Inspection on 13/02/06 for Marlborough House Nursing Home

This inspection was carried out on 13th February 2006.

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

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

Other inspections for this house

Marlborough House Nursing Home 12/07/07

Marlborough House Nursing Home 22/06/06

Marlborough House Nursing Home 12/02/05

Marlborough House Nursing Home 16/11/04

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

CARE HOMES FOR OLDER PEOPLE Marlborough House Nursing Home 241 Aldershot Road Church Crookham Fleet Hampshire GU13 0EJ Lead Inspector Tim Inkson Unannounced Inspection 13th February 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Marlborough House Nursing Home Address 241 Aldershot Road Church Crookham Fleet Hampshire GU13 0EJ 01252 617355 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) Craysell Limited Mrs Jane Ratchford Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47) of places Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Only 27 service users can be accommodated who are in receipt of nursing care at any one time Only 20 service users can be accommodated who are in receipt of personal care at any one time 26th May 2005 Date of last inspection Brief Description of the Service: Marlborough House is a nursing home providing nursing and personal care for up to 47 older people. The home is owned by Craysell Limited and it is located on the outskirts of Fleet and close to the village of Church Crookham and it’s amenities. The establishment is comprised of 2 buildings that are linked on the ground floor. One part is a large house that was converted for use, as a care home and there is a newer purpose built extension. Both parts of buildings have 2 stories and most residents requiring nursing care are accommodated in the extension where all rooms are single and benefit from having en-suite facilities. There are a number of double rooms in the older part of the building that mainly accommodate service users who require personal care and most of these rooms do not have en-suite facilities. The home has a garden that can be accessed by wheelchair users. There are a range of communal rooms throughout the establishment and there is a passenger lift in the extension and a chair lift in the older part that provide access to the first floors of each of the respective parts of the home. Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second of two inspections of the home that must be undertaken in the 12-month period beginning on 1st April 2005. It started at 09:15 hours and finished at 17:45 hours. The inspection procedure included viewing a sample of some bedrooms (15), an examination of documents and records, observation of staff practices where this was possible without being intrusive and discussion with residents (11), and staff (7). At the time of the inspection the home was accommodating 37 residents and of these 12 were male and 25 were female, their ages ranged from 70 to 96 and 25 were receiving nursing care. No resident was from a minority ethnic group. The home’s registered manager was available throughout the visit to provide assistance and information when required. What the service does well: Residents and staff expressed very positive views about living and working in the home and the former particularly appreciated the homely atmosphere that the staff helped create. Residents also felt that the home’s staff looked after their needs well and staff members perceived the quality of care provided by the home as “good”. Staff reported generally amicable working relationships. All residents and the majority of staff spoken to expressed confidence in the home’s registered manager. The general consensus of residents about the food provided by the home was that it was “good”. There were good systems and procedures in place to ensure that medication was managed safely in the home, residents’ financial affairs were safeguarded and that as far as possible residents’ were able to exercise self-determination and their civic rights. What has improved since the last inspection? The home had introduced documentation to demonstrate that the needs of potential residents were assessed before they moved in to the home to ensure that they could be met. New documentation had been introduced for planning the care that residents need to ensure that more than physical support and health care matters were included. There was evidence that the nutritional needs of residents were being assessed as a result of new documents that the home had introduced. Where the use of bed rails was deemed necessary to protect a resident from harm based on a risk assessment this was being recorded appropriately. A programme of installation of radiator guards had been implemented to reduce as the risk of harm to residents. Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 6 A quality monitoring system had been implemented using questionnaires to obtain residents views about the service they received. Records were available concerned with the inspection and servicing of fire safety equipment. What they could do better: The assessments of the needs of potential residents and subsequent plans of care for those individuals could be improved with the use of more comprehensive assessment documents. More robust pre-employment checks would ensure that the risk of unsuitable people working with vulnerable adults was eliminated as far as is reasonably possible. Training in dementia care is needed for staff to ensure that the specific needs of some residents can be met as fully as possible. Regular internal audits of the homes management systems and records and the collation of information from questionnaires used to obtain residents views about the home should inform a plan that should lead to a process of continuous improvement. All staff working in the home must have regular and on going training in fire safety matters to ensure that they know how to respond in the case of an emergency. All systems and equipment in the home must be inspected and tested as required by the relevant health and safety regulations to ensure that they are working effectively and do not present any danger. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home’s admission procedures included assessments of the needs of potential residents before they moved into the home to ensure that the home could provide the care and support that individuals required. These assessments could be improved by ensuring the documentation used was more comprehensive. EVIDENCE: The home had written policies and procedures concerned with the admission of new residents to the home and these referred to the importance of ascertaining the help required by potential residents before they moved into the home. At the last inspection of the home on 26th May 2005 it was noted from an examination of the records of 4 residents that no detailed assessment of the needs of potential residents had been completed before they moved into the home. On this occasion the records of 5 residents were examined 3 of which had been admitted to the home since the last inspection. It was apparent that new documents were being used by the home to record information about potential residents before they moved into the home. Residents spoken to confirmed Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 9 that senior members of staff from the home saw them before they moved into the home in order to see what help they needed. • “The assistant matron visited me at Fleet hospital and made some notes”. • “The matron came to see me at Frimley Park hospital – I was very lucky she came and chose me”. The pre-admission assessments were complemented by more thorough and comprehensive assessments of a resident’s needs when they actually moved into the home. There was documentary evidence that assessments of residents needs were reviewed regularly and revised as necessary when an individual’s circumstances had changed. The home’s registered manger was reminded of the legal obligation under Regulation 14 (1)(d) of the requirement to confirm in writing to potential residents that having regard to the assessment that the care home was suitable for the purpose of meeting the individual’s needs in respect of their health and welfare. It was noted that the preadmission document used by the home omitted to include some reference to some essential areas of potential need (e.g. oral health and foot care). It is therefore recommended that the registered manager consider basing the home’s pre-admission assessment document on the areas of need set out in paragraph 3.3 of the National Minimum Standards for Care homes for Older People (NMS). Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 There were plans of care in place that ensured that residents received the basic help and support that they needed. The plans would however benefit from including needs other than those purely concerned with physical care and health. The home’s procedures and systems for ensuring that medicines were managed and administered safely were satisfactory. EVIDENCE: The records of 5 residents were examined and these documents included the plans of care that had been developed for the individuals concerned. At the last inspection of the home 26 May 2005 a number of weaknesses or omissions in care plans had been identified. These included; a concentration or focus of the physical health needs of residents; a lack of risk assessments; and no documented evidence that residents’ relatives/representatives were involved in care planning. On this occasion it was again apparent that the home had introduced new and additional documents to enhance the process of planning the care of individuals. There was still a focus on physical care and despite this there were some omissions such as oral hygiene and foot care in the written plans (see below). Also where an assessment had indicated the need for a person to receive stimulation and the person’s religious persuasion had been identified there Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 11 were no corresponding entries in the care plan about how those need would be met. In all the plans seen there were general risk assessments in place as well as specific assessments of the nutritional needs of the person concerned and the risk of pressure sores. Strategies for eliminating or reducing the risk of harm had been identified and implemented e.g. pressure-relieving aids were in place. The home’s registered manager said that she had endeavoured to get relatives involved in care plans but had little success. It was suggested that care plans should include detail of some personal care and health needs that would relate directly to the areas covered in assessment as referred to above at page 10, (e.g. oral hygiene and foot care) and also the psychological and social needs of individuals (e.g. spirituality; sexuality; and occupation/leisure). The care plans seen on this occasion did set out the actions staff had to take and for those needs that were identified and what specialist equipment was needed to provide the support and assistance each person required. Observation and discussion with residents confirmed that individuals received the help they required and that the equipment was in place as set out in their plans of care. Also despite not necessarily being included in the care plan they received other help to meet their needs e.g. chiropody treatment, and they could participate in a range of organised group or one to one activities. There was documentary evidence that care plans were evaluated and reviewed regularly. Nursing and health care assistants spoken to were aware of the contents of the care plans that were sampled and the assistance that the individuals concerned required. Comments from residents about the help that they received included the following: “They help me with everything, from taking my pills to taking me to the toilet”. “I sometimes think that I am lucky to be here as my health has improved. I have been on medication that means my blood needs checking and they do that. I have to watch my diet. I am very independent rally but they help me with bathing”. “The people look after me very well”. “I have been here about 10 days. I was apprehensive coming from hospital but it is great, they look after me well”. “I have been here 9 years, I was a complete wreck when I came here but look at me now”. “They help me get washed and dressed”. The home had written policies and procedures available that were concerned with the management and administration of medication. Medicines were stored safely and appropriately in, three locked and secure medicine trolleys and also in a locked room where dressings were also kept in locked cupboards. Inside one cupboard was a locked metal cabinet that was suitable for storing “controlled drugs”. A medical refrigerator was also used for Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 12 medicines requiring special storage conditions. The temperature of the refrigerator was regularly checked to ensure that it was working effectively. Medicines were dispensed from their original containers and all of these were dated when they were opened/started. The administration of medication in the home was the responsibility of registered nurses. One of them also had the specific delegated responsibility for the ordering and checking the return of prescribed medication. Registered nurses spoken to said that they had completed training in the management of medication. There were copies of the signatures of the nurses who dispensed medication readily available. Reference material and information about medicines was also readily available although the copy of the British National Formulary that was seen was somewhat dated. It was suggested that a recent copy be obtained. Records examined included those concerned with the administration; ordering; receipt; and disposal of medicines, and all were accurate and up to date. There were no controlled drugs being kept in the home at the time of the inspection although the home did treat and manage some sedatives as if they were controlled drugs. A check of these was made and the balance of medication held was correct. Daily notes (cardex) kept about residents included entries when a person was given medication that was prescribed for them to be taken as necessary (PRN). Good practice noted during the inspection included; checks of the effectiveness of the medical refrigerator (see above); dating of medication containers when they were opened; and promotion the right of residents to manage their own medicines if they wished subject to a risk assessment. Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 15 The home had good procedures in place for ensuring residents could exercise self-determination. The meals in the home were good and provided variety, choice and catered for special dietary needs. EVIDENCE: The home had several written policies that were concerned with the rights of residents. These included: • Residents’ charter • Confidentiality • Access to personal files and case notes • Voting and the electoral register • Advocacy • Handling money and valuables • Self medication These referred to the right of residents to make their own choices, act independently and enjoy the same rights and freedoms as any person living in the community. The home’s registered manager said that the home did not take responsibility for the financial affairs of any residents, but for security purpose the home would hold small amounts of personal monies on behalf of residents and given to them by relatives to hold for individuals. She said that a small number of residents managed their own finances. Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 14 All the residents spoken to indicated that they were pleased to give the responsibility for such matters to relatives/representatives. The home was displaying details in the entrance hall of an organisation that could provide independent advice should a resident or relative want to obtain such help about matters that may cause them concern. The home permitted residents to furnish their own bedroom accommodation if they wanted to do so and several residents spoken to said they had items of their own in their rooms and appreciated being able to personalise their bedroom accommodation so that it was “like home”. Items seen included tables, dressers, lights and television and audio equipment. The home had written policies and procedures about “Confidentiality” and “Access to Records” (see above). The latter stated among other things that residents had the right to access their own records. Sensitive information about residents was kept in the home’s staff room where staff were often present and also in the manager’s office in locked filing cabinets. Comments from residents about their ability to exercise control over their daily lives included the following: • “The only restrictions here are self imposed, you can get up and go to bed when you like”. • “There are no rules here, its pretty free and easy” • “I go out for a walk to the local shop every day – no problem” • “All the furniture and things you see in my room belong to me”. All residents spoken to said that the food provided by the home was good. Residents spoken to and who were relatively active said they knew what the main meal of the day was because they could see the menu that was prominently displayed or they could go and ask the cook. All said that if they did not like the meal that was on the menu there were other options. • “They will always change it if you are not keen”. They also confirmed that there three meals a day and could have snacks and drinks at other times. • “We always have a drink in the evenings and I have a biscuit with mine” • “I have a sandwich in the evening, cheese or ham”. • “There is always plenty of coffee all day”. • “We have our tea at about 5 to 5:50 and you can have something later if you want”. Information about the needs of service users with specific dietary requirements was readily available in the kitchen e.g. diabetic, soft, chopped up, etc. Pureed meals were provided with all their constituents prepared separately ensuring that their appearance was attractive. Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 15 One resident who required a special diet said, “my diet is watched instead of jam sponge and custard I have fruit salad or melon, sometimes cakes are made with sweetener and I can have them”. Menus that were seen indicated that there were a wide variety of meals available. Some service users ate in their rooms and some in the home’s dining rooms. Staff were observed sensitively and appropriately providing help to those service users that needed assistance at meal times. Comments from residents about the food included the following: • “The food is quite good, there is more than enough, we always have 3 courses, I think we are rather spoilt, we get a nice tea as well”. • “I usually go down and look at the menu in the hallway, or ask the lady in the kitchen. The other night I had a glorious omelette. I ask them not to force vegetables on me because I detest them. The food is pretty good, there is too much sometimes”. • “The food is very good”. • “The food is very good, very filling……”. • “The food is rather good…..”. • “It’s very nice….”. Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 The home had satisfactory procedures in place to ensure that residents could exercise their civic rights. EVIDENCE: The home had written policies and procedures in place concerned with residents right to take part in the electoral process. Residents and staff spoken to confirmed that residents were able to vote in general and local elections. The home’s registered manager had application forms available that were sent to the local council when a new resident moved into the home to ensure that they were included on the electoral roll. Comments about this matter from residents and staff included the following: • “The residents do vote, they can have a postal vote or be taken by taxi to the polling station as one is usually arranged by one of the political parties”. • “At the last election a lot of residents voted by post”. • “They sent me my voting papers but I didn’t bother”. • “Oh yes we get postal votes now but I have been to the polling station”. Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 25 The home’s bedroom accommodation was furnished and equipped satisfactorily for service users needs. There were adequate systems and procedures in place to ensure the bedroom accommodation was both safe and comfortable. EVIDENCE: All residents spoken to were satisfied with the standard of their bedroom accommodation and the furnishings and any equipment in the rooms. Bedrooms viewed were all furnished and equipped as expected by Standard 24 of the National Minimum Standards for care Homes for Older People. The furnishings of the rooms and décor were in good repair. All bedrooms were; fitted with carpets and they were naturally ventilated and heated by radiators. A programme of installing guards on radiators in the “old/original” part of the home had been implemented and to prevent residents from the risk of suffering burns. The radiators in the extension or new part of the building were appropriately guarded. This included both communal areas and bedrooms. In residents rooms where a guard had not been fitted a risk assessment had been done to ensure that action was taken to minimise the risk to the individual concerned from the uncovered radiator. Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 18 Not all bedroom doors in the “new” part of the home were fitted with suitable locks although the manager stated that if a resident wanted a lock fitted that it would be arranged. At the time of the inspection the home was experiencing problems with the boiler and temperature of hot water tested in the wash hand-basin in a ground floor room in the old part of the house greatly exceeded 43°C which is considered the maximum appropriate and safe level in care homes. The responsible individual representing the registered provider/owner (Craysell Ltd) said that the difficulties with the hot water would be resolved by the end of the week. It was suggested that a warning notice be posted by wash hand basins indicating that the water was very hot. Water outlets on baths in the home were fitted with thermostatic mixer valves to ensure that the temperature of the hot water was delivered at a safe temperature and the outlets were checked regularly. The home employed someone to deal with small repairs and maintenance matters. Comments that residents made about their bedroom accommodation and the heating, lighting and ventilation of their rooms included the following: • “I think it is a nice room”. • “Its OK – warm enough – I can open my window if I want and the light is good enough”. • “My room is pretty good, sometimes it is too warm, the bed is quite comfortable”. • “My room is very comfortable”. • “The lighting is OK and I also have a lamp of my own”. • “My room is alright”. Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 The home’s recruitment procedures for new staff were poor and failed to ensure the protection vulnerable adults living in the home. EVIDENCE: The files/records were examined of 2 members of staff that had started work in the home since the last inspection on 26th May 2005. Pre-employment checks that are required to be completed before a person starts work to ensure that they are suitable to work with vulnerable adults had not been completed. One of the individuals started work on 26/09/05 and an enhanced criminal record bureau (CRB) certificate was not obtained in respect of that person until 28/01/06. There was also no evidence that a “Protection of Vulnerable Adults (POVAfirst) clearance had been requested and received prior to that. The other individual had started work on 2/02/06 and there was no evidence that a CRB check had been applied for by the home. There was an enhanced CRB certificate date 5/07/05 for the individual in respect of another employer in the file. The registered manager and responsible individual were informed that CRB certificates were not “portable”. Also that for both individuals at least a satisfactory POVAfirst check should have been received before either should have started work in the home. The responsible individual said that the member of staff who started on 2/02/06 would not work unsupervised or have unsupervised access to residents. A new maintenance/handy person had recently started work in the home and the registered manager said that she had sent for a CRB check but a certificate Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 20 had not yet been returned. She said that consequently he would discontinue working in the home until his CRB check was completed. Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 The home’s manager had the experience and skills necessary to run the home effectively. There were good systems in place for safeguarding residents’ financial interests. There were basic procedures in place for obtaining the views of interested parties about the quality of the service provided by the home. The home’s quality monitoring systems need further improvement and should included audits of records to help inform a development plan for the home. Health and safety procedures were inadequate and failed to comprehensively promote the welfare oft residents and staff living and working in the home. EVIDENCE: The registered manager was a registered nurse and had been qualified since 1967 and she had managed the home for some 9 years. She had kept up todate with developments in health and social care by attending study days, seminars and courses but she said that she had not pursued a formal management qualification because she intended to retire during 2006. The majority of views from both residents and staff concerning the manager’s skills and personal attributes were positive and included the following: Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 22 • • • • • • • • • “She is very nice, understanding and very supportive………..she seems to know what she is talking about” (staff member). “I cannot comment on her hands on care because she spends most of her time in the office……” (staff member). “I don’t see much of matron, although she brings me my paper most mornings, she is very nice” (resident). “ Matron is wonderful” (resident). “She is very nice” (resident) “She is very nice, very friendly. You can call her any time if you need help, even if she is at home at weekends. She explains things so we can understand” (staff member). “She is very good, a very good nurse. She is understanding of staff and if you have any problems you can talk to her in confidence” (staff member). “She will help me if I need it. She is friendly. I would be sad if she went” (staff member) “She is very caring. She goes out of her way if residents have a problem and see that they are looked after” (staff member). The home had written policies and procedures about “Quality Assurance” but at the last inspection of the home on 26th May 2005 there was no evidence of any organised system for monitoring the quality of the service the home provided. Consequently a requirement was made on that occasion that such a system be implemented to include audits of the homes procedures and systems such as care plans, assessments and medication records. On this occasion there was some evidence that a start had been made by the home to obtain the views of residents by using questionnaires about a range of aspects concerned with the service that they received including; staff attitudes; activities daily routines; catering and residents rights. Some information had been obtained but no attempt had been made to collate the data and identify any matters that could be improved. No audits of the home’s systems had been done as required (see above) and the importance of doing this was highlighted when it was pointed out to the registered manager that a care plan that referred to a resident having a catheter was out of date and the plan had not been amended to reflect this. It was also suggested that audits could also be done of falls suffered by residents that may result in identifying any trends that may occur e.g. time of day or place. The home had a range of written policies and procedures that were readily available in the home’s staff room that helped to inform staff working practice. They were reviewed and updated as necessary. Comments from staff about the policies and procedures included the following:“I think that they are useful for staff whose first language is English”. “They are handy and they can be referred to if necessary”. Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 23 Regular meetings were held in the home for different groups of staff in the home according to their roles e.g. catering, registered nurses, as well as the whole staff team. The registered manager said that she had tried without success to organise and arrange meetings for residents and relatives but there was little or no interest in them. There had been 9 requirements and 1 recommendation made as a result of the last inspection of the home on 26th May 2005 and most had either been actioned fully or slow progress was being made with them. One outstanding matter had clearly not been addressed. This concerned the considerable number of residents who had some type of dementia. It was apparent form discussion with staff that they required training in “dementia care” to enable them to understand the behaviour or actions, communicate with and be better able to meet the particular needs of residents with such conditions. Consequently the requirement concerning this matter that that was in the report of the last inspection of the home is repeated in this report. Views expressed by residents about living in the home and staff working in the home included the following: • “I have been here 9 years, so it can’t be that bad. I think it has a good atmosphere, there is good teamwork and I think the standard of care is good” (staff member). • “Its lovely, I am really fitting in, I was in .. hospital which was not as nice as here, they are nice here because they make you feel like family” (resident). • “Its very nice, the people are nice, they look after me well” (resident). • “I have been here nearly 9 years and I love it …. my daughter in law has been so impressed with it she is trying to get her mother in” (resident). • “I have been living here for 6 years and I have no complaints….” (resident). • “I like it, it’s a nice place to work because everyone is so cooperative” (staff member). • “I have worked here about 9 years, I have enjoyed it. It’s a happy home. Otherwise I could not have stayed. We have our ups and downs like anywhere, but we all pull together” (staff member). • “The staff are very happy. If I was unhappy I would go because money is not everything” (staff member). Relaxed and friendly interaction was observed between residents and members of the home’s staff group. One resident after sharing a joke with a member of staff said, “She is one of my saviours as she sorted out my DVD player for me”. The home looked after money on behalf of some residents for security purposes (see also page 14 above). Records were kept of any expenditure or deposits of additional monies (i.e. incomings and outgoings). A sample of the records of 2 residents who had money being looked after by the home were Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 24 examined and checked against the balances being held and they were accurate and up to date. There was evidence from both discussions and records that most staff working in the home had received some training in health and safety subjects that were relevant to their role in the home. These included first aid, fire safety, food hygiene, moving and handling, infection control and control of substances hazardous to health. It was however apparent that not all had received regular fire safety training i.e. with the frequency recommended by either good practice or the local fire and rescue service. It was also difficult to ascertain from the records that the home kept the complete details of the fire safety training that the staff group in the home head received. It was suggested that a spreadsheet of all health and safety training would enable the registered manager to quickly identify the individuals who needed to attend such training. The registered persons are required to ensure that all staff working in the home receive fire safety training at the intervals and with the frequency recommended by the local fire and rescue service. Records also indicated that the safety of the home’s environment was audited regularly and that most systems and equipment in the home were tested and serviced at intervals and with the frequencies either required according to relevant regulations or good practice and that contracts were in place for essential services. These included: • Fire safety equipment • Boilers and central heating • Hoists and slings • Lifts • Pest control • Portable electrical appliances • Refrigerators and freezers A food safety report of an inspection by the local environmental health officer of 11 February 2005 was seen in which it stated that redecoration of kitchen ceiling was required and this had been actioned. The following omissions were noted and must be addressed. The responsible individual representing the registered owner stated a commitment to remedying the matters identified below. • The chairlift in the old part of the home had not been inspected and serviced since 5th November 2003 • Bath hoists had not been services since 16th July 2003 • The electrical wiring installation was inspected in 1st March 2003 and there was no evidence that a recommendation, “that the installation be further inspected and tested after an interval of not more that 2 years”, had been implemented. Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 25 • There were no working nurse call alarms in 2 rooms on the ground floor of the old part of the home i.e. 6 & 7. The responsible individual representing the registered provider/owner said that the alarms referred to above would be functioning by the end of the week. The home had implemented a strategy to address this and one resident could summon help with a small hand-bell and regular checks were made of the other person. Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X X X X X X 3 3 X STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 1 Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 27 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 19(1) Requirement The registered persons must not allow any person to work in the home until all the statutorily required pre-employment checks have been completed in respect of that person. The registered persons must ensure implement a regular programme of training designed to provide a staff group able to asses the psychological needs and provide restorative care. Particular attention should be given to those with a dementing illness. (Previous timescale 30/07/05) The registered persons must ensure that the all systems and equipment in the home are inspected and tested at the frequency set out in the relevant heath and safety legislation and/or guidelines. The registered persons must ensure that all persons working in the care home receive suitable training in fire prevention. Timescale for action 13/02/06 2 OP33 18(1)c (i) 31/05/06 3 OP38 23(2) b & c 31/05/06 4 OP38 23(4)(d) & (e) 31/05/06 Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP3 OP7 OP33 Good Practice Recommendations It is recommended that the homes pre-admission document is based on the areas of need as set out in paragraph 3.3 of the NMS It is recommended that care plans include details of an individual’s wider needs beyond physical care and health. It is recommended that information received in questionnaires about the home and obtained from audits of management systems and procedures are used to inform an annual development plan. Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Marlborough House Nursing Home DS0000012228.V282618.R01.S.doc Version 5.1 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. 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