Inspection on 30/01/06 for Marlfield House

This inspection was carried out on 30th January 2006.

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

The inspector 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

Marlfield House 08/08/07

Marlfield House 06/06/06

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Marlfield House Gilbert White Way Wooteys Alton Hampshire GU34 2LF Lead Inspector Mrs Pat Hibberd Unannounced Inspection 30th January 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 Marlfield House DS0000063857.V278338.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. Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Marlfield House Address Gilbert White Way Wooteys Alton Hampshire GU34 2LF 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) Hampshire County Council To Be Confirmed Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Old age, registration, with number not falling within any other category (40) of places Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection NEW SERVICE. Brief Description of the Service: Marlfield is a Local Authority Home which was purpose built and has provision for 40 residents and was registered in July 2005. There is a temporary Nurse Manager in post following the resignation of the previous manager. The Registered Provider is Hampshire County Council. Accommodation is over two floors; a lift and stairs serve both floors. All bedrooms are en suite with the Home having a number of lounges and dining areas. The Home provides nursing care for men and women over the age of 65 years who may also experience dementia. The Home also provides respite care. The building is situated in landscape grounds with a central paved courtyard, water feature and sensory gardens. Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection of Marlfield Nursing Home that took place over five and a half hours. One inspector and a regulatory manager attended the Home to undertake the inspection. Twenty-three standards were assessed on this occasion. One requirement was identified. All of the core standards for Older Persons have been inspected during the 2005/2006-inspection year. The inspection included a tour of the home and garden. Discussions were held with the Home’s manager, six permanent staff members and two agency staff. Time was spent with a number of residents with a view to gaining an understanding of care provided and to observe staff interaction and support as detailed in care plans. Four residents’ files were viewed and their care provided by the Home in all areas of their life assessed and discussed with both the manager and staff. Prior to the inspection three resident comment cards were received by the commission of which views expressed as to the service provided by the Home will be included within this report. The commission also received a completed pre inspection questionnaire from the Home of which information provided would also be included within this report. The Home was built alongside the residential care home [Marlfield] and has an interconnecting corridor on both floors, between the two homes. As part of Hampshire County Council’s refurbishment programme Marlfield is currently undergoing major redevelopment and the residents were moved temporarily out into the new nursing home, whilst the work takes place. Twenty-four residents moved across to the Nursing Home occupying one floor of the home. The residents will remain in the nursing home until the refurbishment of Marlfield is completed and then they will move back leaving the unit to only admit residents with nursing needs. On the day of the inspection the home was accommodating eight residents with nursing needs and twenty-four residents requiring personal care. Since the Marlfield Nursing Home was opened the manager has resigned. There is currently a temporary nurse manager (who is registered with the commission for another Hampshire County Council Home) in charge whilst a new nurse manager is recruited. The registered manager from Marlfield is working along side the nurse manager. For registration purposes the nurse manager is the responsible manager for the unit. Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There was one area of improvement identified relating to training. The Home is registered to provide for residents who may experience dementia. Whilst senior staff and management have undergone the relevant training all care staff and nursing staff are required to complete the training to ensure the Home has the staff skills and experience to meet residents’ needs. Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 7 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. Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 8 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 Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 9 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): 3,4,5 and 6 The home has a system in place to ensure that individuals’ aspirations and needs are identified and that changing needs continue to be met. EVIDENCE: All residents moving into the Home do so through a care management assessment, this is usually undertaken by a Care Manager in the local Adult Services area office. The process would normally include a visit to the Home enabling prospective residents to meet staff and other residents and view their accommodation. On admission all residents would be given a service user guide of the Home detailing the services and facilities available. In the event of an emergency admission a review would take place of the situation on the next working day when all relevant parties would be involved. In addition to the care management assessment Marlfield has a very comprehensive pre admission assessment form that covers all aspects of the residents’ abilities and capabilities. This would be completed by a senior member of management as part of the admission process Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 10 The nurse manager and senior nurse are currently assessing all prospective residents with nursing needs. The senior nurse indicated that the assessment tool used is in accordance with Department of Health guidance. Since the home opened eight residents with nursing needs have been admitted. The nurse manager involves the client’s care manager in the assessment process and would also attend Social Services’ panel, where prospective admissions are discussed throughout the county. This has also proved to be the means of informing care managers of the criteria for Marlfield Nursing Home. As previously indicated the home is accommodating residents, from Marlfield. The building is currently so arranged that the residents are accommodated on the first floor in a maximum of twenty four bedrooms and residents with nursing needs are accommodated on the ground floor. There are currently twenty-four residents occupying the first floor and eight accommodated on the ground floor. Three residents accommodated in the nursing wing are receiving respite care. One relative spoken to indicated that they did not have anyone from the Home visit them prior to admission for their relatives short stay but confirmed that a care manager was involved from Social services and that the information they received was sufficient for their needs. The inspector was able to view four residents’ files two of which related to individuals who required nursing care on admission. A comprehensive preadmission assessment had been carried out along with other assessments since admission, including a manual handling assessment, risk of falls, communication, mental health assessment and nutrition assessment. One resident spoken to told the inspector that the staff “ couldn’t do better” “they are very helpful”. All indicated that they were settled in Marlfield Nursing Home. Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 11 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 and 10 Residents are treated with dignity and respect with care plans detailed; ensuring health, personal and social care needs are met The Home’s medication policy and procedure is being fully implemented ensuring residents are protected. EVIDENCE: Each resident has an individual care plan which includes a risk assessment relating to needs identified. The care plan is jointly agreed with the resident and their representative (if the resident agrees) and the Home.The care plan and risk assessment is reviewed monthly with the resident by the key worker (the person who mostly works with the individual). At the yearly review the resident, representative, key worker, care manager and a manager will discuss both the care plan and risk assessment to ensure they still meet the needs of the resident. A review can be called at any time should a residents needs deteriorate/change. Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 12 Four care plans of residents were examined. Two of which related to individuals who are accommodated in the nursing wing. The documents were detailed and the plans were based on the assessments the home carried out in order to identify what help individuals needed. The plans set out clearly the actions staff had to take and what specialist equipment was needed to provide the support and assistance each person required. Observation and discussion with one resident confirmed that the individual received the help they needed and that the equipment was in place as set out in their plans of care. There was evidence from both the care plans and related documentation and discussion with the residents concerned that individuals and/or their representatives had been involved in developing the plans and agreed with their contents. One resident commented “ staff talked to me about the care I need “ All nursing and care staff (including an agency staff member) spoken to were fully aware of the contents of the care plans that were sampled and the assistance that the individuals concerned required. The care plans /documents included assessments of the potential risks to residents treatment of pressure sores, malnutrition, and falls. Strategies for eliminating or reducing the risk of harm had been identified and implemented e.g. pressure-relieving aids were in place for one resident who has a pressure sore. There was documentary evidence that care plans were evaluated and reviewed regularly. There are five GP practices providing health care to the Home. All residents have access to a dentist, chiropodist, optician, continence advisor, occupational therapist and district nurses. The home had written policies and procedures concerned with the management and administration of medication. A range of reference material about medication was readily available. Medication is kept in locked and secured medicine trolleys and cupboards and also where required in a medical refrigerator. Controlled drugs were stored securely and in an appropriate metal locked cabinet. Medicines were dispensed from their original containers with fifteen staff trained and responsible for the management and administration of medication in the Home. Records were kept of the ordering, receipt, administration and the disposal of medicines and these were accurate and up to date. The home had implemented new methods for the disposal of unwanted and unused medicines. This had arisen as a result of recent changes in the National Health Service contract for community pharmacists and to ensure compliance with legislation about the disposal of industrial waste. One resident self-administers with records kept by staff to monitor the medication taken and, safe storage. Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 13 Much time was spent with residents and staff with a view to gaining an understanding of how the home are endeavouring to treat residents with dignity and respect and uphold their privacy. Residents indicated that staff don’t open their mail, address them by their preferred name, knock before entering their bedroom, have access to a phone and wear what they like. Individuals can get up and go to bed when they choose. Core value training is provided as part of induction and ongoing if required and identified for example following supervision. The senior nurse described the process recently undertaken of a resident who had passed away in the Home. It was evident that dignity and respect had been paramount. Further observations of staff supporting residents with an activity demonstrated that choice was being promoted at the same time ensuring resident’s abilities were recognised and they were treated with dignity and respect. Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 14 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): 12,13,14 and 15. Leisure and routines of daily living are well managed, providing choice and interest for people living in the home. EVIDENCE: There are a variety of activities on offer to residents that include music and movement, visiting entertainers, bingo, word games, craft sessions and cards. There is a visiting church service monthly. Information as to forthcoming activities was available. Staff were observed supporting a craft session of which residents had been given a choice as to whether they wished to partake in. Staff should be commended for their sensitivity and support observed as being offered to residents. For example one was resident was asked if the table was the right height and if the individual had the appropriate equipment to participate “successfully” in the activity. Visitors are welcome but cannot enter into the home unnoticed, as the inner reception front door is on a digital lock system. Visitors also are required to sign in. There are a number of attractive communal areas for residents to sit quietly or entertain their visitors. The home is divided into units each with a Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 15 dining room/lounge and kitchenette, provided with microwave, kettle and refrigerator where beverages can be made home. Residents confirmed that they are given choice within the home including staff asking them how they wished to spend their day, personalisation of their bedrooms and meals (as detailed below). Observations of staff interaction with residents throughout the day indicated that staff were offering choices in services/care provided. Residents have access to their records that are securely held in the office. Marlfield Nursing Home does not have a main kitchen as it has been planned that all main meals will be produced in the residential care home, Marlfield. Whilst Marlfield is being renovated and refurbished, cooking of all meals is undertaken in two portacabins. On the day of the inspection the cook on duty was from an agency and was being supported by two permanent staff members. They had been given instructions as to what meals they needed to prepare for the day and kitchen procedures. The inspector viewed the kitchen environment that was clean although staff indicated that it was limited in space and cold despite two wall heaters being installed. The manager indicated that the new kitchen should be ready within the next 6 weeks although no firm date has been confirmed. In discussion with a number of residents the change in kitchen facilities had not had an impact on the quality of food. One resident told the inspector that the food is “ good I like everything and there is choices “ Another resident told the inspector that “ I am not aware of what is for lunch but I like everything so I don’t mind”. The manager advised that residents are always asked the previous day what they would like for their meals with special diets catered for. Staff were observed asking residents what they would like for meals to be taken the next day. The menus viewed were varied and offered a minimum of two choices at each meal with sausage casserole and omelettes being the two lunch options on the day of inspection. Meals can be taken in the dining room or resident’s own bedroom with one resident indicating that they had been given the choice on admission as to where they might eat their meals. Marlfield House DS0000063857.V278338.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): 16 and 18 The home’s complaints and adult protection policy and procedure is being implemented ensuring residents are safeguarded. EVIDENCE: The Home has a complaints policy and procedure that is held in the duty office. It is available in large print. All residents and significant others (usually relatives) are advised of the Home’s complaints procedure on admission and at reviews. All residents are given a copy with their service user guide with a further copy pinned to the notice boards in the home. Whilst the manager indicated that the Home would hope to address all complaints and strive to reach a satisfactory conclusion for the individual the procedure provides details of the commissions address and telephone number in the event of the complainant being dissatisfied. There is also an independent (outside of the Home) procedure available. Complaints leaflets were viewed in the reception area of the home. There have been four complaints made to the Home two of which were substantiated and two are ongoing. From discussions held with the manager and documentation viewed it was evident that the complaints were being appropriately dealt with. One questionnaire received from a resident raised issues relating to being unsure as to who they would speak to if they had a problem. This was followed up during the inspection with the individual who was able to confirm that they would talk to staff if they needed to. Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 17 In discussion with a number of other residents they indicated that they would talk to staff if they were unhappy. “ I would talk to the woman in the office “ “ ive got no grumbles or problems but would talk to staff if I had “. The home has polices and procedures in relation to abuse and whistle blowing. A copy of The Department of Health “ No Secrets” document is held in the Home. With the exception of six staff who are due to attend a course in February 2006 all have received abuse training. In discussion with one permanent staff member and one agency member it was evident that they were aware of their role and responsibilities in the event of a disclosure / observation of abusive practice. There has been one allegation of abuse reported to Social Services which is being dealt with under the Hampshire Adult Protection Procedures. An action plan has been put in place in the home of which the commission have received a copy. The plan is currently being implemented and will be monitored by Social Services who are the lead agency in any abuse investigation. On the day of the inspection the Finance Administrator was not available. Whilst the manager was able to explain the system used to record any monies held for residents this area of the standard could not be fully inspected on this occasion. The manager explained that the administrator is the only staff member having a full understanding of the system used in the home. The manager acknowledged that this is an issue and is being currently addressed. Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 18 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 and 26 The home is clean, hygienic, safe and well maintained. EVIDENCE: The inspectors were able to tour the building. Marlfield Nursing Home is a new build, which was completed in July 2005 and is purpose built. The Home can be entered by pressing a button that allows a visitor into the small lobby. To access the main building visitors need to be let in by a member of staff. The home has forty single bedrooms, twenty-four on the first floor and sixteen on the ground floor. One bedroom on the ground floor is currently being used as a hairdressing room, but will revert to a bedroom, when the residents move back to Marlfield. The bedrooms are spacious and are all provided with en suite toilets. The bedrooms on the ground floor have been designed for residents with nursing needs and have special beds, hoists and equipment. All bedrooms have a call bell available, lockable storage and individual thermostats. Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 19 There are sufficient communal areas for residents to enjoy a quiet place to sit or relax with other residents. There are kitchenettes in the lounge/dining areas providing opportunities for residents who are able to make drinks/toast. The standard of furnishings and fittings is good. The design of the building has been well thought out and there is a feeling of spaciousness. The decoration is to a high standard and the home was clean, with no unpleasant smells. The whole environment is very pleasant for service users. There is an enclosed garden with a water feature for residents to enjoy. Residents indicated that they enjoyed the private facilities in their bedroom and found the environment” warm and pleasant”. Routine maintenance is undertaken by the county council. The Fire Officer last visited on 2/9/2005 and the Environmental Health Officer 14/10/2005. All residents and visitors spoken to said that the communal areas were comfortable and that the building was kept clean. There were no offensive odours at the time of the inspection and the décor and furnishings were in good condition and domestic in character. Staff were observed during the inspection doing cleaning tasks and all staff were also observed at different times using protective clothing appropriately. There were a range of written policies and procedures available that were concerned with infection control and staff spoken to confirmed that they had received training in the subject. There were “gel” hand disinfection dispensers located strategically in the buildings and there were sluice disinfectors located on both floors of the home. The home’s laundry facilities were suitably sited and equipped and procedures for managing soiled items were appropriate. Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 20 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 and 30 Staffing meets the current needs of residents accommodated. The home’s recruitment procedures for new staff were satisfactory, ensuring the protection of residents. Training needs to be improved to ensure the home can meet the requirements of their registration. EVIDENCE: The Home employs a management team of a Nursing Manager, Non Nursing Manager, Deputy Unit Manager, 3 Assistant Unit Managers and 2 Senior Nurses. All members of the management team have designated roles and responsibilities. There is an organisational structure on display that includes photographs of all staff. The staffing in the Home is organised into two staff teams. One for the nursing wing and one for the floor accommodating residents from Marlfield Care Home. Rotas viewed for the nursing wing indicated that there is always a qualified nurse on duty and two carers to support the eight residents accommodated. This number will increase as residents move in. A senior nurse works alongside the staff team during the week and is in addition to the staff working with residents. Rotas for the residents accommodated from Marlfield Care Home indicated that there is an assistant manager always on shift, the unit manager from the care home Monday to Thursday and two waking night staff. From 7.40am until 3pm there are three care staff and from 2.40pm until 10pm two care staff. There Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 21 are designated cleaning staff for both floors and domestic and laundry assistants. There are three staff employed in the kitchen who provide meals to both floors. Staff spoken to indicated that they considered there to be sufficient staff and time to meet the needs of individuals accommodated. Residents further indicated that their needs were being met and staff were available as and when they needed support. There are 26 care assistants of which 9 (33 ) have achieved National Vocational Qualification (NVQ) in care at level 2 or above. However, one staff member indicated that they would like to attend NVQ training but there were difficulties finding a course locally. This was discussed with management who advised that this would be explored with a view to more suitable options being found for staff. This will be followed up at the next inspection. The records of 4 staff recruited to work in the home were inspected. It was apparent that the home carried out all the necessary pre-employment checks to ensure that the individuals were suitable to be employed to work with vulnerable adults before they actually started work in the home. A range of training is provided for staff with all staff undertaking the County Council corporate induction programme in addition to a general induction in the Home that includes health and safety/ fire procedures. Further training undertaken includes moving and handling, infection control, food hygiene, core values and adult protection. All overseas nursing staff working in the Home undertake training to meet the requirements of the Nursing Midwifery Council prior to commencing employment. Some of the staff working in the nursing wing had undertaken further training that includes the use of hoists and emergency aid. The senior nurse produced a training grid that she is using to monitor training of staff and, ensure all updates are completed within required timescales. Staff spoken to indicated that they felt competent to carry out their role and were well supervised by management. However, the Home is registered to provide for residents who may experience dementia. It was evident from discussions with management that training in this area had not been provided for care and nursing staff despite an assurance at registration that this would be undertaken within the first six months of the home being open. A requirement was made for the training to be arranged for all staff within the next three months and the commission advised to this effect. Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 22 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, and 38. There is an effective manager in place addressing the needs of staff and residents. The home has systems in place for; monitoring the quality of the service provided by the home; ensuring residents interests are safeguarded and the health and safety of both staff and residents is promoted. EVIDENCE: The temporary manager Ms Brodison has a wealth of experience having managed residential care homes for a number of years. Ms Brodison is a Registered General Nurse, has a BS(c) (HONS) Ageing and has completed her Registered Managers Award. Ms Brodison has a range of responsibilities and indicated that these are reflected in her job description and include ensuring the written aims and objectives of the Home are met, policies and procedures are implemented, the Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 23 budget is properly managed and residents are aware of their terms and conditions of residency. From discussions with staff and residents and documentation viewed Ms Brodison is demonstrating her ability to ensure systems are in place to achieve and meet her role and responsibilities and, provide effective leadership and management of the Home. Residents were seen to respond positively to the manager who was able to demonstrate throughout the inspection her understanding and knowledge of service users’ needs. The Home has an annual development plan with objectives in place to measure outcomes for residents in respect of their care, staff and environment. The objectives are linked to the County Councils overarching corporate strategy /objectives. However, the manager indicated that this is an area of development and had been “ quite a challenge” due to the change in management since the home opened in July 2005.It was agreed that this would be followed up at the next inspection when the manager indicated that a more formal process would have been implemented including questionnaires for residents and their relatives/carers. Whilst resident meetings are also held the manager indicated that not all residents are able or wish to fully engage in the meetings. Systems currently implemented to ensure there is an effective quality assurance and monitoring of residents’ views include care plan and risk assessment evaluations on a monthly basis – or sooner if required and monthly visits undertaken by senior managers of which copies of the outcome of those visits are forward to the commission. The home had a range of written policies and procedures copies of which were kept in the home’s nurses’ station/office and were readily available. Staff spoken to said that they were helpful and could be referred to for guidance and that they informed their practice. The policies and procedures were reviewed regularly and updated as necessary. There was evidence from both discussions and relevant records being kept by the home that all staff working in the home had received regular training in health and safety subjects that were relevant to their roles in the home. These included, first aid, fire safety, food hygiene, moving and handling, infection control and control of substances hazardous to health. Comprehensive and clear records being kept indicated that risk assessments for safe working practices had been completed and that all 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. These included: • Fire safety equipment • Electrical wiring • Gas appliances and central heating • Portable electrical appliances • Hoists and slings Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 24 • • • Lifts Clinical equipment Hot water systems –(tested for temperature and the presence of Legionella). However, in discussion with an agency cook who was working at the Home for the first time it was evident that she had not been instructed as to what to do in the event of a fire in the Home. This was mentioned to the senior nurse on duty who immediately ensured the instructions were given to the staff member. The senior nurse indicated that normal practice in the Home would be to ensure all agency/new staff were given an induction into fire procedures. Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 25 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 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 26 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. 1 Standard OP30 Regulation 18 Requirement The Registered Provider must ensure all staff have undergone dementia care training to ensure the Home has the staff skills and experience to meet residents’ needs and their registration. Timescale for action 30/04/06 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 Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 27 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 Marlfield House DS0000063857.V278338.R01.S.doc Version 5.1 Page 28 - 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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