Inspection on 01/07/08 for Marlborough House

This inspection was carried out on 1st July 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Marlborough House 04/07/07

Marlborough House 26/06/06

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Marlborough House 54 Kirkley Cliff Road Lowestoft Suffolk NR33 0DF Lead Inspector Julie Small Unannounced Inspection 1st July 2008 09:30 Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 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 House DS0000067388.V367505.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. Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marlborough House Address 54 Kirkley Cliff Road Lowestoft Suffolk NR33 0DF 01502 572586 01502 584841 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) Amber Care (East Anglia) Ltd John Reid Clarkson Romayne Coleman Care Home 12 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (4) of places Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Persons of either sex aged 18-65 years who require care by reason of learning disability (not to exceed 12 persons). Four persons whose names were made known to the Commission for Social Care Inspection in July 2004 aged 65 years and over, who require care by reason of learning disability. The total number of service users accommodated must not exceed 12 persons. 4th July 2007 3. Date of last inspection Brief Description of the Service: Marlborough House is a registered care home for twelve adults with learning disabilities with an age range from early twenties to over seventy years. It has recently changed ownership and is now owned by Amber Care (East Anglia) Ltd. A new manager has been appointed from within the existing staff team. Marlborough House is a large Victorian house situated on Kirkley Cliff in Lowestoft, opposite the Promenade Gardens and with views of the sea. There is access to the centre of Lowestoft with public transport. Accommodation is over three floors with a stair lift between the ground floor and first floor. Communal rooms are situated on the ground floor with two large airy lounges facing the front of the house, large and small dining rooms are located off the kitchen and there is access to a small garden area from the dining rooms. One double room is on the ground floor, which has en-suite facilities. Other rooms are on the first and second floor, some have en-suite facilities and two have small kitchenettes. Other bathrooms and toilets are available for residents whose rooms do not have en-suite facilities. During the inspection the manager advised that fees range from £355 to £656 per week depending on the funder and the level of care required by the individual. Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The unannounced inspection took place Tuesday 1st July 2008 from 9.30 to 16.00. The inspection was a key inspection which focused on the core standards relating to adults and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. Since the last inspection the manager had left the organisation and there was an acting manager in post. We had received an email advising us that the previous manager had resigned. However, we had not been informed of the dates that they had left and the current management arrangements in the home. Following the inspection we received written notification of the management arrangements and we forwarded this to our Regional Registration Team to make the appropriate changes to the home’s certificate. Prior to the inspection a relative of a person that lived at the home was spoken with by telephone. The acting manager was present during the inspection and provided the requested information promptly and in an open manner. During the inspection a tour of the building was undertaken, three staff members were spoken with and four people that lived at the home were spoken with. Records viewed included three care plans of people that lived at the home, fire safety records and staff recruitment records. Further records that were viewed are identified in the main body of this report. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) and surveys were sent to the agency. The AQAA and seven service user surveys, one relative survey and one staff survey were returned to us. What the service does well: The home was attractively decorated and furnished and people that lived at the home reported that they liked their home. Interaction between staff and people that lived at the home was observed to be friendly and professional. Staff were observed to ask and listen to people about what they chose to do. Care plans were detailed and identified the support that people required and preferred. Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 6 A relative survey received stated in the section of what the home does well ‘overall good but could do so much better if they were not all so overworked, they go out on outings…’ What has improved since the last inspection? What they could do better: The Statement of Purpose needed to be amended to reflect the changes in the management of the home, to ensure that people were aware of the staffing and management structure in the home. Clear guidelines as to when PRN (as required) medication should be administered, for example at what point of the person’s specific behaviours that warranted the administration of PRN medication should be in place to ensure that the medication is administered to people in a safe way. The clear methods of administration for prescribed medication such as maxijul super soluble powder should be recorded to ensure that people are safeguarded by the home’s medication procedures. It was noted that several notifiable incidents had occurred and they had not been reported to us. These included a person who had a bruised eye, an incident between people that lived at the home and the fact that the boiler had been condemned. We required the information to ensure that we are made aware of incidents that had occurred in the home and the actions that had been taken at the home to ensure that incidents were dealt with appropriately. We had been informed of two falls that a person had, one of which resulted in hospital treatment. Marlborough House DS0000067388.V367505.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. The summary of this inspection report can be made available in other formats on request. Marlborough House DS0000067388.V367505.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 Marlborough House DS0000067388.V367505.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): 1, 2, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect that they are provided with the information that they need to make an informed choice about where to live, that their individual needs and aspirations are assessed and that they are provided with an individual contract with the home. EVIDENCE: The Statement of Purpose was viewed and the acting manager stated that the document was in the process of being updated to reflect the current management arrangements in the home. The Statement of Purpose included details of the registered providers and the previous manager, staff and details about the services that people could expect from the home, including consultation, quality assurance, safeguarding, fire safety and privacy and dignity. The Service User’s Guide was viewed and was in both picture and text format which was accessible to the people that lived at the home. A copy of the document was displayed in the hallway near to the office which was accessible to people that lived at the home and visitors. The document included details about the home, rooms, visitors to the home, complaints, Customer First Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 10 (Social Care) and CSCI (Commission for Social Care Inspection) contact details, which provided people with contact details of other organisations that they could contact if they had concerns about the care that they were provided with. The records of three people that lived at the home were viewed and each included a signed contract and assessment of needs that had been completed prior to them moving into the home, which had been updated with changing needs and people’s preferences. There had been no people admitted to the home since the last inspection. The previous inspection report identified that the needs assessments met the required standards. The AQAA stated that they were hoping ‘to fill the vacant bed space with a person suitable for the client group’ and ‘all new service users would have a full assessment carried out to ensure we were able to meet their needs’. A relative survey stated that they and their relative were usually provided with enough information about the home to help them to make decisions. Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 11 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, 8, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect that their assessed and changing needs and personal goals are reflected in their care plan, that they are supported to make decisions about their lives and that they are supported to take risks as part of an independent lifestyle. EVIDENCE: The records of three people that lived in the home were viewed and each contained a detailed care plan that clearly explained the support that people required and preferred to meet their needs. The care plans were ‘person centred’ and included the wishes, future goals and likes and dislikes of each person. The care plans clearly detailed how people’s diverse needs were to be met, for example their cultural foods and what they did not eat due to their religion and their chosen religious worship, such as if they chose to worship in the community or not. Care plans detailed how people’s independence should be respected and areas of their care that they could manage themselves, such Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 12 as with personal hygiene. The records included risk assessments for areas of their lives and chosen activities, the risk assessments included details of the possible risks and methods of minimising the risks. Staff spoken with reported that the care plans detailed the information that they needed to meet people’s needs. They had a clear knowledge of people’s individual needs and the interaction between staff and people that lived at the home was observed to be friendly and professional. A staff survey stated that they were sometimes provided with up to date information about the people that lived at the home and commented ‘sometimes clients have appointments with professionals and the reports are not written up for staff to read’. A relative survey stated that they felt that their relative’s needs were usually met and that they felt that their relative was usually provided with the care and support that they expected and agreed. A relative was spoken with and reported that their relative’s needs were met in the home. The AQAA stated ‘individual care plans are in place for all service users. These will be reviewed again in 6 months, or at any time the service user’s needs change. These are also discussed at monthly meetings. We listen to service user’s choice, likes and dislikes and help them to follow them’. Daily records, which were shift reports, and the handover book were viewed and details of people’s wellbeing and actions during each day were recorded. The AQAA stated that they could do better by improving information on shift reports. Staff spoken with said that they were provided information about any issues that had arisen on the previous shift or with individual people when they came on shift. People were consulted with regarding the support and care that they were provided with, which ensured that their preferences and choices were included in their care plans. Each person was provided with a key worker who they regularly met with to discuss their wishes and their care plans were regularly updated to reflect their choices. There were minutes from review meetings and during the inspection one person told us that they were going to their review that day with a staff member and that a family member would also be at the review. They were observed preparing for the review with a staff member and on their return the staff member reported the outcomes of the review to the acting manager. The person confirmed that their views were listened to. The acting manager informed us that they had recently introduced house meetings, where people that lived at the home could discuss and were consulted with regarding issues in their home. The minutes of the meeting that was held 8th June 2008 were viewed and showed that nine people had attended the meeting and that they had discussed the new management structure of the home, the fact that the boiler was broken and was due to be Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 13 repaired as soon as possible, the Service User’s Guide and how they thought that it could be improved and activities that they wished to participate in. People that lived at the home who were spoken with reported that the staff listened to what they wanted and that they could choose what they wanted to do in their lives. Seven service user surveys stated that the staff always listened and acted on what they said. The service user survey asked if they made decisions about what they wanted to do each day, three answered always and three answered sometimes. One person’s records included a behaviour management plan, which identified the agreed methods of working with the person when they displayed aggressive behaviours. Incident reports were viewed and it was noted that there had been an incident between two people that had not been reported to us. The acting manager was spoken with regarding the incident and a notification was forwarded to us the day after the inspection. Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 14 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, 14, 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 can expect to be supported to take part in appropriate activities, be part of the local community, to be supported to maintain contacts, to have their rights respected and to be provided with a healthy diet. EVIDENCE: People were provided with the opportunity to participate in activities that were of interest to them both in the home and in the community. The records of people that lived in the home that were viewed identified if they attended work, college or a day centre and what activities they had participated in. The care plans identified what people enjoyed doing, if they chose to worship in a community setting and family contacts that they maintained. There was a notice board in the home that had photographs of people enjoying their chosen activities, such as parties, trips to the beach and boat trips. There Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 15 was a table football game, several board games, music centre, television, video player and a selection of video films that people could use if they wished to. The AQAA stated ‘we have been able to offer more activities by enabling service users to access them through a group called Optua. We now access Crown House when they have arranged evening events, discos, pantomimes and keep fit night’. The acting manager told us that a person had planned to go to a Kylie Minogue concert, which they were looking forward to. Seven service user surveys stated that they could do what they wanted to during the day, evening and weekend. A person spoken with said that they had recently completed a college course and that they were considering what they wished to do next. The person and the acting manager told us that a local charity shop had expressed an interest in employing the person on a voluntary basis, which the person said they were thinking about. The person said that they had plenty to do and enjoyed going out, they told us about a recent holiday that they had enjoyed. They said that they enjoyed cooking and often helped with cooking the meals in the home. They said that their family visited often and that the staff at the home helped them to telephone their family members. Another person that was spoken with told us about their holiday and the activities that they enjoyed, they said that they had a lot to do, could choose what they wanted to do and that staff supported them in their chosen activities. They said that they were going on a boat trip the day after the inspection. The person said that they had two friends that they visited and their friends also visited them at the home. A person that was spoken with was observed talking to a staff member about their favourite activity, which they did independently. The staff member showed an interest in what the person had to say. The person then told us about their activity, which they enjoyed and shared the information that they had gathered and the people that they were friends with in the community. They said that they also enjoyed going to the pub for a meal, which staff supported them to do. During the inspection people were observed to be supported by staff by going out to the local shops to buy items that they wanted. A relative survey stated that they were always kept informed of important information about their relative. A relative that was spoken with reported that they maintained regular contact with their relative. The AQAA stated ‘we welcome family and friends at any time. We encourage and support home visits’. Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 16 Two people spoken with during the inspection confirmed that they had a key to their bedroom and during a tour of the building it was noted that bedrooms were provided with a lockable set of drawers, which provided a safe place to keep their belongings in. During the inspection staff were observed to knock on bedroom doors before entering to ensure that people’s privacy was respected. A person that lived at the home showed us around the home with the acting manager and the acting manager was observed to ask the person not to enter other people’s bedrooms because it was their personal space. It was noted that people were supported to take responsibilities for ensuring that their own home was kept clean and tidy. People spoken with said that they helped to keep the home and their bedrooms clean and there was a rota in the kitchen that identified people’s daily jobs at meal times, such as laying the table and washing up. A person was observed telling staff that they needed to make their bed and tidy their room before they went out. The service user surveys included comments such as ‘I help clean the kitchen and set tables’, ‘I clean my bedroom’, ‘I help to keep my room tidy and help in the kitchen’ and ‘I help wash up and sweep the floors’. Interaction between staff and people that lived at the home was observed to be friendly, respectful and professional and staff included people in their discussions. People were introduced to us and they were provided with information about why we were in their home. People spoken with said that the staff were nice to them. Seven service user surveys stated that staff always treated them well. The menu was viewed and included two choices for each meal, one of which was a vegetarian option and two choices of desert. The menu was varied and nutritious. The acting manager said that the menu was provided on a four weekly ‘rolling’ basis and people had been consulted with regarding what they wanted on the menu. The evening meal for the day of the inspection was gammon, potato wedges, mushrooms and tomatoes or omelette and salad and desert was a choice of ice cream and jelly or yogurt. The acting manager said that they had recently purchased a slow cooker and a gammon joint was observed to be cooking during the inspection. The menu included details of the packed lunches that people had taken to their day services and the days packed lunch was ham and tomato sandwiches, crisps, cake and apple. The acting manager said that the staff worked with people in preparing their meals and that there was no cook at the home. People spoken with said that they were provided with enough food and that the food was good. People were observed to help themselves to drinks during the inspection and some people had a kettle to enable them to make themselves a drink when they chose to and small fridge in their room to keep their personal foods in. Risk assessments were present in their records which identified the risks and Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 17 methods of minimising the risks for the use of the equipment. The acting manager reported that a persons family regularly sent food to their relative and that they kept the food in their fridge to eat when they chose to, they said that staff supported them to ensure that the food did not go bad. A persons care plan that was viewed identified their specific cultural requirements regarding their food. Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 18 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, 21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to be provided with the personal support that they prefer and require, that their physical and emotional health needs are met and that their preferences are respected at the point of death. They cannot be assured that they will be fully safeguarded by the home’s medication practices. EVIDENCE: The care plans of three people that were viewed included details of the support that they needed and preferred with regards to their personal care. The care plans identified what areas of personal care that people could carry out independently. People spoken with confirmed that they chose their own clothing and appearance such as their hairstyles. During the inspection staff were observed to compliment people on their appearance, such as the clothing that they were wearing. The acting manager was observed in a discussion with a person regarding shaving and the person explained to us the methods that they preferred to shave, which they confirmed that they carried out independently. A staff member was observed to support a person in making a hair dressing appointment, which they had said that they wanted to do. It was Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 19 noted that all people that lived at the home that were met looked smart and clean. People’s records that were viewed included details of healthcare treatment that they received. Health care appointments included doctors, dentists and opticians. The AQAA stated ‘service user’s health is always monitored, reporting any changes on the documentation in place. We would also help service users to access the appropriate health professionals’. People’s care plans included their choices of what they wanted to happen in the event of their death, which included if they wanted a notice placed in the newspaper, if they preferred a burial or cremation and if any arrangements had been made. It was noted that one record stated that a person’s parents had requested that the issues of death not be discussed with the person and that the family should be contacted for guidance. The acting manager reported that they had respected their wishes and that they had considered the person’s understanding of the issues. The acting manager stated that they consulted with the people that lived at the home and their representatives in gaining the information to ensure that they did not cause distress. The home’s medication storage was viewed and medication was stored in a secure metal cabinet in the office and the controlled medication was stored inside the cabinet in a smaller secured metal cabinet, which was attached to the wall and provided adequate locking mechanisms. The home used MDS (monitored dosage system) blister packs. There were clear records of received and returned medication. The controlled medication book was viewed and clearly recorded all administered controlled medicines. The book included two staff signatures and a running total of the medication. The recorded total was checked with two of the stored controlled tablets and it was noted that the records correctly reflected the amounts of stored and administered tablets. People’s records that were viewed and identified the types of medication that was prescribed. It was noted that two people were prescribed PRN (as required) medication. Incident records and MAR (medication administration records) charts that were viewed showed when and why the medication was administered. However, there were no clear details of at what point of the people’s displayed behaviours that the PRN medication should be administered. The acting manager and a staff member was spoken with and reported that the staff had a clear understanding of when the medication should be administered but agreed that they would ensure that they would ensure that a PRN guidance would be included in people’s records to ensure that their individual needs were met and safeguarded. The MAR charts were viewed and it was noted that there no gaps and codes were used is people had refused their medication or were absent from the home, such as if they were on home leave. It was noted that a meal supplement called maxijul super soluble powder was prescribed for one person Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 20 to be administered once a day. The MAR charts had been signed for three and four times a day. A staff member was spoken with about this and they explained that the powder was split throughout the meals during each day as it was very thick. However, there was not record of the procedure or guidance from the GP. The acting manager and the staff member agreed that they would ensure that a guidance would be completed to ensure that the person received their prescribed medication safely. Certificates of staff training were viewed and staff had been provided with medication training. Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 21 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 good. This judgement has been made using available evidence including a visit to this service. People can expect that their views are listened to and acted upon and to be protected from abuse. EVIDENCE: A staff survey stated that they knew what to do if a person whished to make a complaint. A relative survey stated that they did not know how to make a complaint and that their complaints were usually responded to appropriately. A relative was spoken with and stated that when they had raised concerns they were always acted upon in a timely manner, however, they stated that there were times that they had wished to speak with the providers but had only managed to speak with the area manager. People spoken with stated that they knew what to do if they were not happy with something in the home, they said that they would speak to the staff and that they were always listened to. Seven service user surveys stated that they knew how to make a complaint and who to speak to if they were not happy. The Statement of Purpose and Service User’s Guide each contained a summary of the complaints procedure. The home’s complaints procedure clearly explained the procedures for making complaints and how they would be acted upon. The acting manager showed us a complaints procedure which they had recently completed. The document was accessible to people that lived in the home and was in picture and text format. The procedure was displayed on a Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 22 notice board in the home for people’s attention and the acting manager said that all people that lived at the home were provided with a copy. The AQAA stated ‘we listen to the views of service users. All service users have keyworkers who will help them access the correct help’. The AQAA stated that there had been two complaints made in the past twelve months which were resolved within twenty eight days. The complaints, concerns and compliments book was viewed and it was noted that compliments were recorded and concerns and complaints were recorded and dealt with in a timely manner. The records identified actions that were taken and that the people that had raised the concerns were advised of the actions taken and were satisfied with the outcomes. There were entries in the book from the acting manager and from the area manager, which showed that the records were regularly monitored. The records stated that the management had checked the entries and that the concerns had been acted upon appropriately. The safeguarding procedures clearly explained what staff should do if they had concerns about the safety of a person that lived at the home. Staff training certificates that were viewed showed that staff had been provided with safeguarding training and safeguarding was also included in the induction training when they started working at the home. Staff spoken with had a clear understanding of the procedures for reporting concerns. However, it was noted that there were issues that should have been reported to CSCI, such as an incident that had occurred between two people that lived at the home (a notification was sent to us the day after the inspection, which stated that one person’s behaviour was monitored by the home and social care through a behaviour management plan) and there was a person that had a bruised eye, the acting manager and the records viewed explained that they thought that the person had caused their own injury by accident. We were appropriately notified of incidents that had occurred in 2007. We had received a notification of an incident between two people, that a safeguarding referral had been made and we were made aware of the outcomes of the issues. The acting manager reported that they had reported the incidents to the area manager and they had discussed if incidents warranted a notification to be made to CSCI or for safeguarding alerts to be made to social care. The records and storage of people’s finances were viewed, it was noted that records identified a running total for each person’s money kept in the home and clear records for their transactions. The home had a clear procedure regarding the safeguarding of people’s finances and property. Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 23 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, 26, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to live in clean, comfortable and safe environment. EVIDENCE: The home was clean, well maintained and attractively furnished and decorated. There were no unpleasant odours in the home. People that were spoken with reported that they were happy with their home. Seven service user surveys stated that the home was always fresh and clean. There were communal areas that people could use, such as a large dining room, large lounge and another large lounge, which was being used as a games room. The rear and front gardens were attractive and the rear garden had seating to enable people to relax in the garden if they wished to. The maintenance report book was viewed, which showed where required repairs had been noted and they were ticked when they were completed. The last report was 22/06/08 regarding a broken drawer in a person’s bedroom. Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 24 During the inspection the repaired drawer was returned to the person, which showed that repairs were undertaken in a timely manner. The AQAA stated ‘regular checks are made around the home for maintenance needs, these are recorded and carried out when needed’. During a tour of the building it was noted that the dishwasher was out of order, the acting manager reported that they were going to purchase a new one and that washing up was undertaken by hand by the staff and the people that lived at the home until the dishwasher was replaced. The boiler had been condemned 4th June due to a flue failure. The acting manager reported that two quotes had been obtained and that they were due to receive the final quote the week of the inspection. They stated that the organisation was taking the matter seriously and that it would be repaired as soon as possible. The acting manager stated that hot water was obtained from the emersion heater and that people rotated the times of their bathing to ensure that there was sufficient hot water and that they could shower at any time. We had not received a notification of the incident. People’s bedrooms were viewed and it was noted that they were all clean and tidy and that their personal possessions and memorabilia reflected their individuality and interests. A person who showed us around the home confirmed that they had chosen the décor of their bedroom. However, it was noted that in two of the bedrooms there were laundry baskets that were full of dirty clothing. The acting manager said that people did their laundry on a weekly basis, that a relative had pointed this out and that they were looking at methods of ensuring that people’s uncovered dirty laundry was not left in their bedrooms for a week at a time. The AQAA stated ‘service users are able to choose what colours their bedrooms are decorated in. Service users are also involved in the choice of furniture, curtains and colours’. The laundry was viewed, which was located in a shed in the garden. The laundry area contained sufficient washing and drying machines and there was also space in the garden for drying laundry. The laundry was clean and tidy and there were hand washing facilities provided. It was noted that the laundry and communal toilets and bathrooms provided hand wash liquid and disposable paper towels to minimise cross infection. Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 25 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, 33, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be supported by a competent and trained staff team and that they are protected by the home’s recruitment procedures. EVIDENCE: People that lived at the home were safeguarded by the home’s recruitment procedures. The recruitment records of three staff members were viewed and they contained the required information such as satisfactory CRB (Criminal Records Bureau) checks, two written references and an application form. A staff survey stated that appropriate checks had been made prior to them working at the home. There were training certificates included in the staff records and training provided included a Skills for Care induction, safeguarding adults, challenging behaviour, medication, fire safety, food hygiene, manual handling and first aid. A staff survey stated that they had been provided training that was relevant to their role, helped them to understand and meet the needs of individual people and to keep them up to date with new ways of working, the survey stated that Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 26 their induction mostly covered what they needed to know when they started their job. Staff spoken with confirmed that they had been provided with the training that they required to help them to do their job and meet people’s needs. They had a good understanding of the responsibilities of their roles and the needs of the people that lived at the home. A relative survey stated that they felt that staff sometimes had the right experience and skills to meet the needs of their relative. The acting manager stated that there were fifteen people that worked at the home and six had achieved and a minimum NVQ (National Vocational Qualification) level 2 and one was working on their award. The home had almost met the target of 50 staff to have achieved a minimum of NVQ level 2 by 2005 that was identified in the National Minimum Standards relating to adults, which showed that the home were actively working toward ensuring that people’s needs were met by appropriately qualified staff. NVQ certificates were stored in the individual staff files. The AQAA stated that they planned to improve with the NVQ qualification of staff in the next twelve months. A relative survey and a relative that was spoken with stated that there were insufficient staff numbers that worked at the home. The acting manager reported that there had been five staff that had been recruited April 2008, two newly recruited staff were spoken with and stated that they had recently started working at the home as it had taken a long time for their CRB to be returned to them. Staff spoken with said that there were sufficient staff numbers working at the home and that they were not asked to work unreasonably long hours. The staff rota was viewed and the home was staffed twenty four hours a day, during the night there was a sleep in staff member and during the day there were between three and four care staff. During the inspection it was observed that there were three staff members and the acting manager working at the home. People spoken with said that they liked the staff and that they helped them with what they needed. The AQAA stated ‘we ensure we always have the correct amount of staff on shift’. Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 27 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. People can expect to be listened to regarding the service that is provided at the home. They cannot be assured that hazards are fully monitored. EVIDENCE: We were notified that the previous manager had handed in their notice, however we had not been notified of their leaving date and what the current management arrangements were. It was noted from the AQAA and during the inspection that an acting manager and deputy manager were undertaking managerial duties of the home, with the support of the area manager. We explained to the acting manager that we required notification of the management arrangements of the home to ensure that the correct information Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 28 was on the registration certificate. This information was forwarded to us the day after the inspection. The AQAA stated that the acting manager ‘had worked for Amber Care for three years so knows how the company likes to work’. The acting manager stated that they had achieved an NVQ level 3 in care and the foundation in care management qualification. The acting manager and deputy manager were spoken with and had a good understanding of their roles and responsibilities and the acting manager had made improvements in the record keeping in the home. However, it was noted during the inspection that there were several incidents which we had noted from the incident reports that should have been reported to us as laid down in Regulation 37. Incidents included an incident between two people that lived at the home, which was sent to us the day after the inspection and a person that had a bruised eye. We had received two notifications regarding a person falling and having hospital treatment and a further fall. The acting manager was spoken with regarding the types of incidents that should be reported to us and they stated that they discussed all incidents with the area manager to check if they needed to be reported or not. They reported that they would forward notifiable incidents in the future without delay. Records of monthly Regulation 26 reports were viewed, they included a visit to the home by the area manager where they spoke with staff and people that lived at the home and checked that the environment and records were being maintained appropriately. The acting manager had recently introduced resident meetings and the minutes for one was viewed. The minutes showed that people were consulted with regarding their home, such as if they could identify improvements they wanted in the Service User’s Guide. People’s records that were viewed included records of review meetings and key worker meetings where people had expressed their views about the service that they were provided with. Environmental risk assessments were viewed and they included the identified risks and methods of minimising the risks in areas such as using the slow cooker, washing line and the fire door. It was noted that there was no risk assessment for staff that were pregnant that could be at risk from aggressive behaviours of people. It was observed that there was a pregnant staff member working at the home. Fire safety records were viewed, which included a fire risk assessment and there were regular fire safety checks. Records of health and safety checks were viewed which included fridge and freezer temperature checks, food probe Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 29 checks, tests of electrical items, pest control monitoring and a food hygiene risk assessment. Health and safety related procedures were viewed and included a COSHH (control of substances hazardous to health) manual, emergency and crisis policy, first aid, health and safety, accidents and continence and waste management, which clearly explained methods of safeguarding people that lived at the home. The boiler had been condemned and the acting manager reported that the organisation had stated that it would be repaired as soon as possible, however, there was no completion date provided. We had not been notified of the details of the boiler being condemned. Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 2 3 3 X 4 X 5 3 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 3 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 3 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 2 X 3 X X 2 X Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 31 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 YA37 YA42 Regulation 37 Requirement Notifiable incidents must be reported to CSCI without delay, identifying how incidents had been dealt with in the home to ensure that people are appropriately safeguarded Clear guidance must be completed regarding PRN (as required) medication and food supplements to ensure that medication is administered to people in a safe way To ensure that there is adequate hot water and heating in the home to meet people’s needs, the boiler must be repaired. Timescale for action 30/07/08 2 YA20 13 30/07/08 3 YA42 37, 23 30/07/08 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 Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Marlborough House DS0000067388.V367505.R01.S.doc Version 5.2 Page 33 - 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!