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Inspection on 22/12/06 for Marlborough Court Care Centre

Also see our care home review for Marlborough Court Care Centre for more information

This inspection was carried out on 22nd December 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Care staff members that were observed, appeared to be caring and professional in their manner with residents.

What has improved since the last inspection?

The Home has produced an up to date Statement of Purpose and Service User Guide, sent both documents to the CSCI and supplied each of the residents with a copy of the Service User Guide. Care plans and records seen were improved since the previous inspection and particularly so on the nursing unit.

What the care home could do better:

Requirements were made in respect of improving medication practice and to ensure that any service users with raised mattresses also have correspondingly raised bed rails. A requirement was made to ensure that no service users who have dementia are admitted to the nursing unit unless a variation has been sought from CSCI as this unit is only registered for conventional nursing care. As stated in the summary, clarification has been sought regarding a permanent registered manager for the home. In this respect a recommendation has been made that there should be a joint handover period between the acting manager and any permanent manager in order to ensure stability and consistency for both service users and staff members. A recommendation was made to emphasise the importance of regular supervision for staff members and that this should be a priority. Recommendations were also made in respect of meals that condiments should always be available on tables, attention paid to ensuring food trolleys are used properly to retain hot food, and service users are provided with appropriate assistance to eat when necessary.

CARE HOMES FOR OLDER PEOPLE Marlborough Court Care Centre 7 Copperfield Rd Thamesmead London SE28 8RB Lead Inspector Keith Izzard Key Unannounced Inspection 20th December 2006 09:30 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 Marlborough Court Care Centre DS0000006766.V313153.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. Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marlborough Court Care Centre Address 7 Copperfield Rd Thamesmead London SE28 8RB 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) 020 8310 8881 020 8310 7767 Ashbourne Limited and Exceler Health Care Services Leasing Limited *** Post Vacant *** Care Home 78 Category(ies) of Dementia (28), Old age, not falling within any registration, with number other category (50) of places Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 10 beds for general nursing care of people aged 50-59 years 11 beds for the general nursing care of people aged 60 years 29 beds for the residential care of old people Date of last inspection 8th June 2006 Brief Description of the Service: Marlborough Court Care Centre is a purpose built, three-storey home situated in North Thamesmead overlooking the River Thames. The home consists of 21 single bedrooms on the ground floor for people requiring conventional nursing care, 27 single bedrooms for older people with dementia on the first floor and 29 single bedrooms for older people requiring conventional personal residential care on the second floor. All of the rooms have en-suite facilities. Each unit has a separate dining room, two lounges, toilets and three bathrooms. A separate laundry, kitchen and staff changing facilities are provided on site. Outdoor areas include a garden, patio area and an aviary at the front of the property. Visitors can park in the private car park in front of the home. Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second unannounced inspection of this home in the current inspection year and took place on 20/12/06 by two Inspectors and lasted for 7.00 hours. The previous inspection took place on 08/06/06 and both reports should be read in conjunction as this report both updates and upgrades some of the outcomes for this inspection year, 01/04/06 – 31/03/07. The primary focus of the inspection was to check on compliance with the previous requirements made, and in particular to look at care plans. Two adult protection alerts were received since the previous inspection and dealt with via adult protection procedures. In one instance the allegation was substantiated, namely that staff had been at fault in not responding promptly to a service user requiring admission to hospital; and in the second instance an allegation of poor care / abuse made by London Ambulance staff was not substantiated, but provided evidence of poor care plans and recording on the nursing unit. Both this inspection and a joint investigation conducted by Commissioning unit staff has demonstrated that this area is now being addressed and there has been considerable improvement in the quality of care plans that were examined. The Inspectors interviewed a number of residents on each of the units, two relatives, several members of staff and a visiting District Nurse. All residents and relatives interviewed were happy with the level of service, as was the District Nurse. The home currently has an acting manager, appointed because of the suspension of the manager from duty pending the outcome of an investigation. Whilst the acting manager has done much to influence improved care planning and recording and also improving staff morale, a requirement has been made for the Registered Provider to confirm in writing the position regarding the permanent management of the home in view of the length of time that the home has been without a permanent Registered Manager. What the service does well: Care staff members that were observed, appeared to be caring and professional in their manner with residents. Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Requirements were made in respect of improving medication practice and to ensure that any service users with raised mattresses also have correspondingly raised bed rails. A requirement was made to ensure that no service users who have dementia are admitted to the nursing unit unless a variation has been sought from CSCI as this unit is only registered for conventional nursing care. As stated in the summary, clarification has been sought regarding a permanent registered manager for the home. In this respect a recommendation has been made that there should be a joint handover period between the acting manager and any permanent manager in order to ensure stability and consistency for both service users and staff members. A recommendation was made to emphasise the importance of regular supervision for staff members and that this should be a priority. Recommendations were also made in respect of meals that condiments should always be available on tables, attention paid to ensuring food trolleys are used properly to retain hot food, and service users are provided with appropriate assistance to eat when necessary. Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 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. Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 8 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 Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An updated Statement of Purpose and Service User Guide have been produced and copies of the Service user guide made available to all service users. EVIDENCE: Standard 1 This Standard was reassessed as requirements were made at the previous inspection to update both the Statement of Purpose and the Service User Guide and ensure that the latter was supplied to each service user. The Inspectors noted that on both the conventional residential and nursing care units this had been complied with. On the dementia care unit copies were retained on the individual care files for service users. Copies of both documents were clearly displayed in the entrance area to the home, in order that they should be readily available for reference by any visitors to the home; this is good practice and this Standard is now met. Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 10 Standards 2-5 These Standards were not assessed on this occasion as they were assessed and reported on at the previous inspection on 8th June 2006 and were found to have been met within the current inspection year: 01/04/06 - 31/03/07. Standard 6 was not assessed, on either occasion, as the Standard is not applicable to this home, as an Intermediate care service is not provided. Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7- 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans had shown improvement in overall quality and content, particularly on the nursing unit. The home is not registered to accommodate dementia care nursing service users and a variation in registration would be required to do so. Service users reported that they were treated with dignity and respect. EVIDENCE: Standard 7 This Standard was reassessed as a requirement was made at the previous inspection to improve care plans on the nursing unit; additionally, concerns had also been raised by two contracting local authorities following an investigation into an allegation of abuse toward a resident. See Standard 18. The outcome of this investigation was that the allegation was not substantiated; however, the inadequacy, of some care plans on the nursing Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 12 unit was established by two contracting officers from the London Boroughs of Bexley and Greenwich, in early November 2006. The Inspector was subsequently informed that improvements were underway following intervention by the acting manager of the home, who will also produce an action plan, to be submitted to the next Bexley Adult Protection strategy meeting in February 2007, confirming how improvements are being made. At this Inspection three care plans were viewed on each of the units. These included assessment of need, risk assessments and care plans to show how identified needs were to be met. The care plans on both the residential care and dementia care units were satisfactory. On the nursing unit one resident had a pressure sore and records on wound management were good and up to date. It was also evident from the records that the tissue viability nurse had assessed the resident. Since the last inspection management had implemented additional care recording for all residents. This included daily body mapping, weekly weight checks and weekly progress reports. Staff members were completing food and fluid charts for a high number of residents. Care plans seen were reviewed monthly. On the nursing unit a number of residents had bedrails fitted. Risk assessments were completed prior to fitting bedrails. However some of those seen on beds with pressure relief mattresses were not high enough to protect the resident. When using an additional mattress care must be taken to ensure additional height bedrails are used to ensure the safety of the resident. See Requirement 1 Standard 8 It was evident from records seen, by talking to staff and from a tour of the unit, that a number of residents were suffering from Dementia. The unit is not registered to provide dementia care; however some residents had been transferred from the dementia residential unit to the nursing unit. Staff members on the nursing unit had not received training on dementia care and were clearly finding it difficult to care for this category of resident. One resident was particularly difficult and had not had a psychiatric assessment. A visiting District Nurse on the residential units stated that he felt staff were competent and professional but felt that staff should receive training in wound care. See Requirement 2 & Recommendation 1 Standard 9 Medicine management was checked on the nursing and residential units. Both units had access to a policy and procedure in relation to medicine management and adequate storage areas for medicines. Staff had access to up to date information on medicines and had recently received training from Boots, the medicine supplier. Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 13 On the residential unit medicines were stored at the correct temperature. None of the residents on the unit managed their own medicines. Records were kept for receipt, administration and disposal of medicines. Staff should take care to sign the record of medicine for disposal and have this signed by the person removing the medicines. Administration records were well kept and records checked for two residents were found to be correct. When a resident refused medicines the GP was informed. In one cupboard there were two boxes of Paracetamol. The label had been removed from one box and there was no label on the second box. There was no record for receipt or administration of these medicines. On the nursing unit medicines were stored at the correct temperature. None of the residents on the unit managed their own medicines. Records were kept for receipt, administration and disposal of medicines. Staff should take care to sign the record of medicine for disposal and have this signed by the person removing the medicines. Medicine administration records were checked for three residents and a number of discrepancies were noted. Five of the medicines checked were inaccurate in relation to the amount received and administered. Two members of staff had not signed hand written entries made on administration, which must be done unless the entry is made by a GP. Staff had copies of two homely remedy lists agreed by the GP. Both lists included topical applications. Management must advise staff which list to follow. The medicines being used for homely remedies had been prescribed for a named resident. This practice is unacceptable and the provider must purchase homely remedies separately, even if the products are identical. Records were kept for administration of homely remedies. See Requirement 3 Standard 10 This Standard was met at the previous inspection and assessed again as met as all the service users and relatives interviewed were complimentary about staff members and the way they were treated by them. Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Whilst satisfactory, some recommendations were made to improve the quality of mealtimes. EVIDENCE: Standards 12-14 These Standards were not assessed on this occasion as they were assessed and reported on at the previous inspection on 8th June 2006 and were found to have been met, within the current inspection year: 01/04/06 - 31/03/07. Standard 15 As a requirement was made at the previous inspection to ensure that residents are given appropriate assistance at mealtimes this Standard was reassessed. Lunch was observed on the nursing unit. The nurse in charge served the meal. Tables were nicely laid up but did not have any condiments. Staff gave residents assistance sensitively where needed. Meals were covered when Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 15 taken to bedrooms; however staff left meals in rooms before they were ready to assist the resident. The meal should be left in the hot trolley until staff members are ready to help with feeding the resident. It was nice to see residents being offered a choice of meal at the table. A high number of residents needed help to have their meal. The domestic supervisor helped some residents to have their meal. Consideration should be given to how best to manage mealtimes and maybe have two sittings to ensure all residents get the time they need to have their meal. Recommendation 2 Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 16 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An updated Service User Guide was produced and a copy given to each service user thus facilitating awareness of the complaints procedure. Prompt action is taken to investigate adult protection concerns and appropriate measures adopted in accordance with local Adult Protection Procedures. EVIDENCE: Standard 16 At the previous inspection this Standard was almost met, and remains so, as it could only be partially reassessed on this occasion. However the home has now produced a Service User Guide that contains details of the complaints and a copy is readily available in the reception area of the home and individually provided to service users. An anonymous complaint by a member of staff was received by CSCI in November 2006 that was critical of the events surrounding the suspension of the manager of the home and other matters to do with staff morale. A transcript of the letter was provided for the regional manager who agreed to investigate the complaint. The regional manager subsequently confirmed that the complaint could not be substantiated and in any event the suspension of the manager was still subject to an ongoing investigation. Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 17 Two other complaints were made directly to CSCI just prior to the inspection taking place, as these were both to do with service users no longer placed at the home, these were not investigated or assessed at the inspection in view of the lack of time available. However, these matters will be investigated in a separate focussed inspection and any significant outcomes reported on within the next scheduled inspection of the home. Standard 18 Since the previous inspection in June 2006 there have been two adult protection alerts that have been investigated under local adult protection procedures. In the first instance, regrettably, home staff members had through a series of errors not called for an ambulance with sufficient urgency for a service user who had suffered a fall. The outcome of the investigation was that the allegation of delay was substantiated and a series of recommendations were made and subsequently implemented by the home in order to prevent any such incidents happening again. Two members of staff were subject to disciplinary proceedings and one subsequently resigned. All staff members have subsequently received specific training and clarification of emergency procedures and six recommendations arising from the investigation were implemented as confirmed in a letter from the Regional manager to the chairperson of the adult protection meetings. The second incident related to an instance of a complaint by the London Ambulance Service, in respect of the condition of a service user being taken to hospital from the home. The outcome of this was that the allegation was not substantiated and a separate concern that emerged, regarding the alleged conduct of the ambulance crew, is still subject to ongoing investigation. In respect of both these incidents the Inspector is satisfied that correct procedures in respect of adult protection were implemented and that the home both reported them as significant incidents under Regulation 37 and responded appropriately to the adult protection meetings. Recommendations that were made following the investigation have been implemented by the acting manager of the home, and in respect to the most recent incident will be confirmed in a report being provided by the acting manager for the next Bexley Adult Protection meeting in early February 2007. Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Attention is required to décor and some refurbishment in some shower areas and en suite areas in service users’ rooms and the bathroom on the residential care unit upgraded and put back in use. EVIDENCE: Standards 19 & 21 Some tiles were missing on the walls in the shower rooms, and in a number of shower rooms the pipe boxing under the washbasin also needed cleaning and repainting. In a number of the en-suite units seen the pipe boxing under the washbasins needed cleaning and repainting. The registered person must ensure all areas of the home are kept in a good state of repair. The unused bathroom on the residential care unit must be upgraded and put back into use. Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 19 The missing tiles in the shower room on the nursing unit must be replaced and the woodwork under the washbasin cleaned and repainted. An audit of the en-suite units must be undertaken and the woodwork under the washbasins cleaned and repainted where needed. See Requirement 4 Standards 20 & 22-25 These Standards were not assessed on this occasion as they were assessed and reported on at the previous inspection on 8th June 2006 and were found to have been met within the current inspection year: 01/04/06 - 31/03/07. Standard 26 The three units were generally clean and tidy. However, the lounge in the nursing unit had not been vacuumed prior to the residents sitting there in the morning. Residents who were interviewed on each of the three units were happy with their private space and the communal space provided. Marlborough Court Care Centre DS0000006766.V313153.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels were in accordance with the Staffing Notice Training levels were satisfactory. EVIDENCE: Standard 27 This Standard was reassessed, as it was not met at the previous inspection in respect of the nursing unit. The staffing level on all three units was assessed as satisfactory on this occasion. On the ground floor nursing unit there was one trained nurse and four care staff on duty. Discussions with staff and examination of duty rosters suggested that the home had been complying with the minimum staffing notice. Standards 28 & 29 These Standards were assessed as met at the previous inspection. Standard 30 A yearly planned training programme was provided and accessible to staff. The programme included routine training such as moving and handling, fire safety Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 21 and adult protection and other training such as infection-control, use of bedrails and managing challenging behaviour. A training programme had been provided for 2007 – 2008 and this included training on dementia care. Training records seen showed that a number of staff had received training during 2006 on topics such as medicine management, first aid, preparing care plans, nutrition and other training relevant to their roles. Staff seen said they received adequate training to enable them to fulfil their roles. A visiting District Nurse on the residential units commented that training should be provided for staff members in wound care as stated in Standard 8. See Recommendation 1 Marlborough Court Care Centre DS0000006766.V313153.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The acting manager has been successful in implementing improvements in care planning and recording; however, the appointment of a permanent Registered Manager must be addressed as a priority. Regular supervision for staff must now be implemented and sustained on a regular basis. EVIDENCE: Standard 31 The home now has an acting manager, following the suspension of the previous manager. At the previous inspection in June 2006 it had been anticipated that the then new manager would be applying to be come the Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 23 registered manager in the near future, subject to a satisfactory probationary period. This has now been delayed owing to ongoing suspension and the situation now requires some clarification from the Registered Provider as the home has been without a Registered Manager for a considerable period of time, having had four temporary managers following the departure of the previous registered Manager. The Inspectors noted the improvements in care plan documentation following the most recent adult protection concerns, implemented by the acting manager, and that staff members interviewed felt that she was approachable and had contributed to raising morale in the home following a very difficult period for staff members. Nevertheless, the ongoing management of the home must be addressed in order to provide stability and consistency for both service users and staff members. See Requirement 5 and Recommendation 3 Standard 33 This Standard was not assessed on this occasion as it was met at the previous inspection. Standard 34 This Standard was not assessed as it not a key Standard. Standard 36 This Standard was assessed, as concerns have emerged in recent months regarding the adequacy of supervision. Structured supervision plans were in place with dates set for individual supervision sessions to take place. The plan was to provide staff with supervision every two months. There was evidence seen on staff files to show that since June 2006 staff had received some formal supervision, and staff members spoken with indicated they had received some supervision but that this had not been on a regular basis. The acting manager acknowledged that changes had only just been implemented in this area. The Inspectors agreed that in view of evident shortfalls in response to recent adult protection issues reported on under Standard 18, it was necessary to make a recommendation that the scheduled programme of regular supervision is now implemented and sustained as a matter of priority. See Recommendation 4 Standard 37 Because of shortfalls in care planning and recording this Standard was assessed only as “almost met” at the previous inspection. Evidence was now available that this area had improved in response to concerns expressed by two local authority contracting unit investigations and related adult protection proceeding recommendations. Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 24 Standard 38 Accident records seen were well completed and a system was in place to monitor residents for 24 hours following an accident. The manager reviewed all accidents in the home and sent a quarterly report on accidents occurring in the home to head office. Marlborough Court Care Centre DS0000006766.V313153.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 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X X 1 3 3 Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 Requirement The Registered Person must ensure that bedrails fitted are of a suitable height to ensure the safety of the resident. Timescale for action 01/02/07 2. OP8 14 The Registered Person must ensure that prior to admission the home is suited to meeting the needs of the resident. Residents with dementia must not be admitted to the nursing unit unless an application to vary registration has been made to the Commission. The Registered Person must ensure the safe storage, administration and disposal of medicines and ensure: • Medicine records are kept so that an audit trail can be completed. Administration records must reflect when medicines from one months supply are bought forward to the next months record. DS0000006766.V313153.R01.S.doc 01/02/07 3. OP9 13 (2) 01/02/07 Marlborough Court Care Centre Version 5.2 Page 27 • • • • Two members of staff must sign hand written entries on medicine administration charts unless this is done by the GP. Staff must sign records of medicines sent for disposal. The home must have a current homely remedy list agreed with the GP and this must not include topical applications. Medicines prescribed for a named resident must not be used as homely remedies for other residents. If homely remedies are required then the provider must purchase these. 01/04/07 4. OP19 23 The Registered Person must ensure all areas of the home are kept in a good state of repair. The unused bathroom on the residential care unit must be upgraded and put back into use. The missing tiles in the shower room on the nursing unit must be replaced and the woodwork under the washbasin cleaned and repainted. An audit of the en-suite units must be undertaken and the woodwork under the washbasins cleaned and repainted where needed. 5 OP31 8 Clarification in writing to CSCI is required from the Registered Provider in respect of the ongoing lack of a Registered Manager and when this might be resolved. 01/03/07 Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP8 OP12 Good Practice Recommendations Training should be provided for staff members on the residential units in wound care. The Registered Person should ensure residents have access to condiments to compliment their meal, ensure meals are stored in the hot trolley until staff members are ready to assist with feeding and review mealtime management to ensure all residents get the assistance they need to have their meal. Whilst a requirement has been made to clarify the position regarding the appointment of a Registered Manager for the home, the Inspectors recommend that the acting manager should remain in place until such time as a progressive handover could be organised in order to maintain the overall progress that has been made, particularly in relation to care plans, and evident improved staff morale in recent months. The recent scheduling of supervision for staff members must be implemented and sustained on a regular basis as a matter of priority. 3 OP31 4 OP36 Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Marlborough Court Care Centre DS0000006766.V313153.R01.S.doc Version 5.2 Page 30 - 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. 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