CARE HOMES FOR OLDER PEOPLE
Marlborough Lodge 83/84 London Road Marlborough Wiltshire SN8 2AN Lead Inspector
Elaine Barber Unannounced Inspection 27th September 2005 10:10 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.V257376.R01.S.doc Version 5.0 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.V257376.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Marlborough Lodge Address 83/84 London Road Marlborough Wiltshire SN8 2AN 01672 512288 01672 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.V257376.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd March 2005 Brief Description of the Service: Marlborough Lodge is a private care home offering accommodation and personal care to 18 older persons. 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 with adequate parking facilities.. Marlborough Lodge DS0000028337.V257376.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection and preparation took eight hours. The inspector talked to seven people living in the home, four members of staff, the care manager and the manager, read records, including personal notes and medication records, and looked at the accommodation. What the service does well: What has improved since the last inspection?
Following a recommendation at the last inspection the care plans had been rewritten so that staff were clear about the care to be provided and people’s needs would be met
Marlborough Lodge DS0000028337.V257376.R01.S.doc Version 5.0 Page 6 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.V257376.R01.S.doc Version 5.0 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.V257376.R01.S.doc Version 5.0 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): 2, 3, 6 Each person had a written contract and statement of terms and conditions with the home. People’s needs were assessed before they moved into the home and they were assured that their needs would be met. People referred for respite care returned home. EVIDENCE: The records of three people who moved into the home recently were checked. One had a statement of terms and conditions and a contract. The manager was drafting a statement of terms and conditions and a contract for one person who moved into the home in the last two weeks. The other person had a contract with the local authority and the home. Each person had a community care assessment and care plan before they moved into the home. They also had an in-house assessment covering all aspects of personal care. A plan of care was developed from these assessments. The district nurses provided any nursing care required. There was no intermediate care but the home occasionally provided respite care and people returned home after this. Marlborough Lodge DS0000028337.V257376.R01.S.doc Version 5.0 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): 7, 8, 9 All people’s health, personal and social care needs were set out in their individual plans to ensure that their needs would be met. People’s health care needs were being met. People were protected by the home’s policies and procedures for dealing with medication. EVIDENCE: The inspector read the care plans of the three people who moved into the home recently. Each had a care plan developed from their assessment. However, they were not yet due to be reviewed. Five other plans were read and these had been evaluated and reviewed every three months. Some people had signed their plans to confirm that they were involved in developing them. The manager reported that some people were not able to understand what they were signing and relatives signed some sections of the plans on their behalf to confirm their input. Following a recommendation at the last inspection the care plans had been rewritten to make them clearer. The manager reported that she aimed to review plans monthly and re-write them every three months if there had been changes. Health care needs were recorded in the assessment and care plans. Nursing care and advice about pressure areas was provided by the district nurse. The
Marlborough Lodge DS0000028337.V257376.R01.S.doc Version 5.0 Page 10 district nurse also provided any equipment and two people had pressure relieving mattresses. The continence advisor also provided advice. The community mental health team monitored psychological health and provided care when needed. People had risk assessments in relation to falls and appropriate interventions were identified in their care notes. There were opportunities for exercise. Nutritional screening formed part of the assessment and a record was kept of nutrition and weight. Some people kept their own GP if they remained in their catchment area. Those who were required to change registered with the local GP practice. People had access to dental services, the optician, chiropody, therapeutic services, hospital and community health services. The GP referred people who required hearing tests and they attended the local hospital. There was a medication policy and the home used a monitored dosage system. There was a record of each person’s medication in their care plan. Records were also kept of medication received into the home, administered to people, returned to the pharmacist and destroyed. Medication was appropriately stored and there was a controlled drugs cupboard and a controlled drugs register was available when required. Staff who administered medication had received training. The pharmacist provided advice . Staff monitored the condition of people on medication and referred them to the GP if needed. Marlborough Lodge DS0000028337.V257376.R01.S.doc Version 5.0 Page 11 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): 12, 13, 15 People found that the lifestyle in the home matched their expectations and preferences and satisfied their social cultural, religious and recreational interests and needs. People maintained contact with their family and friends and local community as they wished. People had a wholesome appealing and balanced diet served in pleasant surroundings at times convenient to them. EVIDENCE: People said that there were activities including chair exercises, bingo, games and trips out in the car. There were also musical quizzes, crosswords, aromatherapy, and staff provided manicures on a Friday. People’s interests were recorded in their assessments and care plans to ensure they would be met. During the inspection a member of staff facilitated chair exercises in the lounge, there was a lively atmosphere and people were observed enjoying the activity. The manager reported that there were increased staffing hours on Saturday and Sunday so that activities could be provided at a weekend. The contract stated that visitors could call at any time between 9am and 9pm and written information was provided for visitors in the service user guide. People could receive visitors in the privacy of their own rooms. People stated that they were visited by family and friends. They also said that they went out, e.g. for a drive or a cup of tea. Marlborough Lodge DS0000028337.V257376.R01.S.doc Version 5.0 Page 12 There was a varied menu with a choice of breakfast and tea and a fixed menu for lunch. People were offered alternatives if they did not like the meal provided. Drinks, biscuits and cake were provided at intervals throughout the day. Special diets were catered for. The meal at lunch time was attractively presented. People were observed eating at their own pace and staff did not hurry them. Most people ate their meals in the dining room but some people ate in their rooms. People said that they enjoyed the food. Marlborough Lodge DS0000028337.V257376.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People were confident that their complaints would be listened to, taken seriously and acted upon. People were protected from abuse. EVIDENCE: There was a complaints procedure that formed part of the contract. The procedure specified that complaints would be responded to within 28 days and included information about referring a complaint to CSCI at any stage. There had been no complaints since the last inspection. There was a policy about prevention of abuse and a procedure for dealing with allegations of abuse. There was also information for staff about ‘No Secrets’ Allegations of abuse were followed up promptly, action was taken and recorded. A recent incident had been dealt with appropriately in line with policy and procedures. Marlborough Lodge DS0000028337.V257376.R01.S.doc Version 5.0 Page 14 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, 26 People lived in a safe, well-maintained environment with access to comfortable indoor and outdoor communal facilities. People had sufficient and suitable toilets and washing facilities and there were sufficient bathrooms to meet their needs. The home was clean, pleasant and hygienic. EVIDENCE: The house is in keeping with others in the road. There is a planned schedule and renewal of the fabric of the building. The garden was kept tidy and was accessible. Some people said that people sit out in the garden in summer. The furniture in the communal areas was domestic in style and homely. There was no CCTV. The home met the requirements of the Environmental Health Officer and fire officer. The combined communal space consists of a lounge/dining area and separate spacious lounge, which provides suitable space in excess of the national minimum standard of 4.1 square metres for each service user. These facilities provide a choice of where to sit and are suitably decorated and furnished.
Marlborough Lodge DS0000028337.V257376.R01.S.doc Version 5.0 Page 15 However there was no communal space where service users could receive visitors in private. There was a combination of domestic style artificial lighting and natural lighting. There were sufficient bathroom and toilets facilities to meet people’s needs. The home provided two bathrooms: one on each floor. The home was clean, tidy, comfortable and free from offensive odours. The laundry room was located on the ground floor and had an industrial washing machine and tumble dryer, which were sufficient to meet the needs of the home. A laundress was employed five days a week to undertake the washing and ironing duties and the care staff also assisted with this task. People’s clothing was labelled or colour coded to ensure that garments were appropriately returned. The sluice was in the laundry room and there were infection control procedures. Marlborough Lodge DS0000028337.V257376.R01.S.doc Version 5.0 Page 16 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): 27,28,29 People’s needs were being met by sufficient staff with an appropriate mix of skills. People were supported by staff who were qualified and competent to do their jobs. People were protected by the home’s recruitment policies and practices. EVIDENCE: There was a minimum of two senior members of care staff and a junior on duty throughout the waking day. Additional care hours were deployed when there were activities. On the day of inspection the hairdresser and the library visited and there were exercises in the afternoon so an additional member of staff was deployed. In addition to the care staff there are the proprietor, cooks, laundress and a housekeeper. There is one waking night staff on duty each night and a member of staff sleeping in. There were some staffing vacancies so the manager and care manager were covering some shifts to ensure this staff cover was maintained. They commented that they were not able to devote as much time as they would like to their management responsibilities. They were actively recruiting to fill vacant posts. There were eleven senior carers and two juniors. Four senior staff had NVQ Level 2, one of whom was working towards Level 3. Two senior carers and the two juniors were working towards NVQ Level 2. The care manager had the registered managers award and the NVQ assessors’ award and was a qualified trainer in moving and handling.
Marlborough Lodge DS0000028337.V257376.R01.S.doc Version 5.0 Page 17 There was a recruitment procedure. The records of two recent recruits, who had not yet started work, were seen. Two written references had been requested for each recruit, plus protection of vulnerable adults list checks and criminal records bureau checks. New staff were only confirmed in post following a satisfactory CRB and POVA check. One person was about to start work before the CRB check was received, however they had a POVA check and would be supervised at all times while they were undertaking their induction. New recruits were given copies of the staff handbook and General Social Care Council code of conduct and practice. All staff received a statement of their terms and conditions. Marlborough Lodge DS0000028337.V257376.R01.S.doc Version 5.0 Page 18 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): These standards were not assessed. EVIDENCE: Marlborough Lodge DS0000028337.V257376.R01.S.doc Version 5.0 Page 19 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 3 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Marlborough Lodge DS0000028337.V257376.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? NA 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. Standard Regulation Requirement Timescale for action 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.V257376.R01.S.doc Version 5.0 Page 21 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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