CARE HOMES FOR OLDER PEOPLE
Marley Court Nursing & Residential Home Bolton Road Heath Charnock Chorley Lancashire PR7 4AZ Lead Inspector
Della Lovell Unannounced Inspection 27th February 2006 10:00 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 Marley Court Nursing & Residential Home DS0000025550.V284751.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. Marley Court Nursing & Residential Home DS0000025550.V284751.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Marley Court Nursing & Residential Home Address Bolton Road Heath Charnock Chorley Lancashire PR7 4AZ 01257 226700 01257 234407 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) Marley Court Nursing Home Limited Mrs Janet Gilchrist Marshall Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (49) of places Marley Court Nursing & Residential Home DS0000025550.V284751.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home is registered for a maximum of 49 service users in the category of OP (Old age, not falling within any other category). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines that may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 12th October 2005 Date of last inspection Brief Description of the Service: Marley Court is a purpose built home, which is registered to care for service users needing both personal or nursing care. The accommodation at Marley Court is offered on two floors, the first floor being accessed by stairs or passenger lift. The home has a range of single rooms some with en suite facilities and double or companion rooms, some of which also have en suite facilities. There are two lounge/dining rooms, one on each floor and a range of W.C’s and bathing facilities throughout, there is also a fully equipped laundry. The home has a large patio area at the front, furnished with hardwood garden furniture and set around a central fountain. This area, along with the side gardens is fully accessible to service users, regardless of mobility. As Marley Court is situated on the main A6 road from Chorley to Adlington it is well provided by public transport. Marley Court Nursing & Residential Home DS0000025550.V284751.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, which took place by two inspectors over one day in February 2006. Information regarding to standards not assessed at this inspection can be located in the previous inspection report. During the inspection discussions took place with the manager, staff, service users and three relatives. A number of records were examined as part of the inspection process. What the service does well: What has improved since the last inspection?
Since the last inspection the registered manager has up dated the homes policy and procedure for the protection of vulnerable adults, to include a clear procedure for reporting and recording allegations. Some staff were able to confirm that that they had received the training in this area. The registered manager had developed a system for supervision of staff and this was well documented on staff files. The registered provider had issued the manager with a job description and the manager is continuing to work towards the registered managers award.
Marley Court Nursing & Residential Home DS0000025550.V284751.R01.S.doc Version 5.1 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. Marley Court Nursing & Residential Home DS0000025550.V284751.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 Marley Court Nursing & Residential Home DS0000025550.V284751.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 individual needs of service users had not been sufficiently assessed prior to admission to the home to ensure that their needs could be adequately met. EVIDENCE: The care records of three people living at Marley Court were examined, which were found to contain information that had been gathered prior to the service users admission to the care home. However, the documents completed by the home were not detailed enough to determine if all assessed needs of those admitted could be adequately met by the staff team. The service user or their representative had not always been fully involved in the pre-admission process to show that they had been given the opportunity to have some input into the care which was required. The pre-admission records for one service user contained some conflicting information in relation to their nutritional requirements, which did not provide staff with clear guidance as to how these specific needs were to be met. Marley Court Nursing & Residential Home DS0000025550.V284751.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): 7 and 8 The health and personal care needs of those living at the home were being adequately met. Service users were not being supported to maintain their leisure interests and hobbies whilst living at the home. EVIDENCE: The care records examined showed that a thorough care planning process was in place. The plans of care were very detailed, providing staff with clear guidance as to how individual health and personal care needs were to be met. However, the plans of care did not incorporate the social care needs of people to show how they were being supported to maintain their leisure interests and hobbies whilst living at the home. A variety of assessments had been conducted, in relation to the provision of care, which identified any potential risks or hazards for the service user, and which showed action that was necessary to eliminate or minimise the level of risk determined in order to ensure that those living at the home were adequately protected. Service users or their representatives had not been consistently involved in the care planning process to demonstrate that they had been given the opportunity to be involved with the care provided. Recorded evidence showed
Marley Court Nursing & Residential Home DS0000025550.V284751.R01.S.doc Version 5.1 Page 10 that advice had been sought, where required, from external professionals to ensure that all health-care needs were being adequately met. One service user commented, “The staff are very nice. I am quite happy with the care” and another said, “They (the staff) are all very kind. They come and help me whenever I need help”. One relative stated, “The care is excellent. I have no concerns for my relative”. Marley Court Nursing & Residential Home DS0000025550.V284751.R01.S.doc Version 5.1 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): 13 and 14 The homes procedures enable service users to exercise choice and control over their lives and service users maintain contact with their families and friends as they wish. EVIDENCE: During the inspection visitors were seen calling in at the home. Both service users and relatives were able to confirm that there were no restrictions with regards to visiting. Service users told the inspector that they were able to see their visitors in their own room or the communal areas if they so choose. One relative spoken to said, “I call most days and can visit when I want.” Service users or their families manage the finances. The home provides a lockable storage area in all the bedrooms and payments are generally made via a relative. The home holds a small amount of money for some service users. All written records were seen to be appropriately maintained and up to date. Observations made confirmed residents had control over their own lives. One service user said that sometimes she has her meals in her room. A tour of the premises confirmed service users had brought their own personal possessions with them on admission to the home. All service users and relatives spoken to said that the staff at the home were very good and always offered choices. Marley Court Nursing & Residential Home DS0000025550.V284751.R01.S.doc Version 5.1 Page 12 The registered manager informed the inspector that the activity person records service users recreational interests. However the manager should make reference to these in the homes initial assessment process. Marley Court Nursing & Residential Home DS0000025550.V284751.R01.S.doc Version 5.1 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): 18 There is a policy and procedure in place which ensures the protection of service users. EVIDENCE: The home had a policy and procedure on protection of Vulnerable Adults. Since the last inspection the registered manager had up dated the policy to ensure that it included a clear procedure for reporting and recording allegations. Some staff were able to confirm that they had received training with regards to this and were able to explain the correct procedure to follow. However some staff were still awaiting the training. The registered person should ensure that all staff are provided with the training to ensure safety the continued safety of the service users. Marley Court Nursing & Residential Home DS0000025550.V284751.R01.S.doc Version 5.1 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 Routine maintenance ensures residents live in a safe, clean and well maintained environment. EVIDENCE: The home is clean tidy and well maintained. The registered manager told the inspector that when rooms become vacant they are re-decorated and refurbished as needed. There are contract maintenance programmes in place for the servicing of equipment and a schedule of maintenance for the home was available for the year 2006 to 2007. Service users all said that they were comfortable in the home. One relative said that her mother’s room was kept nice and clean and the room provided every thing she required. Marley Court Nursing & Residential Home DS0000025550.V284751.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): 28,29 and 30 The procedure for the recruitment of staff did not safeguard service users. Staff at the home are provided with some training, however further training is required to ensure that staff are competent in the job they do. EVIDENCE: On the day of the visit a number of staff file were examined. Since the last inspection the registered manager had re-organised the files into sections which related to; personnel, recruitment and training. The home had applied for Criminal Records Bureau Disclosure’s (CRBS) for all existing staff however the inspector noted that one new staff had commenced employment prior to receiving a POVA First or (CRB) check. It was of concern to note that this had been made a previous requirement at the last inspection and that the situation had reoccurred. In order to ensure service users are protected and in safe hands at all times no staff should work in the home providing care until all documentation has been received. There was evidence that induction for new staff takes place and all staff are kept up to date with moving and handling training. Care staff in the home, serve the evening meal, which has been prepared and left by the kitchen staff. The registered person should ensure that all staff are provided with training in basic food hygiene. No progress had been made since the last inspection with regards to ensuring care staff are trained to NVQ Level 2 in Care. The registered person was reminded that the home should ensure that 50 of the staff are trained to this level.
Marley Court Nursing & Residential Home DS0000025550.V284751.R01.S.doc Version 5.1 Page 16 The inspector noted that staffing levels in the home were sufficient for the numbers of service users living in the home, and staff were seen attentive to service users needs. Marley Court Nursing & Residential Home DS0000025550.V284751.R01.S.doc Version 5.1 Page 17 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): 33 and 35 The home is well managed which ensures the service users interests are safeguarded. EVIDENCE: Service users or their families manage their finances. The home provides a lockable storage area in all the bedrooms and fee payments are generally made via a relative. The home holds a small amount of money for some service users. All written records were seen maintained and up to date. All service users are provided with written terms and conditions which is signed by the service users. The home had a set of policies and procedures in place, which are up dated accordingly. The registered person should ensure that these policies are dated and reviewed annually. One family member said that she could speak to staff at any time and felt that the home had an open door policy with regards to communication.
Marley Court Nursing & Residential Home DS0000025550.V284751.R01.S.doc Version 5.1 Page 18 Since the last inspection the registered manager has introduced a rolling programme for supervision of staff. Staff had received a contract and dates had been booked for staff to receive supervision every two months. The supervision notes were seen to be comprehensive and well documented. The registered person meets with the provider on a regular basis and has been provided with a job description to enable her to fulfil her duty as a manager. The registered manager is continuing to work towards her Registered Managers Award. Marley Court Nursing & Residential Home DS0000025550.V284751.R01.S.doc Version 5.1 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 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X x STAFFING Standard No Score 27 X 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X x X Marley Court Nursing & Residential Home DS0000025550.V284751.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1) Requirement The registered person must ensure that a thorough assessment of needs is undertaken for each service user prior to admission. (Timescale of 30.12.05 not met) The registered person must ensure that service users and or their relatives are provided with the opportunity to be involved in the pre-admission assessment and care planning processes. (Timescale of 30.12.05 not met) The registered person must ensure that all staff receives training in the Protection of Vulnerable Adults. The registered person must ensure that the care plans provide written instructions on how all the needs of service users are to be met by the staff, including social care needs. (Timescale of 30.12.05 not met) The registered person must ensure that information and documentation listed in Schedule 2 of the Care Homes Regulation 2001 in respect of persons
DS0000025550.V284751.R01.S.doc Timescale for action 31/03/06 2. OP3OP7 14(1) (c ) 31/03/06 3 OP18 13(6) 31/08/06 4. OP7 15(1) 31/03/06 5. OP29 19(1) 02/03/06 Marley Court Nursing & Residential Home Version 5.1 Page 21 working in the home are obtained. (Timescale 31/3/05 & 30/12/05 not met) 6. OP29 19(1) Schedule 2 The registered person must ensure that all staff have a satisfactory check with the Criminal Record Bureau. (Timescale of 31/3/05 & 13/10/05) 02/03/06 7. OP30 18(1) (a)(c)(i) The registered person must put a 31/08/06 plan in place to ensure that staff are provided with the appropriate training to the work they are to perform. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The registered person should ensure that the home assessment covers the list in Standard 3.3 of The National Minimum Standards. The registered person should ensure that service users social and leisure interests are recorded at the point of admission. The registered person should make appropriate arrangements to ensure staff are qualified to NVQ Level 2 in Care. The registered person should ensure that the home policies and procedures are reviewed on a regular basis and dated and signed with review date. 2. OP7 3. 4. OP28 OP33 Marley Court Nursing & Residential Home DS0000025550.V284751.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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