses and six care staff provided during mornings, two registered nurses and five care staff during afternoons and one registered nurse and three care staff during night time hours. The management team, ancillary staff and activities organiser are in addition to the care staff provided so that residents are supported in all aspects of their daily lives. A number of staff choose to work long day shifts however the registered manager stated that this did not affect the standard of care provided for residents. Staff recruitment files included the majority of information required by regulations with the exception that a second reference had not been obtained for one person who had recently commenced employment at the Home. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 26 There was evidence that registered nurses employed at the Home were eligible to practice within their current roles. Staff working at the Home were deemed by the management team to be safe to work with vulnerable people, however a risk assessment in respect of this had not been undertaken on one occasion and this may not safeguard residents. New staff undertake training in health and safety issues and the protection of vulnerable adults. Staff had received recent training relevant to their job roles including infection control, food hygiene, health and safety, oral care, diabetes and dementia care. Over 50 of care staff have a minimum of NVQ level 2 in care so that they should have the skills and knowledge to provide a good standard of care. Staff training is planned regarding “dignity in care”. Staff had not undertaken recent training about fire safety however a fire drill involving both day and night staff had been arranged recently so that some staff should have the skills and knowledge to act competently in the event of a fire. It was of concern that during the visit two residents were wheeled in to the dining room using wheelchairs without foot rests as this places residents at risk of injury. One resident was being assisted by the hairdresser who is not trained to undertake this task. This was brought to the attention of the management team who were disappointed that this poor practice had occurred as recent training had been provided in this area and remedial action was undertaken without delay. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This Home is generally run in the best interests of residents living there and systems in place for resident consultation are very good. Arrangements for health and safety are good and any lapses in procedures regarding this are acted upon in order to safeguard residents. EVIDENCE: The registered manager has been in post since 2004 and has had previous experience of working within a managerial role. During the visit a resident said “The manager and owner are very nice and approachable”. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 28 There is an effective management team employed at the Home and there are clear lines of accountability within this team. This team consists of the registered manager, clinical manager and administrator. Both the registered manager and clinical manager provide registered nurse shift cover so that they have the opportunity to care for residents, work alongside the staff team and monitor the care provided. A schedule of planned dates for regular residents’ meetings was on display so that residents can choose which meetings they wish to attend. A copy of the minutes of the most recent residents’ meeting was on display for anyone interested to refer to. One resident met during the visit spoke about her role as a link resident, responsible for liaising with other residents and the management team in order to improve services provided. Staff meetings are arranged regularly so that staff have the opportunity to put forward their views about working at the Home, suggestions for improvements to residents’ daily lives and to be informed about forthcoming training opportunities. Quality monitoring visits are undertaken by the Provider during the day and night. It was of concern that during a night time visit it was discovered that two staff members had been permitted by the person in charge of the shift to take their breaks together leaving an inadequate number of staff available to provide support for residents. Disciplinary action was taken in response to this as a result of poor management of the night shift. We were not informed of this incident as per regulation 37 notifications. Regulation 26 reports of the findings of quality monitoring visits were available and these identified that the Provider met with residents, relatives and staff. A record of actions to be taken for the benefit of residents was kept and there was evidence that these were acted upon. Reports based on the findings of annual resident, relative and staff surveys are included within the statement of purpose and service user guides. Responses included “When visiting here for the first time we were made to feel very welcome”. “Standard of care for my Dad is very high”. “There is a good choice of food for residents and if there is something they fancy and you have not got it in, you always try to get it”. “Wish staff had more time to sit and chat”. A comprehensive record of actions taken in response to these comments was included within the report so that residents can have the confidence that issues raised will be acted upon. In addition a formal quality assurance system is undertaken by an external source so that an independent audit of the services provided at the Home is undertaken. There was a facility available for the safe keeping of small amounts of residents’ money however the administrator stated that residents and their relatives were encouraged to retain their own money. Invoices are sent to Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 29 residents and their families in order to pay for hairdressing, chiropody and personal toiletries and a written record of all money in and out of the safe facility was kept. The balances of money held sampled during the visit were correct. A system for staff supervision had been developed so that staff felt supported within their job roles. This included work performance observations as mentors worked alongside staff in order to assess staff competence and identify individual training needs. Written records identified that shortfalls in work practice highlighted were not always reassessed in a timely manner for the benefit of residents. Shortfalls identified were not always included during subsequent supervision sessions and a period of six months had lapsed between supervision sessions for one staff member. Accident records were well maintained and identified the actions taken by staff as a result of these. A monthly audit of accidents is undertaken so that any trends/patterns can be detected and measures can be implemented to minimise the risk of further incidences of the same. Regular health and safety checks of equipment used at the Home are undertaken so that they are safe to use. In addition a health and safety audit is undertaken each month so that any faults can be detected and rectified. A member of the housekeeping team had left her trolley containing cleaning products unattended and this poses a risk for vulnerable residents who may access these products. The staff member involved advised us that she did not understand what was being said to her when she was questioned about this. The registered manager advised that all staff were aware of the importance of not leaving their equipment unattended and stated that action would be taken to prevent this happening again. Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 3 3 3 x 3 x 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 2 x 2 Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(2) Requirement Care plans should be reviewed thoroughly in order to ensure that residents’ receive the care that they require. Suitable arrangements must be made for the accurate recording of all medicines administered onto medication administration charts. Policies and procedures must be followed regarding any alleged or actual incidents of an adult protection nature in order to protect residents. Arrangements must be made so that staff are aware of the purpose of all visitors into the Home in order to safeguard residents. Suitable mechanical sluice disinfecting equipment must be provided so that commode pots can be cleaned in a hygienic manner (Time scale of 30/03/07 not met) 6 OP27 23(2)(n) Arrangements must be made so DS0000024866.V343765.R01.S.doc Timescale for action 31/10/07 2 OP9 13(2) 30/09/07 3 OP18 13(6) 30/09/07 4 OP19 13(6) 30/09/07 5 OP26 23(2)(k) 31/01/08 30/09/07 Page 32 Marian House Nursing Home Version 5.2 7 OP27 18(1) that residents can summons assistance from staff when required. Arrangements must be made to ensure that there is adequate staff on duty at all times to meet residents needs. (Time scale of 20/11/06 not met) 31/10/07 8 OP29 19(1) 9 OP30 23(4) 10 OP30 13(5) 11 OP38 13(4) 12 OP38 37 Arrangements must be made to ensure that all necessary information about prospective staff members is obtained and analysed prior to commencing employment at the Home in order to safeguard residents. Arrangements must be made so that all staff have the opportunity to acquire the necessary skills and knowledge to act in a competent in the event of a fire in order to safeguard residents. Arrangements must be made so that all staff have the opportunity to acquire the necessary skills and knowledge to use wheelchairs safely. Arrangements must be made to ensure that cleaning products are stored securely at all times thus preventing vulnerable residents from accessing these. CSCI must be informed of any accidents or incidents that affect the health and welfare of residents. 30/09/07 30/11/07 15/10/07 30/09/07 30/09/07 Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The statement of purpose and service user guides should be further amended to reflect the current services provided at the Home so that residents can make an informed choice about whether they would like to live there. Suitable arrangements should be made to ensure that prescription items are discarded after opening as per the manufacturers instructions in order to ensure it’s effectiveness. Care afforded should uphold residents’ privacy and dignity at all times. Opportunities to meet the social care needs of residents unable to participate in group activities should be sought. Menus should identify all hot option alternatives to the main lunch time meal so that residents can choose what they would like to eat. The presentation of pureed meals should improve so that residents are served appetising meals. Written records of all actions taken in response to complaints and concerns raised should be kept as evidence of actions taken for the benefit of residents living at the Home. Arrangements should be made to ensure that any shortfalls identified regarding staff performance are monitored in a timely manner. 2 OP9 3 4 5 6 7 OP10 OP12 OP15 OP15 OP16 8 OP36 Marian House Nursing Home DS0000024866.V343765.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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