Inspection on 25/10/05 for Mariners Folly

This inspection was carried out on 25th October 2005.

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 no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mariners Folly 03/07/07

Mariners Folly 29/12/06

Mariners Folly 15/06/06

Mariners Folly 18/05/05

Mariners Folly 12/10/04

Mariners Folly 14/04/04

Similar services:

Lyncol House

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Insight - Eastchurch

Southfields

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Seabourne House

33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 Mariners Folly 194 Parrock Street Gravesend Kent DA12 1EW Lead Inspector Eamonn Kelly Announced Inspection 25th October 2005 02:00 Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 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 Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 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 Adults 18-65. 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. Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Mariners Folly Address 194 Parrock Street Gravesend Kent DA12 1EW 01474 361935 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) Dharshivi Limited Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th May 2005. (An additional inspection visit was made on 22/09/05). Brief Description of the Service: The home provides care and accommodation for up to 13 people with learning disabilities. Service users have single bedrooms, on 3 floors (not served by a lift). Twenty-four hour care is provided (with an awake and an asleep member of staff on duty at night). The home is in the centre of town with good access to local amenities. There is a small patio area at the rear and a large car park. Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection [which took place over 3 days (25/26/27 October 2005)] consisted of meetings with the manager (Mrs E MacGinley), members of staff and service users. An inspection of the premises was made. Some completed CSCI “comment cards” (questionnaires) were received from service users and their relatives/supporters. A completed pre-inspection questionnaire was received from the home. What the service does well: What has improved since the last inspection? The premises have been rewired (with new external lighting added). Routine maintenance is under the direct control of the manager and the procedure has improved. Some new furniture and carpets have been purchased. Gates have been installed at the front and the security of the rear patio area has been improved. A new communal TV, fridge, freezer, two washing machines and a Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 6 tumble drier have been purchased. Electric hand driers are being introduced (in addition to other methods which will remain). The records of service user’s finances (ie. receipts/account balances) have been improved. The home has assisted service users to obtain additional welfare benefits to which they are entitled. Additional service user consultation has occurred (including via light-hearted questionnaires that also have a practical outcome). The longer-term routines of service users are being reviewed to enable required variations to be made (that suits their changing social care needs). Basic information packs have been introduced to supplement the detailed information contained in service user care plans. The service user’s guide has been updated. What they could do better: Serious defects in procedures for taking up CRB (criminal record bureau) checks were identified during the inspection. Staff concerns about a variety of issues were not receiving sufficient attention. These related to: • • • • • • The need for a cook (between 2.00-6.00 pm) to alleviate the pressures on staff and provide a consistent meal service for service users. Personal contracts for all members of staff (including the manager) that included all terms and conditions of employment. Transparency in the scales of pay for all members of staff. Access to adequate funding for service user’s meals and food. Staff meetings to be attended by the owner and manager to hear concerns expressed. Operational arrangements (eg. rota arrangements) to be under the control of the manager. Service user’s personal contracts needs to show clearly the items that are charged additionally to service users. The low numbers of staff on duty during morning periods, according to members of staff, do not adequately meet the needs of service users. Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 7 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. Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 6. Prospective service users have access to good information prior to admission and initial assessments of need are thorough. Service user’s personal contracts require revision to enable the rights and responsibilities of both parties to the agreement to be clarified. EVIDENCE: The written pre-admission information available to prospective service users and their supporters provides appropriate information about services and facilities. During the inspection visit, the service user’s guide was being updated primarily to reflect the turnover of staff during the last 6 months and progress with training provision. Where service users have been admitted over the past year, there was evidence that their care needs were closely assessed prior to admission. Their individual aspirations were identified and programmes of care agreed. The service user’s personal contract does not sufficiently identify the items that must be paid for by service users. [During the inspection, these items comprised a contribution to TV licences, hairdressing, private chiropody, dry cleaning, a nominal contribution to portable appliance testing (PAT) for items brought into the home at admission stage, and personal spending]. In addition it should show the fees payable, be signed by both parties, contain an outline of the policy relating to smoking and the keeping of pets and outline actual policies in all instances rather than refer to a policy document. Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 & 10. Service user care plans fully describe the changing needs of service users and appropriate information about agreed lifestyles and activities is included. EVIDENCE: Service user’s care plan records (held on computer and paper files) had a record of needs and disabilities and how these were addressed. The records closely reflected the disposition of service users met on this occasion and when compared to profiles during two previous inspection visits. The home is uniquely successful in providing opportunities for each service user to follow a set of tailored routines. This means that some service users attend day centres, others have a more independent lifestyle and some stay with care staff both within and outside the premises. They are supported in making decisions about aspects of their lives and are helped to live in as independent a life as possible with relevant risks identified, recorded and reviewed. Information is securely held: there is some risk posed from having confidential records taken off the premises when photocopying is needed. The home does not have a copier. Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 11 Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15 & 17. Service users have the benefit of being able to be part of the local community, with support to promote personal relationships and opportunities for personal development. There were concerns expressed that the post of chef/cook has been dropped and that there is inadequate funding for meals and food. EVIDENCE: Some service users have paid employment. Others attend college and have a range of activities within and outside the premises (both under supervision or unaccompanied). Service users and members of staff were preparing for an annual performance (to be staged in November) by service users at an external location. There is support and guidance by members of staff for service users to develop and maintain relationships. These relationships are monitored for the security and benefit of service users. There are always one or more members of staff on the premises to support service users with specific and agreed routines. Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 13 Service users outlined a number of their interests and ambitions. The home has a good track record in enabling them to achieve their personal aspirations. There were concerns amongst members of staff that there is inadequate funding for food (eg. approximately £1 per day per service user for food excluding expenditure on meat and bread). There was also concern expressed that the post of cook/chef has been discontinued and members of staff are now required to cook on a rota basis. Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 20 Good support is provided to service users for their physical and healthcare needs. EVIDENCE: Service users have good access to health services. Members of staff accompany service users on GP visits. Some service users have dentist visits to the home. The home currently has contact with an occupational therapist (for the purpose of assisting towards independent living). A speech therapist is currently assisting at the home. Members of staff monitor individual dietary requirements (this is an additional reason why members of staff have requested a return to having a chef/cook employed at the home). The CSCI pharmacy inspector previously indicated that the system of medication administration was sound. All members of staff who administer medication have received “accredited” medication training that includes a significant competency assessment element. Some service users keep their own medication: the manager was satisfied that appropriate recorded risk assessments were in place. Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The home has reasonable measures in place to protect service users. However, serious shortfalls in the procedures used in obtaining CRB (criminal record bureau) checks potentially placed service users at risk. EVIDENCE: Service users were aware of the inspection visit. They were confident in putting their views forward. There was evidence that the manager and members of staff obtained the views of service users in a variety of ways. There were examples where service users expressed concerns and these comments were taken into account by staff. The manager and members of staff are aware of Kent & Medway adult protection procedures. There were 3 significant shortfalls identified during the inspection visit in the procedures associated with CRB (criminal record bureau) checks. These had the potential to place service users at risk. The issues were brought to the attention of the manager. Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Bedroom and communal facilities are suitable for the needs of service users. EVIDENCE: Bedrooms (situated over 3 floors) and good communal facilities are suitable for service users and staff. There are good bathroom facilities and, at the time of the inspection visit, the premises were clean and well maintained. The rear patio area, whilst very small, is a useful facility for service users and staff. Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34 & 36 Service users (and members of staff) do not have the benefit of an effective staff team, good recruitment procedures and comprehensive staff supervision procedures. EVIDENCE: The home previously had the advantage of the services of a chef. Support workers carry out a range of care and support activities: they have stated that a chef is required particularly between 2.00-6.00 pm when service users are all present or are returning from several locations. There are also concerns that there are not enough support workers on duty in the morning (when service users are preparing for different activities, need for medication administration by 2 persons and the need for day care support for service users not attending day centres). The employment contracts of support workers and the manager were not sufficiently accurate as to include all relevant terms and conditions of employment. Rates of pay for different shifts (including night working) were not sufficiently transparent (concerns were expressed by staff in this regard). Members of staff stated that operational arrangements (eg staffing rotas) were not sufficiently under the control of the manager and difficulties/misunderstandings occurred as a result. Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 18 The significant shortfalls in CRB procedures have been referred to earlier in this report (please see Standard 23). Support workers receive formal recorded supervision during which their progress is discussed and, if necessary, plans agreed to address potential or actual problems and aspirations. There were no records available of such supervision relating to the manager/owner. Five members of staff are currently undertaking NVQ Level 2 in Care. One member of staff has completed this qualification. The following improvements in training available to staff were planned by the manager: • • First Aid (full certificate for some and “appointed first aid certificates” for all). Training in risk assessment, adult protection procedures, “challenging” behaviour, autistic spectrum disorders and epilepsy. The manager has made good progress in providing suitable training for members of staff. There has been a significant turnover of staff. A difficulty expressed by members of staff is that they must attend training sessions at external locations without pay and this causes hardship. The induction programme has a positive advantage in that new support workers must work under direct supervision: however, the process should be reviewed so that it complies with current TOPSS/Skills for Care procedures (including maintenance of recommended logbooks). Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Service users benefit from a well run home where the health and safety of service users is effectively promoted. However, there were a number of areas where the views of staff should be taken into account as a means of developing services. EVIDENCE: The manager has achieved the Registered Manager’s Award and also has an NVQ Level 3 in Care. From records (signing in book and staff rotas) seen at the home, the manager acts as a support worker for about 50 of their time. The staff rota provided with the completed pre-inspection questionnaire was not a representative sample. Because of the large size of the home and the need to maintain the current high level of service provision, a full time commitment by the manager is necessary (the manager agreed to discuss this with the owner). This report refers earlier to issues that are of concern to members of staff. The need for the manager and owner to make arrangements to enable staff to Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 20 make their views known about any issues that affect the health or welfare of service users. The completed pre-inspection questionnaire includes a declaration that all relevant safety certificates and associated records are in place and up-to-date. Those seen during the inspection were satisfactory. Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 4 x x 2 Standard No 22 23 Score 3 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 3 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score x x 1 1 x 1 CONDUCT AND MANAGEMENT OF THE HOME 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Mariners Folly Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 x 1 x x 3 x DS0000050495.V258538.R01.S.doc Version 5.0 Page 22 No Are there any outstanding requirements from the last inspection? 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 YA33YA33 Regulation 18 (1) (a) Requirement Timescale for action 15/01/06 2 YA36YA36 18 (2) “The registered person shall ensure that at all times suitably qualified, competent and experienced persons are working at the home..”. There is a need to return to the previous arrangement (when the home was purchased) to have a cook/chef at the home. In addition, there is a need for the manager to carefully assess the numbers of staff on duty at the home in the morning to meet the needs (including changing needs) of service users. “The registered person 15/01/06 shall ensure that persons working at the home are adequately supervised”. There should be arrangements in place for the owner and manager to address relevant issues through a formal recorded supervision Version 5.0 Page 23 Mariners Folly DS0000050495.V258538.R01.S.doc process. 3 YA39YA39 21 (1) & (2) “The registered person 15/01/06 shall make arrangements to enable staff to inform the registered person and Commission of their views..”. The quality assurance procedures at the home must, in addition to obtaining the views of service users and their supporters, also obtain and seek to act upon the views of members of staff. “The registered person 15/01/06 shall ensure that persons employed to work at the home receive suitable assistance, including time off, for the purposes of obtaining further qualifications appropriate to such work”. “The registered person shall not employ a person to work at the care home unless the person is fit to work..and has obtained ..the information and 01/12/05 documents..”. The home must obtain CRB checks for all members of staff and exercise proper care when CRB checks indicate that prospective employees have received police cautions or convictions. 4 YA34YA34 18 (1) (C) 5 YA34YA34YA23YA23 19 (1-7) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 24 No. 1 Refer to Standard YA10YA10 Good Practice Recommendations It is recommended that security and confidentiality relating to records be maintained by adopting appropriate means of copying documents and files (on rather than off the premises). It is recommended that the registered persons (owner and manager) assess the need (as expressed by members of staff) to provide additional and adequate funding for food and meals. It is recommended that improvements be made to recruitment and retention practices by providing accurate contracts of employment to support workers and manager and by transparency in current pay scales. Whilst the induction procedure offers the advantage of new members of staff working under the direct supervision of experienced support workers, the induction procedure itself should be reviewed to ensure that it complies fully with new TOPSS/Skills for Care recommendations. These recommendations are available from the SfC internet site. It is recommended that consideration be given to the need for a full-time manager at the home (this refers to the practice of deploying the manager as a support worker for up to 50 of working hours available). The service user personal contract should be improved so that it outlines the rights and responsibilities of both parties to the agreement (ie. the service user and the registered person). 2 YA17YA17 3 YA34YA34 4 YA36YA36 5 YA37YA37 6 YA5YA5 Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Mariners Folly DS0000050495.V258538.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!