CARE HOMES FOR OLDER PEOPLE
Marlborough Lodge 83/84 London Road Marlborough Wiltshire SN8 2AN Lead Inspector
Tom Webber Unannounced Inspection 24th February 2006 09:00 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 Lodge DS0000028337.V281992.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 Lodge DS0000028337.V281992.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Marlborough Lodge Address 83/84 London Road Marlborough Wiltshire SN8 2AN 01672 512288 F/P01672 512288 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) Susan Lesley Harper David Llewellyn Harper Susan Lesley Harper Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Marlborough Lodge DS0000028337.V281992.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th September 2005 Brief Description of the Service: Marlborough Lodge is a private care home offering accommodation and personal care to 18 older people. Marlborough Lodge comprises two Victorian houses, now forming one building. The home is situated on the A4, Marlborough to Hungerford Road on the outskirts of Marlborough, and is just ten to fifteen minutes walk or two minutes drive from the town centre. A bus service to the town centre passes the home and the bus stop is nearby. The home provides ten single and four shared bedrooms and two bedrooms have en-suite facilities. The shared bedrooms are used as singles and would only be used as a shared facility for married couples. There is a large dining room with some additional comfortable chairs and a large lounge. There is a small front garden and a larger back garden together with adequate parking facilities. Marlborough Lodge DS0000028337.V281992.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken during the course of one day from 09:00 to 13:10. The inspection process focussed primarily on the direct care provided to the residents and the views of ten of the fourteen residents in situ were sought on an individual and group basis. A number of the core standards were also assessed which included residents’ privacy and choice, food, accommodation, staffing, management, residents’ finances and health and safety. What the service does well:
The home is run and managed by persons who are appropriately qualified and have sufficient experience within the relevant care setting. The home ensures that there are sufficient numbers of staff on duty at all times to meet the needs of the residents. The staff team continue to work towards achieving a trained workforce. Residents spoken to commented very positively about the care provided by the staff, stating that staff are very kind, caring and couldn’t be any better. Staff were observed to carry out their duties in a caring and respectful manner. Residents continue to live in a warm, safe, well-maintained, and homely environment, which meets the residents’ individual and collective needs. The home continues to be maintained to a good standard being clean, tidy, comfortable, suitably furnished and decorated providing sufficient and suitable toilets, bathrooms and communal facilities. Although residents’ bedrooms vary in size, they are suitable to meet their needs with residents having personalised them to their individual wishes. The home provides appropriate laundry facilities to meet residents’ needs. Residents spoken to commented very favourably about the cleanliness and size of the accommodation provided. They also commented very positively about the laundry arrangements, stating that their clothing is returned in good condition. Staff respect residents’ privacy and dignity at all times and residents can exercise personal autonomy and choice over their lives within their capabilities. Residents receive a varied, appealing and balanced diet and residents commented very favourably about the quality and quantity of food provided. They confirmed that they receive plenty of food, their meals are attractively presented and alternatives are provided if they do not like the meal on offer. The home has received one complaint since the last inspection, which related to a number of issues. These included the loss of clothing, staff not being attentive particularly in the mornings and at mealtimes, portions of food are too large and hygiene. Evidence was available to show that these issues were suitably investigated and satisfactorily resolved. Residents spoken to
Marlborough Lodge DS0000028337.V281992.R01.S.doc Version 5.1 Page 6 commented that they had no complaints or concerns. However, residents felt confident that any complaints/concerns could be discussed with management and these would be listened to, taken seriously and acted upon. What has improved since the last inspection? What they could do better: 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 Lodge DS0000028337.V281992.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 Lodge DS0000028337.V281992.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): EVIDENCE: These Standards were not assessed during this inspection, as the core Standard 3 had been satisfactorily assessed at the last inspection with Standard 6 not being applicable. Marlborough Lodge DS0000028337.V281992.R01.S.doc Version 5.1 Page 9 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): 10 Staff respect residents’ privacy and dignity at all times. EVIDENCE: Staff give great attention to maintaining residents’ privacy and dignity. All residents are provided with their own bedroom and signs are displayed which identifies their name and the word ‘Private’. The privacy and dignity of residents is maintained discretely and effectively and staff knock on residents’ bedroom doors before entering. Observations and discussions with some residents confirmed that all residents are provided with their own bedrooms where they can conduct all their personal affairs in complete privacy, including medical examinations and treatment. Residents can also choose who and where to see any visitors. Residents have access to a mobile phone, which they can use in the complete privacy of their bedrooms and they are not charged for any calls made when using this facility. Alternatively, residents can have a telephone installed in their bedrooms and some of them have availed themselves of this facility. Residents’ mail is given directly to them unopened, although staff will assist residents to read their mail if requested. Marlborough Lodge DS0000028337.V281992.R01.S.doc Version 5.1 Page 10 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 Residents can exercise personal autonomy and choice and they receive a varied, appealing and balanced diet. EVIDENCE: Observations and discussions with residents confirmed that they can make many decisions without reference to staff and this includes what to wear, when to get up or go to bed. Residents can and have brought items of furniture and personal possessions to make their bedrooms more homely, they can choose how and where to spend their time, where to eat, and what activities to participate in. Areas where residents are expected to refer to staff include going out unescorted, bathing and support with their personal and health care arrangements where assistance is required. The policy of the home is to give a bath when requested. The home will manage residents’ personal spending if there is no one able and willing to do this and if the residents request assistance. It was clear during the inspection that residents are all treated as individuals. The home provides a varied and satisfactory five weekly menu which offers a choice at breakfast and teatime. Breakfast includes the option of a cooked meal. A set main meal is provided at lunchtime, although residents are offered an alternative for this meal if they do not like the meal on offer. Drinks, biscuits and cake are provided at intervals throughout the day. Residents’
Marlborough Lodge DS0000028337.V281992.R01.S.doc Version 5.1 Page 11 special diets are also catered for. Most residents tend to eat their meals in the dining room but some eat them in their rooms. Residents spoken to commented very favourably about the quality and quantity of food provided, confirming that they receive plenty of food, their meals are attractively presented and alternatives are provided if they do not like the meal on offer. Marlborough Lodge DS0000028337.V281992.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Residents were confident that any complaints/concerns would be listened to, taken seriously and acted upon. EVIDENCE: Residents are provided with a complaints procedure that forms part of their contract. The procedure specifies that complaints would be responded to within 28 days and includes information about referring a complaint to the CSCI at any stage. The home has received one complaint since the last inspection, which related to a number of issues. These included the loss of clothing, staff not being attentive particularly in the mornings and at mealtimes, portions of food are too large and hygiene. Evidence was available to show that these issues were suitably investigated by the home, an agreed action plan was established which involved both staff and residents and the issues investigated were satisfactorily resolved. However, the manager was advised of the need to ensure that the outcomes to each issue are suitably recorded. Residents spoken to commented that they had no complaints or concerns. However, if they did have any, they felt confident in discussing them with the manager and staff who would listen and deal with them appropriately. Marlborough Lodge DS0000028337.V281992.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 25 and 26 Residents continue to live in a warm, safe, well-maintained, and homely environment, which meets the residents’ individual and collective needs. The home continues to be maintained to a good standard being clean, tidy, comfortable, suitably furnished and decorated providing sufficient and suitable toilets, bathrooms and communal facilities. Although residents’ bedrooms vary in size, they are suitable to meet their needs with residents having personalised them to their individual wishes. The home provides appropriate laundry facilities to meet residents’ needs. EVIDENCE: The home is in keeping with others in the road and continues to be maintained to a good standard being clean and tidy and provides sufficient light, heating and ventilation. A spot check of the accommodation confirmed that the standard of furnishing and decoration within the home continues to be suitably maintained. Marlborough Lodge DS0000028337.V281992.R01.S.doc Version 5.1 Page 14 The combined communal space consists of a lounge/dining area and separate spacious lounge, which provides suitable space and a choice of where to sit The communal rooms are suitably furnished and decorated and provide a combination of domestic style artificial lighting as well as natural lighting. The home provides sufficient bathroom and toilets facilities to meet the needs of the residents. These facilities are provided with suitable locks and are located on the ground and first floor levels. The home provides ten single and four shared bedrooms, two of which provide en-suite facilities. The shared bedrooms are used as singles and would only be used as a shared facility for married couples. Residents’ bedrooms vary in size and are suitably furnished and equipped to ensure comfort and privacy. Residents can and have brought items of furniture and personal possessions to make them more homely with residents having personalised their bedrooms to their individual wishes. Residents’ bedrooms have been provided with a lockable storage space. Residents spoken to commented very favourably about the cleanliness and size of the accommodation provided. The home is maintained to a good standard being clean and tidy and is free from offensive odours. The laundry room provides sufficient facilities to meet the needs of the home. A laundress is employed to undertake the washing and ironing duties and the care staff also assist with this task. Residents’ clothing is labelled or colour coded to ensure that garments are appropriately returned. Residents spoken to commented very positively about the laundry arrangements, stating that their clothing is returned in good condition. Marlborough Lodge DS0000028337.V281992.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30 The home ensures that there are sufficient numbers of staff on duty at all times to meet the needs of the residents. The staff team continue to work towards achieving a trained workforce. EVIDENCE: The home provides a minimum of two members of care staff on duty throughout the waking day with additional care staff deployed during the day at other times particularly when activities are provided. The above staffing levels exclude those hours worked by the proprietor, cook, laundress and housekeeper. There is one waking night staff on duty each night with a member of care staff also sleeping in. Existing care staff cover any shortfall of staff hours. Residents spoken to commented very positively about the care provided by the staff, stating that staff are very kind, caring and couldn’t be any better. Staff were observed to carry out their duties in a caring and respectful manner. The home continues to work towards achieving at least 50 of the care staff team being trained at NVQ level 2 in care. To this end, three members of care staff have achieved this qualification with a further four care staff completing the same award and another due to commence it. Another member of care staff has achieved NVQ level 3 and is completing the NVQ Assessor’s course. Marlborough Lodge DS0000028337.V281992.R01.S.doc Version 5.1 Page 16 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, 35 and 38 The home is run and managed by persons who are appropriately qualified and have sufficient experience within the relevant care setting. Some discrepancies were noted with a few of the residents’ finances. The health, safety and welfare of the residents and staff are promoted and protected, apart from some areas of fire prevention. EVIDENCE: The proprietor has appropriate management and supervisory experience in the relevant care setting and she has overall responsibility for the management of the home. She holds a CSS (Certificate in Social Services) qualification and has also achieved the NVQ level 5 in Management as well as being a NVQ Assessor. She is supported in this task by a care manager who has day to day responsibility for the care of the residents. The care manager holds a SEN nursing qualification and has also obtained the registered managers award and the NVQ assessors’ award as well as being a qualified trainer in moving and handling.
Marlborough Lodge DS0000028337.V281992.R01.S.doc Version 5.1 Page 17 The policy of the home is for residents to manage their own money or appoint an appointee to do so on their behalf. However, the home will administer small sums of personal money on residents’ behalf if requested. Records are maintained of all financial transactions with receipts where money is held by the home on behalf of some residents. However, a spot check of the system of money held showed that the home needs to always ensure that two signatures are recorded for any withdrawals, one of which should be a resident’s wherever possible. In addition there appeared to be a couple of discrepancies in the recordings. The care manager agreed to ensure that the residents’ cash sheets are audited and will inform the Commission of the outcome of it. All residents have been provided with lockable facilities within their bedrooms to keep their money secure. The proprietor ensures that there are safe working practices within the home and complies with the relevant legislation. Policies and procedures are in place to ensure a safe working environment. All staff have received training in the various mandatory courses including health and safety. Window restrictors have been fitted to all windows above the ground floor. A number of deficiencies were noted in relation to fire prevention which was acknowledged by the care manager. These included the lack of weekly tests being carried out since 29/12/05 and the means of escape, fire fighting equipment and emergency lighting not being tested and checked since 31/12/05. Evidence was not available to confirm that fire instruction had been provided since the end of 2004. However, the care manager was sure that staff had received instruction since that date and has agreed to send written documentation to confirm this, which has since been received. Marlborough Lodge DS0000028337.V281992.R01.S.doc Version 5.1 Page 18 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 3 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 2 17 X 18 X 3 3 3 X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 2 X X 2 Marlborough Lodge DS0000028337.V281992.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP16 Regulation 22(3) Timescale for action The registered individual must 30/04/06 ensure that the outcome is recorded in respect to all complaints investigated. The registered individual must 31/03/06 undertake an audit of residents’ finances and report the outcome to the Commission. The registered individual must 30/06/06 ensure that all checks and tests in relation to fire prevention are carried out and suitably recorded in the fire log book. Requirement 2. OP35 17(2) 3. OP38 17(2) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Marlborough Lodge DS0000028337.V281992.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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