CARE HOME ADULTS 18-65
Marion House 40 The Avenue Moordown Bournemouth Dorset BH9 2UW Lead Inspector
Tracey Cockburn Key Unannounced Inspection 26th July 2007 10:30 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 Marion House DS0000003961.V344286.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 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. Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Marion House Address 40 The Avenue Moordown Bournemouth Dorset BH9 2UW 01202 521985 01202 519002 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) Prospects for People with Learning Disabilities Vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th June 2006 Brief Description of the Service: Marion House is a large detached house in a quiet residential district of Bournemouth known as Moordown. The local area includes a wide range of shops, churches and community services, and is served by local bus services. The home accommodates up to eight adults of both sexes who have learning disabilities and some additional disabilities such as visual impairment. Each resident has their own bedroom; seven are on the first floor and the eighth on the ground floor. A Day Opportunities service is attached to the property but is separated from the care home by a locked door and has its own entrance at the rear of the property. The home comprises of a lounge, a dining room, a quiet room, a laundry and a kitchen. There are three bathrooms with toilets, three shower rooms with toilets, and two other separate toilets. Outside there are attractive grounds that include a fountain, sensory garden and pergola. The home is staffed 24 hours a day and there is a designated key worker and support key worker for each service user. PROSPECTS has been involved in the support of people with learning disabilities since 1975 and operates various services across the U.K. It is an organisation rooted in Christian principles and the ethos of the home reflects this. There is however no requirement for anyone to engage in religious activity whilst they are supported by PROSPECTS. The weekly fees are £600.00. For further information on fees and contracts the office of fair trading website is helpful: www.oft.gov.uk Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place without warning in the morning and was completed in the afternoon. This was a key inspection which means that 22 standards which the commission regards as important were looked at. The requirements and recommendations from the previous key and random inspections were also reviewed to monitor progress. A total of 5 hours were spent in the home. An additional visit was done to look at staff records, which were in a locked cupboard, and the key could not be found on the day of the inspection. At the time of the site visit there were 3 people who live in the home present. 3 staff were on duty. 1 was an agency worker providing 1:1 support for a resident. As part of the planning process, the Annual Quality Assurance Assessment was sent to the service. This has not been returned. During the site visit a tour of the home took place, people who live in the service were observed, 1 resident was spoken to about their experience of living in the home. Discussion with staff took place and a variety of files were examined these included, staff meeting records, staff files and the care files of individual people who live in the service. 8 survey forms were left for people who live in the service. Care professionals were contacted. 6 survey forms were returned. There has been no manager for the service since January 2007. Prospects has arranged senior management cover in the absence of the acting manager. 2 senior care staff have also been taking on management tasks to support the acting manager who is also responsible for 2 other services. What the service does well:
People who are considering moving into the service have their needs fully assessed before making any decisions. This means both the home and the individual know whether or not the service can meet their needs and aspirations. People who live in the service are aware of their changing needs and goals because they are talked about at monthly meetings with their key worker. Their care plans are changed to reflect any changes in their needs. People who live in the service tell us that they are able to make decisions about their lives. People who live in the service tell us that they are able to participate in community activities, which interest them. They also tell us that they are able to have relationships with the people they want to. People also tell us they have their rights respects in their daily lives. This means they are supported to
Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 6 make decisions about issues which are important to them, such as where they go on holiday or who they have a relationship with. The ‘All about me’ records and essential lifestyle plans demonstrate that the service is providing care and support to meet the physical and emotional needs of the people in the service, in the way they want and prefer. The home they live in is very homely and comfortable and clean, which they take pride in. People who live in the service are supported by an effective staff team, who communicate well. People who work in the home maintain the health, safety and welfare of the people living in the service. They have done this by working together to achieve a shared goal by putting the people who live in the service first. What has improved since the last inspection? What they could do better:
At the end of this inspection there are 4 requirements. The home operates a policy of no physical restraint. However to ensure that individual members of staff know what to do if a situation occurs when physical intervention is a possible solution there needs to be training for staff. This will ensure that both residents and staff are protected from abuse.
Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 7 Staff must be working towards appropriate qualifications. There must be a fulltime manager in post ensure the home is well run. The home should make the annual development plan available for everyone. 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. Marion House DS0000003961.V344286.R01.S.doc Version 5.2 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 Marion House DS0000003961.V344286.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who are considering this service would have their needs assessed before any decision was made about moving into the service. This means that they would know if the home could meet their needs or not. EVIDENCE: There have been no knew admissions to the home since the last inspection. At the previous inspection in June 2006 the report stated: “There is a policy and procedure in place that clearly sets out the homes admission procedure. Local authorities fund all service users living in the home and case tracking showed assessments were provided prior to their admission to ensure their needs could be met.” There has been no change. Marion House DS0000003961.V344286.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live in the service have individual plans of their care needs. This means that everyone has a clear understanding of how each individual likes and needs to be supported. People who live in the service are supported to make decisions about their daily lives and risk assessments support the lifestyle they want. EVIDENCE: Each service user has a care file named “All About Me” which they keep in their rooms. A sample of two residents’ files was examined as part of the inspection. These files contain information about the service user’s likes, dislikes, goals, daily routines, personal and health care needs. For example “I clean my room and do not need to be reminded or like to be reminded” and “I like to choose whether to have breakfast or get dressed first”. Each service
Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 11 user also has a detailed Essential Life Plan which is more descriptive and details the service user’s needs and how staff can best meet these. Essential lifestyle plans also contain information on who contributed to it such as family, friends, and boyfriend. The plans also contain information on what people ‘must have’ and ‘what you need to know to support me successfully’. Some people have chosen to have their ‘all about me ‘ files stored securely in the office rather than in their bedrooms. Each file where this has happened contains a signed declaration to that effect. Another ‘all about me’ file contained information ‘things that are important to me’. Each file also contains a Quality of life monitoring form which details important things, which have happened each month such as visits from a healthcare professional or visit from family or trip out. It also contains information on what the person would like to do in the coming month. 1 person wanted to go on a picnic to the new forest. Service users have regular monthly key worker meetings that are recorded when they are consulted about their plan so any necessary changes can be made. Regular residents meetings are held where service users have the opportunities to discuss activities, food, decoration/furnishings and holidays. Risk assessments are now held in each person’s individual file. Marion House DS0000003961.V344286.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live in the service are able to participate in activities, which interest them in the local community. They have relationships with the people they want to and their rights are respected. People who live in this service are offered a healthy diet. EVIDENCE: A variety of activities take place, residents attend day activities run by prospects, and they also participate in work experience. Residents go out and participate in a variety of leisure activities such as swimming, gardening, going on outings. Residents meetings are held monthly and the minutes of these meetings demonstrate that people are talking about holidays, changes in key worker, staying up late and they are discussing any changes that the home have made
Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 13 to staff rotas. At one meeting on 17/07/07 they discussed the changes and that they were not happy that staff start the shift at the weekend at 8am. Resident’s ‘all about me’ files demonstrate their individual daily routines and preferences such as when they get up and what they like to do, whether they bath before or after breakfast or the different routine they have at the weekend when they have no work experience of day centre activity. One person said in the survey form that they could not do what they wanted during the day. Most people who responded to the survey forms said they were about to make decision al the time about what to do each day one person said they could only make decisions sometimes. People who live in the home are responsible for daily chores. One person enjoys helping in the kitchen. At the last inspection a recommendation was made that residents are more involved in the preparation of food. There is evidence in the monthly meetings that they have been involved in deciding what food they would like on the menu. At the meeting on 28/03/07 each resident was asked for menu suggestions. They came up with a variety of different food such as; lasagne, roast pork, chicken curry, jacket potato, sweet and sour pork with noodles. The new menu incorporates the entire menu suggestions made by residents. Marion House DS0000003961.V344286.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live in this service receive support in the way they prefer and have their physical and emotional needs addressed. The home has a policy and procedure for the safe handling of medication, which ensures that the people who live in the service are protected. EVIDENCE: At each person’s monthly key worker meeting a record is maintained of any visits undertaken to the dentist, doctor, optician or other healthcare professional. Information is also recorded on their weight. Each person’s ‘all about me’ file contains detailed information on how they like and need to be supported. The file also contains information on their personal preferences for getting up and going to bed. People living in the service said they are able to make choices about what they wear and this is recorded in their individual files.
Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 15 The home has a policy and procedure concerning the administration of medication. The Boots monitored dosage system was introduced at the beginning of July. All staff received Boots medication training on 18/06/07. One member of staff said it was too early to tell but so far the new system was working well. Each person who lives in the service has a medication cabinet in their bedroom. Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Improvements to the complaints system and financial transactions means that people who live in the service can be confident that their views are acted upon appropriately and they are protected from abuse. EVIDENCE: The home has a complaints procedure. It is in a user friendly format for residents and in the surveys returned all 6 said that they knew how to complain and who to speak to. In speaking with staff they knew what to do if a resident complained to them and they said they would take it seriously. One member of staff explained the changes they had made since the last inspection in the recording of concerns. The home has a policy on adult protection. Staff have received training and this information is in their records. There have been no adult protection referrals since the last inspection. All information on resident’s personal banking is kept in 1 large file, which is not confidential. If a resident asked to see their bank details they could see the personal information of other residents. Each person has a ‘my money and my agreement’ document which clearly states their income each week. This document is in an easy read format and signed by the individual and a member of staff. Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People live in a homely and comfortable environment, which they see as home and take pride in. the home is clean. EVIDENCE: People who live in the service said they were very happy with their bedrooms and liked their living environment. Observation during the inspection also determined that service users had unrestricted access to all communal areas of the home. Of the 6 survey forms returned by residents there were 4 that said the home is always fresh and clean. One survey form responded ‘sometimes’ to the same question. Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 18 The premises were observed to be clean and hygienic with good procedures in place to prevent the spread of infection, e.g. separate hand washing areas and clear guidance in the preparation and storage of foods. There is a separate laundry room with impermeable walls and flooring. Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. A dedicated staff team supports people who live in the service. The recruitment process has improved and people who live in the service are protected by the practice in place. Training has to be linked to the needs of the people in the service to ensure their needs are fully met. EVIDENCE: In the survey forms returned most of the forms said that staff are friendly and supportive. One form said that staff were only sometimes supportive. During the site visit one person said that staff were very good, they listened and were helpful. Staff were observed being supportive and kind. They were respectful when speaking with residents. Staff spoken to demonstrated an understanding of the needs and disabilities of the people they were supporting. One member of staff felt it would be useful to attend a training course on understanding challenging behaviour. A number of care staff are working towards National Vocational Qualifications. The staff team have been left with a huge responsibility in the absence of a registered manager. There has been a higher rate of staff leaving. 1 member
Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 20 of staff said that after the team meeting in April when issues about staff behaviour and concerns that they were not working as a team were raised, there was a marked improvement. The rota was changed to make everyone equal. Some staff left and the staff remaining said that they communicate well together and they are happier. During the inspection staff were observed talking about activities they were doing, checking out what work had not been done and working on paperwork in the staff office. One staff file was checked this contained the correct information such as 2 written references, confirmation in post on completion of satisfactory checks. There was no evidence that people who live in the service are involved in the process. There was a copy of the member of staff’s terms and conditions. The appropriate police checks had been completed. The training needs of the staff have been identified and individual staff members have a record on their file of the training courses they have attended. Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Senior care staff with the support of an acting manager have run the home. This has put immense pressure on staff. They have worked hard to maintain the health, safety and welfare of the people living in the service. EVIDENCE: The home is currently without a registered manager. There has been no one in post since January 2007. At the time of the inspection a new manager had just been recruited and will be starting in late September 2007. It is all credit to the staff team that over the past 7 months they have worked together to ensure that the care of the people living in the service has not been compromised. However this has put considerable strain on individual members Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 22 of staff. There have been a number of staff leave the service. One person cited “lack of manager “ as an area that needed to improve. One member of staff gave examples of when they have had to make decisions, in particular situations without any management support. This member of staff said that these situations made all staff feel very vulnerable. One member of staff also said that they have all pulled together for the sake of the residents. The member of staff also said they have worked longer hours than they are contracted to do. One member of staff said that they did not feel supported by senior managers in the organisation. Two senior members of staff have taken on management tasks and have done this extremely well in that some of the outstanding requirements have been addressed by them. There is also evidence that they have tackled some difficult issues relating to staff behaviour in a direct manner in staff team meetings. The minutes reflect the issues and the action taken by the staff acting up. There was no evidence of an annual development plan. However the home has a system in place for monitoring quality in the home. Certificates were in place demonstrating that the equipment and facilities are regularly serviced and maintained. The staff have attended training courses on safe working practices. There is now a chart of staff fire training which was recommended at the last inspection. Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 3 X Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 24 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 YA23 Regulation 13(7) Requirement The registered provider must consider how it will secure the welfare of all residents in the home. If there are incidents of challenging behaviour where the only practicable means of securing the welfare of a resident is through physical restraint and the home has a policy of no physical restraint then staff need to know what they should do to protect residents and themselves. The registered person must achieve the target of at least 50 of care staff achieving a NVQ 2 qualification in care. (This requirement was made at the previous inspection with an original timescale of 31/10/06). The registered provider must appoint someone to manage the home The registered person must make an annual development plan available to CSCI with evidence that feedback has been obtained from service users and this has been incorporated into
DS0000003961.V344286.R01.S.doc Timescale for action 31/12/07 2. YA32 18 31/12/07 3. 4. YA37 YA39 8 24 30/09/07 30/11/07 Marion House Version 5.2 Page 25 the plan. This would provide action points/targets to further improve the quality of service in the home. (This requirement was made at the previous inspection with an original timescale of 30/09/06). 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 Marion House DS0000003961.V344286.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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
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