Inspection on 04/07/07 for Marlborough House

This inspection was carried out on 4th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Marlborough House 01/07/08

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 09/07/2008.

CARE HOME ADULTS 18-65 Marlborough House 54 Kirkley Cliff Road Lowestoft Suffolk NR33 0DF Lead Inspector Deborah Kerr Key Unannounced Inspection 4th July 2007 10:00 Marlborough House DS0000067388.V345477.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.V345477.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.V345477.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.V345477.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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. 26th June 2006 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. The home has a detailed statement of purpose and a booklet called ‘Your guide to living a good life at Marlborough House’. The booklet provides clear and easy to read information, informing prospective users of the service about the facilities and services available. Contracts outline the terms and conditions of residence and specify the method of payment, but do not reflect the fee between the home and the individual. Fees range from £331 to £618 per week depending on the funder and the level of care required by the individual. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on a weekday lasting eight hours. This was a key inspection, which focused on the core standards relating to adults, aged 18-65. The report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from the Annual Quality Assurance Assessment (AQAA), issued by the Commission for Social Care Inspection (CSCI). The home’s Statement of Purpose and Service Users Guide were reviewed and a number of records including those relating to people living in the home, staff, training and health and safety records. Time was spent with three people living in the home, the manager and two staff. ‘Experts by Experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ is used to describe people whose knowledge about social care services comes directly from using them. Patrick McDonagh, Expert by Experience joined the inspector on this site visit. Patrick’s comments and observations are added to this report and can be identified in bold text. What the service does well: People using this service continue to be supported to achieve a lifestyle that is appropriate to their needs and take part in fulfilling activities. The care plans provide detailed information about the individual’s capabilities and the actions staff need to take to ensure that all aspects of the person’s health, personal and social care needs are met. A booklet called ‘Your guide to living a good life at Marlborough House’ is excellent. The format is designed using simple clear language and photographs providing detailed information about the service. The living environment is appropriate for the needs of the people using the service, rooms are homely, clean and comfortable and people’s individual rooms seen are nicely personalised with their own possessions, which reflect their individual characters. The expert by experience found the home to be clean and the staff were helpful and friendly and the people living in the home had a good quality of life. Residents felt they could talk to the staff and were able to talk about issues that concern them at meetings. People are able to go to the shops on their own or accompanied by a member of staff. They are able to choose how they spend their money Residents are able to choose their own clothes. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Contracts must be updated to reflect the individual’s current fees. Where the individuals lack the capacity to agree and sign the terms and conditions between themselves and the home, support from family or an independent advocate must be obtained to act in their best interests. To ensure each person living in the home is consulted and has a say in their care, their care plans should be made available to them in a format that the individual can understand, where applicable using easy to read writing and visual images, similar to the ‘guide to living a good life at Marlborough House’. To protect the health, welfare and safety of people using the service the procedure for managing controlled medications must be improved. Arrangements for death, dying and terminal illness, have not been addressed and need to be ascertained, agreed and recorded in each persons care plan to ensure that at such time, the individual is supported to manage degenerative Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 7 and terminal illness, through an established plan, which constantly monitors pain, distress and other symptoms and in accordance with their wishes, spiritual and cultural beliefs. To ensure people living in the home are safeguarded and protected from financial or other forms of abuse, information relating to staff recruitment and people’s individual financial records must be available for inspection at the home. Additionally, there must be robust recruitment policies and practice to obtain all of the appropriate checks prior to employing a person in the home. 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.V345477.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.V345477.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, 3, 5, People who use the service experience good quality outcomes in this area. Marlborough House provides detailed easy to read information so that people are able to make an informed choice before moving into the home, however contracts need to be updated to reflect the individual’s current fees. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has produced a detailed statement of purpose and a booklet called ‘Your guide to living a good life at Marlborough House’. The format is designed using simple clear language and photographs of staff, other people living in the home and informs the individual about the facilities and services available. The care plans of three people were tracked during the inspection. Each person has a detailed care plan, which sets out how the home intends to meet the individuals current and changing needs, aspirations and the support they need to achieve their personal goals. There has only been one new person to move into the home for some time. Their file contained a detailed report from Social Services Adult Review Team for Learning Disabilities, detailing the reason for the admission to the home. An Occupational Therapist report provided information about their assessed daily living skills, which identified what the individual, could do for themself and where they needed support. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 10 Information in care plans confirmed that people have access to specialist services to support their mental health needs and specific conditions related to their learning disabilities. These included visits to a consultant psychiatrist, the community nurse and ongoing support from the Suffolk Mental Health Partnership (SMHP). Staff individually and collectively have the skills and experience to meet the needs of people living in the home. Recent training has included challenging behaviour, non-violent crisis intervention, understanding and supporting people with autism, fragile X syndrome and autistic spectrum disorder. Two of the three people using the service being tracked had been issued with a contract outlining the terms and conditions of residence. These specify the method of payment, but do not reflect the amount that is charged by the home to the individual. Where the individuals lack the capacity to agree and sign the terms and conditions between themselves and the home, support from family or an independent advocate must be obtained to act in their best interests. Marlborough House DS0000067388.V345477.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, 10, People who use the service experience good quality outcomes in this area. People using the service are supported to take risks, and make their own decisions, which enables them to lead positive and fulfilling lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans contained detailed information covering all aspects of the individuals personal, health and social care needs. Care plans should be made available in a format that each person can understand, using easy to read writing and visual images, similar to the ‘guide to living a good life at Marlborough House’, this will ensure that the individual knows and agrees to the content of the care plan. Care plans contained established procedures for people likely to be aggressive or display behaviours that can be challenging to others. These plans had been discussed and agreed with the individual, their family, the social worker and staff to ensure that all people followed the agreed procedure for the protection of the individual and other people living in the home. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 12 The procedures focus on the individual’s positive behaviour and identified likely triggers to inappropriate behaviour and states the techniques for staff to use to diffuse the situation. These assessments are being reviewed and updated as and when required. Minutes of the recent monthly care team meeting, confirmed people using the service and staff are consulted on the day-to-day running of the home. Issues discussed, included changes to the menu and people’s preferences of meals and social activities. More formal information was discussed to ensure all people were aware of how to make a complaint and the procedures to follow in the event of a fire. People’s rooms are reflective of their individual tastes and personalities, discussion with the manager and staff confirmed that each individual is fully involved in choosing the décor. The Annual Quality Assurance Assessment (AQAA) identified that the home have changed the way staff work from ‘task based’ to creating an ‘individualised service’. People living in the home are being encouraged to be more independent and less reliant on staff for their needs and personal development, for example where able people are being encouraged to do their own washing and ironing, clean and tidy their own rooms and prepare simple meals. Care plans contain detailed risk assessments, which encourage people to take responsible risks as part of their day-to-day lives. These covered using domestic appliances, preparing food, road safety and recognising the value of money. For one individual the strategies recorded in the risk assessment were being supported by objectives for learning and development whilst at their day care placement. Residents are invited to meetings every month, one of the residents told the expert by experience that they are able to talk about their problems. Resident’s are encouraged to take part in cleaning and washing is on a rota basis, but generally staff undertake the cleaning in the house. Residents said that they have certain times to do their washing and ironing. Residents are able to make phone calls. Information taken form the AQAA identifies confidentiality issues are seen as an important aspect of staff’s work and that this is discussed as a regular issue at team meetings to ensure that information about people living in the home is handled appropriately. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 13 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): 11, 12, 13, 14, 15, 16, 17, People who use the service experience excellent quality outcomes in this area. People using this service can expect that they will be supported to take part in appropriate leisure and work related activities within the local community and have the opportunity to mix with other adults. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information taken from the AQAA identifies people are being encouraged to develop their skills, via college, work experience and day centres. People spoken with and information recorded in their personal profile and daily activity sheet’s confirmed this. The AQAA also confirms that all the people living in the home are given the opportunity to vote, but only two people choose to exercise their right to do so. People are supported to attend work placements such as ‘Step Forward Industries’ and a local charity shop. Additionally people attend various day care facilities, which provide educational and leisure activities, including woodwork, basic literacy and numerical skills. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 14 The AQAA identifies that the home have investigated different outlets for social development. They have accessed learning through leisure information and contacted a local bus company tour operator. Photographs seen on notice boards around the home showed people enjoying a Mystery Tour trip, which included a pub carvery lunch and a boat trip. The staff and people living in the home spoke of the benefits of being part of the Amber Care Group. This has increased social contact for the people using the service. They now have wider contact with people from their peer group within the community and take part in joint activities, such as Bingo. This is a monthly event involving refreshments. They also attend Pool evenings or just visit for a coffee and a chat. The minutes of the care team meetings confirm that people have been consulted about the activities they wish to take part in. Requests were made for more visits to cinema and a beetle drive. They also want to have a karaoke evening combined with a BBQ and wish to invite people from the neighbouring Amber Care Homes. The manager confirmed arrangements are being made to hold this event. Other leisure activities that people have taken part in include a visit to pets corner, a car boot sale, visits to the local pub and near by coastal resorts of Beccles and Cromer. Although, none of the people living in the home have their own pet, people spoke of their enjoyment of going out for walks with a member of staff and their dog in the evenings. People are supported to integrate in community life, they are free to come and go as please. Some of the people living in the home have lived locally for many years and are well known in the neighbourhood. Depending on the ability of the individual people are able to visit friends and family on their own or supported by staff. Information in the care plans confirmed that people are supported through the risk management process to use public transport and go out alone to places of interest, such local football matches during the football season, shopping and the Salivation Army drop in centre. Care plans also confirmed that people are supported to maintain relationships with their families and often spend the weekend at their parental home. People using the service are able to play music as long as they are not disturbing people. They can choose what to watch on TV and like playing snooker or pool. They sometimes go to the pub. One resident does gardening sometimes, but it is when he wants to. In the evenings residents can choose to go to the pub or go for walks and they choose when they go out and where they go. At the weekend’s people can relax and do what they want. They get up at any time they want and choose when they go to bed. They can spend the weekend with whomever they want including friends and relatives. Most of the residents go to a local church, one resident stated that they could go to church on their own. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 15 The terms and conditions of residence clearly state that the cost of a week’s holiday is not a part of the contractual terms with the home. Therefore individuals are supported to plan and choose an annual holiday away from the home in accordance with their budget. Four people were currently on a week’s holiday, two were staying in a chalet in Clacton and two were at a holiday centre in Sheringham, which provides twenty-four hour care. People were observed moving freely around their home spending their time as they chose. Each person has their own bedroom, which is fitted with a door lock. Where people choose not to hold a key to their room, they can lock the door from the inside for privacy, however staff have access with override key in an emergency. People using the service are being encouraged to contribute to the day to day running of the home, which includes keeping their rooms clean and tidy, maintaining the garden and helping to prepare simple meals, snacks, cakes and sandwiches for their packed lunches. People are able to choose where they eat their meals; there is a choice of two dining areas. They have a good choice of food with the option of a full English breakfast available at weekends until 9am. Residents have a menu for food and get to choose what they like. Menus seen reflect people are provided with a choice of meals, which meet their cultural needs and preferences, these are varied and reflect a well balanced diet. People were seen enjoying their evening meal, which consisted of a choice of steak and kidney casserole and vegetables or omelette and salad, followed by prunes and custard. The kitchen is domestic in style, but is large enough to cater for the number of people in the home and encourages people to participate in the preparation and clearing away of food. All meals are ‘home-cooked’ using mainly fresh ingredients. The food store seen confirmed that the home has a good range of quality food. These were being stored in accordance with food safety standards. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 16 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, People who use the service experience good quality outcomes in this area. People living in the home can expect to have their physical and emotional health needs met and have personal support provided in a way that maximises their independence, however to protect their health, welfare and safety the procedure for managing controlled medications must be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person’s care plan sets out their individual needs and identifies what they can do to meet their own personal care needs and the level of support they need to achieve this. This can be physical help, encouragement, observation or prompting. Care plans also list the individuals preferred daily routines stating the times they like to get up and go to bed, they also describe people’s likes, dislikes and interests. Residents living in the home can have a bath or a shower every day and they can choose their own clothes. People using the service were observed returning from their day care activities. Staff were observed calling people by their preferred name. The interactions between staff and the individuals were friendly and appropriate. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 17 All health appointments are documented in care plans. These records confirmed people are being supported to access routine healthcare appointments, such as the dentist, opticians and doctors and include annual check up’s for people with dietary needs such as high cholesterol. Detailed record’s are being made where the support and advise of other specialist healthcare providers is required. These included appointments at the audiologist department, input from community nurses to assess and review medication, referrals to a neurologist and a consultant psychiatrist. Sometimes the doctor comes to see the residents at the home, depending on their illness. Residents go to the dentist and said that they are a nice person. They also spoke of eating healthy foods and going for walks. A copy of the homes procedure for administering medication is placed at the front of the Medication Administration Records (MAR) charts folder. A previous requirement was for the medication procedure to be updated to reflect the procedure for administering medication covertly. Examination of the procedure confirmed that there are now guidelines for staff to follow should the occasion arise where an individual refuses to take their medication. Staff are required to obtain permission from the individuals GP and/or social worker to administer medication in an alternative form, such as for example hidden in liquids or to crushed the medication using the correct equipment. The medication procedure gives good guidance to staff for the ordering, receipt, storage, administration and disposal of medication. All staff are issued with the medication policy and procedure and receive training from the pharmacy prior to undertaking the role of administering people’ s medication. The medication is locked in the staff office in a separate cupboard. Prescribed medications are delivered by the pharmacy in blister packs. Some additional medication such as lotions and eye drops are stored in a separate cupboard or fridge as per the manufacturers instructions. The senior on duty was observed administering the teatime medication. The MAR charts for all the people living in the home were checked; these had been recorded, signed and dated appropriately. Generally the process is well managed, however two people are prescribed controlled drugs. One of the people was on holiday therefore could not check the amount. The other person’s Temazepam had not been entered into the controlled drugs register and there was some confusion as to the number of tablets being held. The MAR chart reflected that following a home visit the General Practitioner (GP) had prescribed the person, Temazepam on a PRN (as required) up to three times day. The GP had administered one of the Temazepam on the same day. A signature on the MAR chart indicated that staff had administered a second Temazepam, however the third Temazepam could not be accounted for. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 18 Further investigation found that the remaining tablet had been added to a new box of 25 Temazepam, making all tablets accounted for. A requirement was made at the last inspection for a record of people’s final wishes to be made, as a number of people living in the home are in their late sixties and early seventies. Of the three care plans examined only one had paperwork relating arrangements for death, dying and terminal illness, however this had not been completed. Although this is a sensitive subject this the individual is supported to manage degenerative and terminal illness through an established plan, which constantly monitors pain, distress and other symptoms and in accordance with their wishes, spiritual and cultural beliefs. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 19 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, People who use the service experience good quality outcomes in this area. People living in the home can expect to have their concerns taken seriously and be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The policies and procedures for dealing with complaints and safeguarding the people living in the home were examined in conjunction with information provided by the manager in the AQAA. The complaints and concerns book is accessible to people living in the home, their families and staff. The complaints procedure has also been discussed with people using the service at care team meetings and the procedure is displayed on a notice board in the hallway. The complaints procedure and information seen in the complaints log confirms that complaints are dealt with immediately and a written report produced. Three complaints had been logged and fully investigated with satisfactory outcomes since the last inspection in June 2006. The manager identified in the AQAA that record keeping could be improved, by keeping more factual evidence and ensuring records are kept up to date. To rectify this the staff attended record keeping training and have been instructed to only record the facts following an incident. Records confirmed that all staff have regular training about Protection of Vulnerable Adults. Staff spoken with confirmed they would raise any concerns about bad practise with the manager. They also demonstrated a good understanding of what constituted as abusive practice. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 20 The adult protection policy covers the prevention, dealing with and reporting of allegations of abuse in accordance with the Department of Health guidance’ No secrets’. This includes reporting allegations of abuse to Social Services Customer First Team. The manager was advised that the procedure needs to be amended to reflect the new Adult Safeguarding Board (ASB), which was implemented in February this year replacing the previous Suffolk Vulnerable Adult Protection Committee (VAPC). Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 21 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, 27, 28, 29, 30, People who use the service experience good quality outcomes in this area. The physical layout and design of the home enables people to live in a safe and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Marlborough House is a Victorian building, which is in keeping with the local community. The house has large windows and high ceilings in all the rooms, which let in a lot of natural light, making the rooms bright and cheerful. The home was found to be clean and tidy with attractive décor and furnishings, which are domestic in style and of good quality. The expert by experience thought the home was clean and that staff were helpful and friendly. The environment is safe and accessible and meets people’s individual and collective needs in a comfortable, homely and friendly environment. People’s own rooms were nicely decorated in colour schemes and themes of their choosing. They were personalised with pictures, posters, photographs, small ornaments and a collection of stuffed toys. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 22 Each person has their own belongings in their room and has a designated key worker to help them choose the colour of the paint in their room. The home has a handyman who paints and decorates their rooms. Bedrooms are fitted with a door lock and person has the option of holding their own door key, however, residents informed the expert by experience that not everyone has a key to their room, but there are plans in place to fit them. Accommodation is over three floors with a stair lift between the ground and first floor. Communal rooms are situated on the ground floor with two large airy lounges, which face the front of the house. There are two dining rooms, which are located off the kitchen, and there is access to a small garden area from the dining rooms. There is one double room on the ground floor. To maintain the individuality of the two people sharing this room, key workers have supported them to purchase different furniture and bedding. The shared room has en-suite facilities that are suitable for wheelchair users, which have grab rails and other equipment available for safe moving and handling whilst promoting the individuals independence and safety. 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 ensuite facilities. These were all clean with no unpleasant odours. All bathrooms and toilets have locks fitted. The home has taken into consideration the needs of people from different ethnicities to ensure that their cultural needs are being met. A wet room has been installed to facilitate the ritual of washing. Appropriate hand-washing facilities of liquid soap and paper towels are situated in all bathrooms and toilets where staff may be required to provide assistance with personal care. Laundry facilities have the appropriate equipment to launder clothing and bedding including a washing machine with a sluicing programme. The infection control policy inspected offers robust guidance on reducing the risk of cross infection. Soiled clothing or bedding is taken to the laundry in alginate bags that go directly into the machine to reduce the handling of infected linen. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 23 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, 36, People who use the service experience adequate quality outcomes in this area. Staff at the home are trained, skilled and in sufficient numbers to meet peoples needs, however people using this service are not currently protected by the homes recruitment process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels and training were examined using information taken from the completed AQAA and during the inspection. The duty roster showed that the home is staffed using flexible hours providing 24-hour care to meet the individual needs of the people living in the home. Generally two people work 7-2 with a third working 7-10 to help with breakfast and ensure people are ready for their day care and work placements. One person works 3-10, and another from 4-10 with a third person covering the hours 5-11 and the sleep in duty. One waking member of staff covers the night shifts. The home does not employ domestic or laundry staff, those duties are included in the carer’s role and the people using the service are encouraged to help within their capabilities. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 24 Examination of staff files identified that not all of the appropriate recruitment checks had been completed or were unavailable for inspection. Of the three files seen, one had a copy of the original Criminal Records Bureau (CRB), but no record of a Protection of Vulnerable Adults (POVA) check being undertaken. Their contract stated the date their commenced employment was 7 weeks prior to their CRB being received. The second file had a satisfactory POVA first check, but no CRB. The third file had no evidence of a POVA first or a CRB. One file had no evidence to confirm that two satisfactory references had been obtained. A previous requirement was made for checks to be undertaken on all prospective staff prior to employing them, which includes exploration of any gaps in their employment record. Completion of application forms is inconsistent, only one had been fully completed, another had been partially completed and the third had no application form at all. These do not provide sufficient information of the past work experience and employment history of the people employed to work with the vulnerable adults living in the home. The manager advised the inspector that the documentation relating to staff’s recruitment checks are held at another home owned by the same organisation. They were advised to forward copies of the information the following morning by facsimile to the Commission for Social Care Inspection (CSCI) to confirm the checks had been undertaken. A fax was received the following morning with the details of CRB’s for two of the staff, however one of these was a copy of the one seen at the inspection. No copies of the POVA firsts or references were attached. Conversations with staff and certificates seen on the personal records confirmed that they are provided with the training they need to gain the knowledge and skills to perform their work role and meet people’s needs. Most recent training undertaken includes protection of vulnerable adults, first aid, managing challenging behaviour, unisafe non-violent crisis intervention, understanding and supporting people with autism, fragile X syndrome and autistic spectrum disorder, health and safety, fire safety, food hygiene, safe handling of medication and dealing with loss and bereavement. Staff spoken with confirmed that they had regular training, they explained they are in the process of completing a distance learning course on equality and diversity. They also confirmed that they received supervision on a regular basis and were able to discuss relevant work related issues and their personal training and development opportunities. Figures in the AQAA reflect that the home employs fourteen carers plus a manager and deputy manager. Six staff have a recognised National Vocational Qualification (NVQ) level 2 with 4 working towards completion. According to these figures the home has met the National Minimum Standard (NMS) target of 50 of care staff to hold a recognised qualification. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 25 Staff files seen confirmed that new staff are completing the Skills for Care Induction, which includes all six standards relating to the principles of care, the role of the worker, health and safety, effective communication, recognising and responding to abuse and develop as a worker. The files confirmed that the new employees are provided with an employees handbook and complete an in house induction, which is a guide familiarising the employee with the layout and health and safety arrangements of the home. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 26 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, 38, 39, 40, 41, 42, People who use the service experience adequate quality outcomes in this area. People using this service can be confident that the home is appropriately managed in regards to their health and safety, however to ensure they are protected from the risk of abuse information relating to staff recruitment and people’s individual financial records must be available for inspection at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has the qualifications and experience to run the home. They have been in post since October 2005 and has completed a National Vocational Qualification (NVQ) level 4 and the Registered Managers Award (RMA). During the inspection the manager demonstrated a clear sense of leadership and awareness of the diverse and unique needs of the people living in the home. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 27 Staff described the manager and deputy as supportive and confirmed that they and the people living in the home attend regular meetings where they are able to openly discuss problems, concerns, training and day-to-day issues of the home. They also spoke of the benefits to the people using the service of becoming part of a larger organisation, such as improved support and social networks and availability of staff to cover sickness and holidays. The manager confirmed that a quality assurance exercise is in the process of being completed. They showed the inspector some examples of questionnaires, which have been given to people living in the home, to seek their views of the service provided at Marlborough House. The manager agreed to forward a copy of the results of the survey to the Commission for Social Care Inspection (CSCI). A copy of the results of the satisfaction questionnaires was received at the CSCI office on the 23rd July 2007. Marlborough House currently has twelve people living in the home, three people were unable to complete the surveys and one person was not in residence at the time the survey was carried out. Therefore the questionnaires reflected eight people’s responses to comfort of their room, quality of care, staff, cleanliness and décor of the home, choice of meals, response to complaints, laundry service, social activities and the overall impression of the home. The outcomes of the survey showed that 63 of the responses to the questions were excellent, 31 responses were good and 6 felt these services were fair. As well as obtaining feedback from the people using the service, the quality assurance and quality monitoring systems need take into account the views of family, friends and other professionals associated with the home to reflect how the home is meeting the aims and objectives set out in the statement of purpose. People using the service are supported to manage their own finances wherever possible. For those unable to manage their finances the manager is appointee. All fees are paid by direct debit to the head office of Amber Care. Each person is in receipt of their personal allowance, which is paid into their bank account. For people unable to manage transactions themselves, the manager holds the individuals debit card and draw’s money out of the bank at their request. The manager completes a ‘service users money sheet’ to show all transactions in and out of their personal account. It was not possible to check the records against the individual’s balance as all financial records are kept at another home owned by the same organisation. One resident told the expert by experience that they get help with budgeting at the club they work at; the residents get their benefits weekly and can choose how they spend their money. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 28 Generally people using the service are protected by the home’s record keeping, policies and procedures, with the exception of the organisational arrangements for keeping records realting to recruitment and indivdual’s financial records at their head office. This does not allow people using the service to have immediate access to information held about themselves, neither does this practice allow for their protection due to the inconsistency of the required paperwork relating to the recruitment of staff. Information obtained from the AQAA and seen during the inspection confirmed the home takes steps to safeguard the health, safety and welfare of people living in the home. Equipment and appliances are regularly checked and serviced; these include weekly hot water checks and fire alarm testing. The home has appointed a member of staff as a designated health & safety person, who makes regular checks of the building and interior. They have also appointed a fire marshal in line with the new fire regulations. Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 29 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 4 2 3 3 3 4 X 5 2 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 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 1 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 2 3 3 3 3 2 3 X Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5 (b) Requirement Contracts must be updated to reflect the individual’s current fees. Where the individuals lack the capacity to agree and sign the terms and conditions between themselves and the home, support from family or an independent advocate must be obtained to act in their best interests. The procedure for the receipt, administration and disposal of controlled medications must be improved. This will protect the health, safety and welfare of people living in the home. The end of life needs of people living in the home must be discussed with the individual. This will ensure that in these circumstances they will be treated with dignity and respect and in accordance with their wishes. This is a repeat requirement from 26/06/06 Timescale for action 30/08/07 2. YA20 13 (2) 03/08/07 3. YA21 12 (3) 30/08/07 Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 31 4. YA34 19 (1) (b) Schedule 2 The manager must ensure that all of the appropriate checks are undertaken prior to employing a person in the home. This will protect the people living in the home from the risk of suffering from abuse or being placed at risk of harm or abuse. This is a repeat requirement from 26/06/06 10/08/07 5. YA41 17 (2) (3) Schedule 4 Records relating to staff recruitment and peoples finances must be kept in the home and made available for inspection at all times. This will ensure people are protected from financial and other forms of abuse and have access to information about themselves. 10/08/07 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. Refer to Standard YA6 Good Practice Recommendations Care plans should be made available in a format that the individual can understand, where applicable using easy to read writing and visual images, similar to the ‘guide to living a good life at Marlborough House’. The adult protection procedure needs to be amended to reflect the new Adult Safeguarding Board (ASB), which was implemented in February this year replacing the previous Suffolk Vulnerable Adult Protection Committee (VAPC). 2. YA23 Marlborough House DS0000067388.V345477.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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.V345477.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. 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