Inspection on 24/04/08 for Marine View Rest Home

This inspection was carried out on 24th April 2008.

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

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

Other inspections for this house

Marine View Rest Home 13/06/07

Marine View Rest Home 28/04/06

Marine View Rest Home 19/10/05

Marine View Rest Home 25/05/05

Marine View Rest Home 13/10/04

Marine View Rest Home 12/05/04

Marine View Rest Home 19/07/02

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Marine View Rest Home 277/279 Kingsway Hove East Sussex BN3 4LJ Lead Inspector Judy Gossedge Unannounced Inspection 24th April 2008 10:40 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 Marine View Rest Home DS0000014214.V361063.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. Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marine View Rest Home Address 277/279 Kingsway Hove East Sussex BN3 4LJ 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) 01273 417696 01273 272272 marineview@hotmail.co.uk Mr Mohammed Shareefuddin Ali Mr Mohammed Shareefuddin Ali Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users must be older people aged sixty-five (65) years or over on admission. The maximum number of Service Users to be accommodated is nineteen (19). 13th June 2007 Date of last inspection Brief Description of the Service: Marine View Rest Home is registered as a care home providing services for up to nineteen (19) older people. There is no nursing care provided at the home. District nurses will visit those service users requiring nursing input. The home is located in Hove opposite the Hove Lagoon. There is no parking available at the home, but street parking is available on adjacent streets within the area. Some areas of the home provide views of the sea. There are local amenities within walking distance and access to public transport is nearby. The home is two houses that have been joined together and converted for its current use. Rooms are located over three floors and service users residing in rooms above first floor must be able to independently mobilise. One stairway leading to first floor has a stair lift available. There are eleven single bedrooms of which two have en-suite facilities and four double bedrooms, of which one has en-suite facilities. One single bedroom is below ten square metres. There are three bathrooms, one shower, a wet room with toilet and five toilets located throughout the home for service users. There is a dining room and good-sized lounge room for service users to use. The weekly fees charged at the time of the Inspection range between £314.00 and £423.00. Additional costs are; hairdresser, chiropody, papers and toiletries. The Statement of Purpose, Service Users Guide and copies of previous CSCI Inspection reports are available upon request at the home. Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Marine View Rest Home will be referred to as ‘residents’. This unannounced Inspection took place over five hours on 24 April 2008. Prior to the Inspection the Registered Provider who is also the Registered Manager completed an Annual Quality Assurance Assessment (AQAA) and information detailed within is quoted in this report. A tour of the premises took place to look at communal areas and a selection of resident’s bedrooms and care records were inspected. Twelve people were resident and nine residents were spoken with, five individually and four in the communal areas. The care that four of the residents received was reviewed. The opportunity was also taken to observe the interaction between staff and residents in the communal area. Ten service users surveys were sent out on this occasion and seven completed surveys were returned. The Manager, three senior care workers, cook/activities co-ordinator were all spoken with. Five care workers surveys were sent out and three completed surveys were returned. Two relatives were spoken with by telephone after the Inspection. What the service does well: What has improved since the last inspection? Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 6 The radiators in the four rooms at the front of the home have now been guarded. The lounge door has been fitted with a self-closing device. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 7 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 Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 8 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, 2, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential new residents are individually assessed prior to any admission to ensure that their care needs can be met in the home and there is information about the home for residents and their representatives to read. Intermediate care is not provided in the home. EVIDENCE: The AQAA details there is a Statement of Purpose, Service User’s Guide in place and a copy of the last Inspection report was seen to be available to read in the home. The Statement of Purpose was viewed during the Inspection and should detail that respite care is now being provided in the home. This was discussed with the Manager who stated this would be addressed. Six of the seven service user surveys stated they had received enough information about Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 9 the home and one had not. One resident commented, ‘my relative came to visit the home first.’ One relative was able to confirm receipt of information, and had visited the home prior to their relative’s admission. One commented they would have welcomed more information on the home. The AQAA detailed that a contract is in place, with the Manager retaining a copy, which is kept in the home. All seven of the service users surveys stated they had a contract/terms and conditions, but these were not viewed on this occasion. The AQAA detailed that no service user is admitted to the home unless a thorough assessment is undertaken prior to any admission. A robust preadmission assessment is undertaken, but that this is an area that is continually being looked at to improve. The Manager stated he is aware the recording of information obtained at the pre-assessment needs to be expanded to ensure that the home can fully evidence that all of the assessed needs can be met within the current services and is in the process of addressing this. The Manager accompanied by a senior care worker undertakes the assessment to ensure individual resident’s care needs can be met in the home and to provide staff with information on the care to be provided. For two new residents admitted to the home since the last Inspection pre-admission information had been completed. One relative was also able to confirm an assessment visit had been made to their relative. Intermediate care is not provided in the home. Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 10 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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have individual plans of care; however, where risks are identified the recording should be developed as to how these risks are to be managed. Personal care and support is provided in a way that maintains and respects the privacy, dignity and lifestyle of the resident. There are policies and procedures in place to manage medicine. EVIDENCE: The AQAA detailed that there are policies in place to ensure that equality and diversity issues for individual residents are both identified and incorporated into residents individual plans of care. These are reviewed monthly and are based on consultation with residents, their relatives/representatives and staff. A selection of four of the resident’s individual care plans was viewed. A detailed recording format is in place and demonstrated that the detail being Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 11 recorded continues to be developed. For one resident who had been resident in the home for over four months the information had not been fully completed to give clear guidance to staff of the care to be provided. The care plans viewed had been reviewed to ensure that this information is up-to-date and current care needs are being met. Another residents care needs had changed and was recorded in the review, but the care plans had not been updated to detail the residents current care needs. A photograph was not in place for all residents. This was discussed with the Manager and senior care workers present and it was agreed that all these issues would be addressed. So Requirements were not made on this occasion. Supporting risks assessments had been recorded and staff spoke of ongoing work in recording risks. Not all the recording detailed how identified risk are to be managed in particular in relation to falls, where a resident self medicates and where service users go out independently from the home. This was discussed again with the Manager, who in some cases was able speak of procedures in place to minimise any risks, but which had not been recorded. The Manager agreed to look again at the risk assessments and who undertakes these and seek further guidance. A further Requirement has been made. The Manager has subsequently confirmed actions, which have already been taken to address this issue. Staff spoken with demonstrated a good understanding of residents care needs and the three care workers surveys stated they were always given up-to-date information about residents care needs. Five of the service user surveys stated they always received the care and support that they needed and two usually, and all stated that staff act and listen to what they say. Residents’ health needs are being met at the home. Five of the service users surveys stated they always received the medical support they need, one usually and for one it was not applicable. There were records of health care appointments and the two residents spoken with confirmed that they access to a GP, dentist, optician and chiropodist if they wish. One relative was also able to confirm their relative had been supported to attend a number of health care appointments. The staff team were observed during the Inspection to ensure that the privacy and dignity of residents is respected at all times. Three residents spoken with were also able to confirm this. Feedback received from resident and relatives spoken with, observations and information detailed in residents individual care plans confirmed of the care and support provided ensured that service users are enabled where possible to exercise choice whilst at Marine View. The feedback from all the residents and relatives spoken with was that they were satisfied with the overall care provided in the home. Residents and relatives, comments were, ‘I have been very happy here since 2000,’ ‘the staff are marvellous,’ ‘the carers are very caring,’ ‘my relative is very happy and well looked after.’ The AQAA details that medication policies and procedures are in place and staff receive medication training. The sample training records viewed and staff Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 12 spoken with evidenced care workers who administer medication have received medication training facilitated by an external provider in 2006. The Manager stated he was aware this should be kept under review to ensure training needs are identified and met and that further guidance would be sought as to when any training update was due. The Manager confirmed that a pharmacist regularly visits the home. The AQAA detailed that where one resident was self-administering a risk and an assessment was in place. This was viewed and was evidenced it had been reviewed, but did not give clear guidance on how any risks are to be managed. The Manager stated he would re-look at this and seek guidance and a further Requirement has been made. The storage and a sample of the recording of the administration of medication were viewed and were adequate. Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Where possible residents are enabled to exercise choice in their lives whist resident in the home. There are some opportunities to participate in social and recreational activities, the frequency of which should continue to be developed. Residents are encouraged to maintain contact with family and friends as they wish and a varied diet is provided. EVIDENCE: The AQAA details activities are facilitated every other day for example, bingo, cinema afternoons with sweet and nibbles, games like basketball, chair aerobics, and board games. Staff spoke of colouring and drawing with residents, poetry reading and the booking of external entertainment. On other days staff spend time talking with residents reminiscing and which they did on the day of the Inspection. The record of activities was inspected and demonstrated that activities are not regularly provided. Residents spoke of some activities they had participated in and a number of service users go out Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 14 independently to access local facilities and did so on the day. Some residents informed the Inspector that they do not participate in activities by choice. Feedback from the service user survey was varied and two stated activities are always arranged, four usually and one sometimes. Comments received were, ‘this is my choice to join in activities when I wish to,’ and ‘I choose not to.’ It was discussed with the Manager again that the range and frequency activities are provided should continue to be developed. Relative’s spoken with and residents who had had visitors commented that there was flexible visiting and that staff are very welcoming. The care and support provided was observed to enable residents where possible to exercise choice whilst at Marine View. A number of residents regularly go into the community alone. The four residents files viewed and residents and relatives feedback confirmed this. There is a visitor’s book that all visitors must sign when they enter and leave the home. The meals are served mainly in the dining room, although some residents had chosen to have their meal in their bedroom. The cook was not working on the day, but did visit the home during the Inspection. A senior care worker was cooking that day and stated she held a basic food hygiene certificate. Staff confirmed that Environmental Health had visited the home since the last Inspection and the home had been awarded a hygiene rating of four stars. Residents and staff spoke of residents being asked to choose from the choice available for that day. Due to the absence of the cook, staff stated that there had been some changes to the proposed meals provided during this period. Special diets are catered for. Lunch on the day was grilled steak or shepherds pie, carrots, and cabbage, followed by a selection of yoghurts, mousse or crème caramel. Fresh fruit is also available. Staff was available to offer any assistance to service users if required and residents were observed to be enjoying their lunchtime meal on the day of the Inspection. The AQAA details that nutritional needs are monitored and a sample of records are kept of individual food consumption, now including the recording of breakfast provided to ensure residents have had an adequate diet. The feedback from the service users surveys were varied and stated they always, usually or sometimes liked the meals. Comments received from residents were, ‘if I dislike the meal offered I have other meals offered,’ and ‘we are given a choice.’ One resident confirmed they were being supported to reduce their weight. The two relatives spoken with had not been present when the food was served but one stated their relative had commented that the food was good. Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 15 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures are in place to enable residents or their representatives to raise any concerns about the care being provided, also to ensure that residents are protected from abuse. EVIDENCE: The AQAA details that there is a complaints policy and procedure in place and a copy of the complaints policy is available in the resident’s bedrooms. Copies of the complaints procedure were seen during the Inspection to be available to reference around the home. That no complaints have been received since the last Inspection, and the CSCI have not received any further concerns. All the service users surveys stated they knew who to speak to if they were not happy and how to make a complaint. One relative was not aware of the procedure but would speak to the Manager with any concerns. Residents spoken with and all the relatives confirmed that it was an environment where they would feel comfortable raising any concerns with the staff or the Manager. The three care workers surveys stated they knew what to do if residents etc have any concerns, and one commented ‘I would go to my Manager.’ Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 16 The AQAA details there are policies and procedures in place in relation to the protection of vulnerable adults. That no complaints have been received which have been investigated under adult protection procedures. A copy of the new East Sussex County Council, Brighton and Hove safeguarding adults’ procedures is available to reference in the home. Care workers spoken with had an awareness of adult protection procedures and stated they had received training/update. The sample of training records viewed also confirmed attendance at this training provided by an external agency. Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and homely environment and are provided with comfortable indoor and outdoor communal facilities, but the standard of décor and furnishings is variable. EVIDENCE: A tour of the building was made. The home is decorated and furnished in a homely style, but the standard of the décor and furnishings varies. Feedback received on the environment was varied. The AQAA detailed that there is an ongoing maintenance and redecoration-taking place in the home. During the tour one broken chair was removed and where a plug was not in place in one of the sinks the Manager stated this would be addressed. Further feedback was received that plugs are not always in place for use. The Manager spoke of Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 18 work, which has been undertaken since the last Inspection with the renewal of some of the kitchen units, the dining room being redecorated and new carpet laid, two bedrooms re-carpeted and following feedback from the residents a wet room with a heated floor has been built. The Manager also stated he is still looking into the feasibility of fitting a passenger lift in the home subject to meeting all current requirements. There are eleven single bedrooms on all floors, one of which is below ten square metres; two have en-suite facilities and four double bedrooms of which one has en-suite facilities. One was being used as double bedroom at the time of the Inspection and the Manager stated these are only used as double bedrooms if this is with the agreement of both of the residents. Residents are able to control the temperature in their own bedrooms. All bedrooms have an emergency call bell system, which the AQAA detailed was updated in 2006. None of the residents spoken with had used this facility so could not confirm that staff responded promptly. A selection of bedrooms was viewed which had been personalised and reflected a range of individual styles and interests. There are adequate toilets and assisted bathing facilities in the home. Heating is provided by a central heating system with radiators guarded in the home. Records were viewed of the regular testing of the hot water in the home to ensure that the hot water outlets accessed by service users is maintained at close to the recommended safe temperature of 43° C. Where asked residents confirmed that there was adequate heating and access to hot water. There is a separate dining room and a large lounge on the ground floor. There are grab rails placed throughout the home in areas where residents may require some assistance with mobilisation. There is a stair-lift between the ground, and first floor within the home, however there is one step that must still be negotiated to access the opposite side of the building. Residents with bedrooms on the second floor will need to be able to independently mobilise to access these bedrooms via a steep staircase. CCTV cameras have been fitted at the home, which are restricted to the entrances of the home for security and will not impose on the privacy of the service users residing at the home. The AQAA detailed that there is a policy in place for preventing infection and managing infection control. The Manager stated that department of health guidance has been used to assess the homes current infection control management. The home was clean and free from offensive odours at the time of the Inspection. Five service users surveys stated the home was always fresh and clean and two usually. There is a paved area at the rear of the home Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 19 Recordings of the regular routine fire checks carried out in the home were viewed. Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A robust recruitment procedure needs to be in place to ensure residents are in safe hands at all times. Care workers are being provided with training to ensure they can meet the care needs of the residents. EVIDENCE: The AQAA details that it is planned that two members of care staff are deployed to work in the home during the day, one of whom is a senior care worker and that the Manager works in the home seven days a week. This level of staffing was in place at the time of the Inspection. At night the home deploys one ‘waking night’ member of care staff and there is someone on call at night if additional assistance is required. The night staffing provided should be kept under review to ensure that the care needs of the residents continue to be met. There are also ancillary staff that work in the home and to cover catering, and three times a week a domestic assistant works in the home with care workers covering the other days. During the Inspection the cook was not on duty and a further member of the care staff was on duty to cover the catering tasks. The staff rota was also viewed. This detailed when staff are due to work, but there is not a record of who has actually worked where there Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 21 have been changes made. This was discussed with the Manager who agreed to address this, so a Requirement has not been made on this occasion. Five of the service users surveys stated staff is always available when they needed them and two usually. One commented, ‘there is staff about at all times who will sit and talk to me.’ Relative’s stated that a number of staff on duty during their visits, who were available to talk to them, and that felt that their relative received the care and support that they needed. Senior care workers confirmed they have achieved the National Vocational Qualification (NVQ) Level 3 and the AQAA detailed that eight of the eleven care staff hole NVQ level 2 in care and a further care worker is currently working towards this qualification. The AQAA details that the recruitment process followed includes the completion of an application form, that the career history, identification, qualification and recruitment are checked, references and a Criminal Record Bureau (CRB)/ a Pova First checks are gained and a current photograph of the member of staff sought. The recruitment documentation was viewed for the two new members of care staff working in the home, who had been recruited since the last Inspection. A clear record of the recruitment checks undertaken and when should be in place to evidence the recruitment process. For one care worker the references were not in the home to view, but were supplied later during the Inspection, for the other two references were in place supplied by the applicant, but the authenticity had not been verified. This was discussed with the Manager and a further Requirement has been made this in relation to recruitment procedures. The three care workers surveys stated they had had checks carried out prior to working in the home. There is induction training, which the AQAA detailed meets the requirements of the General Skills for Care induction standards in place for the new staff to complete. The records for one new member of staff who had been recruited since the last Inspection had a record of this induction having been completed. For the other the induction had not commenced. The Manager stated this was due to language difficulties, but this member of staff had received the homes induction, had been supported by a senior care worker during this period and had attended external training. Two of the care workers surveys stated the induction covered everything they needed to know very well and one mostly. Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 22 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 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home benefits from a Manager who ensures an open, supportive, homely and caring environment, but the outcome of the quality assurance process needs to be published annually. All environmental risk assessments need to be recorded to evidence all checks in place to ensure a safe environment for staff and residents. EVIDENCE: The Registered Provider is also the Registered Manager for the home, has owned the home for seventeen years and has obtained his knowledge and skills in care through out this period of owning the home. Staff confirmed that he is supportive and approachable. The Manager has evidenced since the last Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 23 Inspection that he has completed the required elements of NVQ Level 4 in Care and the Registered Managers Award. The Manager stated he and a senior care worker are due to attend training on the mental capacity act. The AQAA details that there is annual development plan for quality assurance in the home and that further quality surveys have just been sent out. It was evidenced that feedback about the service provided has been sought from residents, and the Manager confirmed has been extended to include relatives/representatives and other professionals who attend the home, and that this will be collated following receipt of these and available to reference. Residents meetings are held and one resident commented on attending these meetings. A meeting was held on the day of the Inspection. The AQAA detailed that policies and procedures were in place and had been reviewed. Resident’s individual plans of care had been reviewed. Residents either maintain their own finances or relatives/representatives will handle their financial affairs. The Manager has confirmed that it would be ensured that receipts are kept of any purchases bought on a resident’s behalf to safeguard the residents and the staff. The AQAA details that staff are provided with supervision. The Manager has employed an external consultant to undertake this task and a sample of recording was viewed as part of the staff documentation sampled. Two care workers surveys stated they regularly met with their Manager and one never. This was passed to the Manager to ensure all staff is receiving the required supervision and who has subsequently confirmed this is in place. Training records were not collated but detailed on individual staff member documentation, so it was not possible to evidence that all staff completed the required training. But staff spoken with confirmed that they are kept up to date and the sample of staff documentation viewed, which included copies of training certificates for the two new staff and the three staff on duty during the Inspection evidenced staff had received training/updates in moving and handling, basic food hygiene, first aid, health and safety and infection control within the required timescales and provided by external agencies. All threecare workers surveys stated they had been given training relevant to their role, which helped them understand individual residents needs and kept them upto-date. The Manager and a senior care worker who takes the lead for health and safety stated they both attended a course on health and safety for managers and received further guidance in risk assessment. The AQAA detailed that the maintenance of equipment and services has been carried out. The electrical curcuit certificate was issued in June 2003. This was discussed with the Manager, who on checking the certificate was made aware this will need to be renewed this year and stated that this would be Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 24 addressed. The Manager has subsequently confirmed that a contractor has been booked to complete this. A fire risk assessment is in place for the home. The Manager stated a regular fire check is undertaken in the home but is not fully recorded. This was discussed with the Manager who stated he had received further guidance, which had made him aware of the need to complete and record these checks and stated this would be addressed. Fire doors have been fitted with selfclosing devices. The door into the lounge highlighted at the last Inspection has now also been fitted with a self-closing device. Staff spoken with and records evidenced that staff attended fire training provided by an external agency and there are also fire drills facilitated in the home. The last fire drill was undertaken in February 2008. The Manager stated that further training is due this year which new staff will be expected to attend. Records of environmental risk assessments of the resident’s bedrooms had been developed to include internal communal areas. The Manager stated that checks were also undertaken for the outside areas, but these checks were still not recorded and should be. The Manager stated all checks would now be recorded. Records of any incidents and accidents in the home were viewed. Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 25 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 26 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 13(4) Requirement That risk assessments are further developed to detail how any identified risks are to be managed to protect residents. This issue is outstanding since 30/05/07 2. OP29 19 (1) (b) That for all staff working in the home a thorough recruitment process is followed. That where required references have been verified prior to staff working in the home, to protect residents. 3. OP33 24 (1) (2) (3) The outcome of the quality assurance is made available to read to ensure residents and their representatives have enough information about the home. 31/07/08 30/05/08 Timescale for action 30/06/08 4. OP38 13 (4) (a) That a regular check of the fire 30/05/08 precautions is undertaken and recorded to protect residents and staff. Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Marine View Rest Home DS0000014214.V361063.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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