Inspection on 02/06/06 for Marling Court

This inspection was carried out on 2nd June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Marling Court 14/08/07

Marling Court 15/12/05

Marling Court 09/06/05

Marling Court 21/10/04

Marling Court 20/05/04

Marling Court 01/07/03

Similar services:

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Henry Nihill House

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

CARE HOMES FOR OLDER PEOPLE Marling Court Bramble Lane Off The Avenue Hampton Middlesex TW12 3XB Lead Inspector Sandy Patrick Unannounced Inspection 10:00 2nd June 2006 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 Marling Court DS0000017382.V289525.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. Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Marling Court Address Bramble Lane Off The Avenue Hampton Middlesex TW12 3XB 020 8783 0157 02087830078 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) Richmond upon Thames Churches Housing Trust Mrs Susan Edwina Penfold Care Home 37 Category(ies) of Dementia (25), Old age, not falling within any registration, with number other category (20), Physical disability over 65 of places years of age (20) Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To admit one named female service user aged 63 years. The Registered Person must ensure that all staff are appropriately trained in dementia care. 15th December 2005 Date of last inspection Brief Description of the Service: Marling Court is a purpose built residential care home in Hampton providing personal care and accommodation for up to thirty-seven people. Up to twentyfive of whom may have dementia. The number of places registered for service users with dementia was increased from seventeen in November 2004, when the home applied for a variation to the categories of registration. A condition of this variation was that all staff must be appropriately trained in dementia care. Marling Court is situated close to local facilities and amenities and is set within a residential area. The home’s internal décor is pleasing with a large homely lounge. There are four interconnecting units, each with its own kitchenette, sitting and dining area. The lobby area is welcoming and off this are the Manager’s office, the duty office, the kitchen and laundry. The home has attractive gardens accessible to service users. CCTV cameras monitor the entrance and nearby designated parking spaces. The home is owned and managed by Richmond upon Thames Churches Housing Trust. The Registered Persons have produced a Service User Guide, which includes information on the aims and objectives of the service. The charges for Marling Court are between £547 – 577 per week. Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days, 2nd and 5th June 2006 and was unannounced. The Inspector met with service users, staff on duty, the Manager and senior managers who were visiting the home to conduct interviews for a new Manager. The Inspector was made welcome and was invited to share a midday meal with the residents of one unit on one of the days. The Manager retired from her post earlier in the year but agreed to stay working at the home part time until a new Manager has been recruited. Other senior staff have helped to manage the home on a day to day basis. Following the interviews for a new Manager held during the inspection, a person was successfully recruited. The CSCI contacted professionals who work with the home and asked the Manager to distribute surveys to residents and relatives in order to gain their views on the service. Two residents, five relatives and six professionals returned surveys. Both residents said that they received suitable information about the home to help them make a decision about moving there. They both felt that they received the care and support they needed. They said that staff were usually available when they needed them. They liked the activities, usually liked the food and thought the home was kept fresh and clean. Both residents knew who to speak to if they were unhappy about anything. All five relatives said that they were made welcome at the home, that they felt staff demonstrated a good understanding of the residents’ needs and that they felt residents were happy at the home. Two relatives thought that the staff were very good at communicating with them. One relative said that they felt it would be nice if more outings were organised for residents. One relative felt that other activities could be improved. One relative said that following a change in need for their relative the management said that the home could no longer meet their needs and that they felt this was not right and that the management had been too quick in making this decision. One relative commented that the atmosphere at the home was warm and welcoming and that staff were very caring. One relative said that there were too many agency staff. One person wrote, ‘top quality caring and all the staff have a pleasant attitude’. All six professionals said that they felt staff communicated clearly with them. Four of the professionals said that the staff had a good understanding of the needs of residents and followed specialist advice. But two professionals said that staff did not understand about the needs of residents who have dementia. Both these professionals said that the Manager and staff did not tolerate changes in need for people with dementia and that the staff needed more Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 6 training in this area. This is an area highlighted by the Inspector within this and previous inspections. Many of the professionals said that they found the staff kind and caring. One person wrote that it was a pleasure to visit the home. Some of the professionals were concerned about the amount of activities at the home. Two of the professionals raised concerns about staffing at nighttime. Residents who spoke to the Inspector generally said that they were happy and liked the staff who worked with them. What the service does well: What has improved since the last inspection? What they could do better: The home needs to develop a more person centred approach where individual needs and wishes are identified and met. There needs to be further improvements to make sure residents’ social and leisure needs are met. The staff need to have more information and training to understand the needs of people who have dementia. The staffing levels at night must be reviewed to make sure residents are safe. Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 7 Some of the staff need training in protection of vulnerable adults, manual handling and first aid. There should be improvements to the environment to make sure residents can orientate themselves and to make sure there is enough space for residents to dine comfortably. 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. Marling Court DS0000017382.V289525.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 Marling Court DS0000017382.V289525.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): 1, 2, 3, 4 & 5 Quality in this outcome group is good. This judgement has been based on information received from the home and seen during a visit to the service. A range of information is available for residents to make a decision about moving to the home and they are invited to visits and spend time at the home. Assessments made on residents before they move to the home could be improved. The staff do not have the skills and knowledge necessary to meet the needs of the residents who have dementia and further work in this area is needed to make sure residents’ needs are met. EVIDENCE: The home has a suitable Statement of Purpose and Service User Guide which are available for prospective residents. There have been no changes to these since the last inspection. The new Manager should review these and update information once she is in post. The home’s aims and objectives displayed in Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 10 the reception area are from 2004/2005. These would benefit from being updated and redesigned so that they are easier for residents to understand. Copies of the most recent inspection report are available in the home’s foyer. All residents are assessed by senior staff during a visit to the home prior to admission. The Inspector looked at a sample of records for eight different residents. Some of these had moved to the home within the last year. Some of the assessment information was very basic and did not give a good picture of the resident and their individual needs. The format for assessments does not give due space for information on social, cultural and ethnic needs and staff had not completed these sections very fully. Some of the wording on assessments was unclear and did not make sense. Information on general observations made during the resident’s visit was in some cases very limited and basic. Two of the health care professionals who work with some residents said that they felt assessments were insufficient. The Inspector recognises that assessments are largely based on information from other parties and that the staff need time to get to know residents as part of a fuller assessment. However, some of the information on these assessments could be more detailed and the staff doing these must make sure they gain as much information and detail as possible. At times they made need to ask more searching questions and work with families and other representatives so that they understand the importance of thorough assessments. Residents move to the house for a six week trial stay and this forms part of the assessment process and allows residents to see if they like living at the home. Records of review meetings for residents at the end of this period were seen to be in place. Reviews allow the resident, their representatives and the home to decide whether their needs can be met and if they want to stay. Individual licence agreements are in place for all service users. These include terms and conditions of residency, a charter of rights and copies of the complaints and admissions procedures. Copies of contracts are given to service users and a copy is held by Richmond Churches Housing Trust. The home offers a place for up to twenty-five residents who have dementia. However, some staff do not have the knowledge and skills to effectively meet their needs and further training is required. (Refer to Health and Personal Care and Staffing Sections of this report). Marling Court DS0000017382.V289525.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 & 10 Quality in this outcome group is adequate. This judgement has been based on information from the home, other professionals and during a visit to the home. Care plans are in place but need improving so that information is clear, accurate and identifies individual needs rather than being task orientated. Medication is generally well managed but some improvements to recording are needed. Most staff were kind and caring but some staff did not respect the privacy and dignity of residents. EVIDENCE: All residents have individual care plans and these summarise their needs. They are reviewed regularly and copies of the care plans are kept on the units. There are no photographs of residents in the care plans or medication records on the unit and there should be to avoid the risk of new or temporary staff not being able to identify residents. Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 12 Some of the care plans and risk assessments included general statements such as, ‘has dementia’ and ‘needs reassurance’. These statements do not give staff clear information. Other statements were inappropriate or confusing, such as ‘well behaved’ and ‘staff to be firm’ and one care plan referred to a toileting regime. Care plans should contain clear and factual information that will support staff to give the care needed. Care plans are very task orientated rather than looking at individual needs and wishes. The care plans were often very general and similar and more work to look at individual needs and adopt a person centred approach should take place. One care plan referred to a resident who often refused to take a bath. However there was no clear guidance for staff on how to support this resident to feel more at ease during bath time. Personal preferences and likes should be recorded so that staff can have a clear understanding of how best to support residents to meet their needs. Some of the risk assessments for residents had not been reviewed following falls, changes in medication or other incidents. One risk assessment included information about equipment which was no longer used. Some of the information on risk assessments was unclear and some contradicted other information within care plans. The Manager must make sure risk assessments are clear, accurate and are reviewed and updated following changes in need, for equipment, medication and falls. Bathing records generally indicated regular baths and showers, but some showed longs gaps or up to eleven days between baths being offered. Some of the bathing records identified problems with skin but there was no evidence that this was followed up in the care plan or in future bathing records. There is a suitable medication procedure and all staff administering medication are trained to do so. Medication was generally stored and recorded accurately. However, the receipt of some medication was not recorded and some symbols on the administration records were not used correctly. Members of staff discussed an incident where they felt a resident was putting other residents at risk and had taken what they felt was appropriate action. However, the action they took was in direct conflict with instructions in the care plan. The incident had been discussed with the Deputy Manager at the time. However, no risk assessment had been developed following the incident and event records had been changed so that they gave inaccurate information. The Inspector discussed the incident with the Deputy Manager. A risk assessment must be developed for this resident so that staff know what action to take. Records must not be falsified or changed. The Inspector observed staff interactions with residents. In all units staff were seen to be kind and caring, however some showed a limited understanding of the needs of people with dementia. For example, some residents were told to Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 13 sit down when they wanted to walk around. Staff supporting residents during mealtimes did not understand that some residents did not want to eat at that time. It is important that the staff have information and training about dementia so that they can interpret different needs and support the residents. The requirement for training in this area is restated (refer to Staffing Section). In one unit the Inspector observed a member of staff walking straight into a resident’s bedroom to get something. The resident was in the lounge and the staff member did not ask the resident’s permission. The Manager must make sure the staff respect the privacy of residents and do not enter their bedrooms without permission. Another staff member referred to a resident as a ‘good girl’. The Manager must make sure staff do not use inappropriate terms. One staff member walked up to a resident and started combing their hair without asking them if they wanted them to do this or even telling them what they were doing. This is not acceptable and the staff should always consult residents about their care. Residents are registered with a number of local GPs, and are able to retain their family GP if they are local. There is evidence of input and support from other health care professionals. Details of consultation and interventions are recorded. Health care needs, including information from health care professionals, is recorded within care plans. Marling Court DS0000017382.V289525.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 & 15 Quality in this outcome group is adequate. Some areas require further improvements. This judgement is based on information gained during a visit to the home. There has been some improvements to activities, but further improvements are needed to make sure individual needs are met. Visitors are welcome and are able to continue to be involved with the care of relatives if they wish. Most residents like the food but further choices need to be available. EVIDENCE: Since the last inspection the home has tried to improve activities. Some activities are very good and a lot of thought and time has gone into preparing events around Christmas, Easter, the summer fare and other special events. There is also a regular Saturday film club. The work of staff and the enjoyment residents gain from these activities is recognised. The staff have also been more proactive in taking residents out for short walks to the park and local shops. Some residents went out during the inspection in small groups and staff spoke about plans for other residents to go out in the evening. This is Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 15 very important and residents should be able to enjoy the local community and feel that they can get out of the home if they wish. Throughout the inspection visits, residents were seen to spend time in unit’s lounges. Often music was playing and some residents were relaxing or reading newspapers. Some of the time the staff on duty were sitting and chatting with residents, but for the majority of time staff were busy attending to other tasks in the kitchen or elsewhere on the units and residents were left without conversation or stimulation. There is a programme of organised activities, but this is generally one activity for each day. On the first day of the inspection the organised activity was craft. The Inspector asked the staff on duty in one unit what they did for this. They said that the residents sometimes did colouring and at Easter made Easter cards. There was no plan for this activity and the staff said that they would just get the colouring things out and see if people wanted to join in. The units should be equipped with resources for residents to participate in these sorts of activities at any time. Colouring and basic craft equipment, books, magazines, puzzles, dominos, cards, other games and other materials should be available at all times. Residents could therefore choose to do these at any time of the day and not just when set activities are organised. The resources should be based around the likes and abilities of the residents on each unit. The organised activities should be better planned. Some activities, such as karaoke and other events held in the main lounge are organised and residents clearly enjoy these. However, these are not organised for everyday and on days when the staff on units are responsible for organising activities there should be more planning and preparation time to make sure the activities meet the needs of the residents of individual units. Information in care plans on social interests is mixed. Some families have provided a good range of information on personal histories and things that are important to them. In some of these the information given by families was not transferred into the main care plan. For example cultural preferences and heritage. Keyworkers should be more proactive in seeking information about individual interests, likes and dislikes, life experiences and cultural needs. Information from the resident and their families should be included within the care plan under relevant sections so that staff can adopt a more person centred approach which enables them to plan activities and care to meet individual needs. Regular resident meetings are held and minuted and information for residents is posted on notice boards. A regular church service is held at the home and residents are free to attend this if they wish. The staff were able to tell the Inspector about the cultural Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 16 needs of one resident. Some of the social histories for residents indicated different countries of origin and childhood for many of the residents. The staff should be proactive in finding out whether these residents have any cultural needs and how these could be met. Visitors are made welcome at the home. Relatives can remain involved in the care of residents if this is what they wish. The menu is varied and offers some choices for residents. Most residents said that they liked the food. The chef visits the units after meals to ask residents about their enjoyment of the food. The Inspector shared the midday meal with residents of one unit. The majority of residents on the unit did not want the pudding offered. No alternative was offered. The Registered Person must make sure alternative puddings, yoghurts and fruit are available for residents who do not want the set pudding. One resident told staff that they were hungry at 11am but they were not offered anything to eat at this time or until lunch. Staff supporting residents to eat did not sit next to them but stood over them and in some cases walked away then returned. There is a problem with space in one dining area (See Environment Section) and this means it is hard for staff to find room to sit with residents. However, any resident who needs support must have a dedicated staff member who sits with them for the duration of their meal. Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 17 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, 17 & 18 Quality in this outcome group is good. Some improvements are needed. This judgement is based on information from the home and information gained during a visit to the service. There are appropriate procedures for complaints and protection of vulnerable adults. EVIDENCE: There is an appropriate complaints procedure that includes timescales and information on contacting the Commission for Social Care Inspection. There has been one complaint since the last inspection and this was appropriately investigated by the local authority. The Deputy Manager said that residents participated in the recent local elections and all residents were on the electoral register. Age Concern visit the home once a year to conduct a quality audit and to speak to all residents. The Manager said that they also provide an advocacy service to support residents who do not have families or representatives outside of the home. The home has adopted the London Borough of Richmond Protection of Vulnerable Adults procedure. In addition, Richmond Churches Housing Trust has its own procedures on abuse and whistle blowing. Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 18 Some staff have not had training in protection of vulnerable adults and must have this. Staff need to be aware that some of the practices the Inspector observed could be seen as abusive, such as telling residents to sit down when they wanted to get up and combing their hair without speaking to them. Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 19 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, 22, 23, 24, 25 & 26 Quality in this outcome group is good, although some improvements are needed. This judgement is based on evidence seen during the inspection visit. In general, the environment is safe and well maintained. There is a pleasant homely atmosphere and residents are able to personalise their rooms. There are insufficient facilities in one of the units. There needs to be further development to support orientation for residents who are confused, so that they become familiar and secure with their environment. The current procedure for washing soiled laundry is not safe and must be changed. EVIDENCE: Accommodation is provided on two floors, accessible by stairways and a passenger lift. There are four interconnected units each with between seven and ten bedrooms, a lounge/diner and a kitchenette. All rooms have en suite facilities and there is a bathroom on each unit. There are two flats at the home, each accommodating one service user. Both flats have a small kitchenette, a shower room and WC. Bedrooms are personalised. There are two attractive, enclosed, level access garden patio areas. Plants, pictures, Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 20 photographs and ornaments throughout the home add to the general ambience. There is a programme of maintenance and bedrooms and communal areas are decorated as needed. The Manager said that funding for new carpets in the corridors had been approved and they were waiting for these to be purchased and fitted. The home’s maintenance man was addressing minor areas of wear and tear and paintwork. During 2005, the home was registered to accommodate a greater number of residents who have dementia. Richmond Upon Thames Housing Trust need to consider ways to improve the environment to meet the needs of these residents. Particular attention should be paid to how residents orientate themselves and identify their rooms. Residents and their families should be consulted about how they would like their rooms to be identified. They should be offered choices of name plates, numbers or pictures that are meaningful to them. The Inspector joined residents of one unit for their midday meal. The unit has only one communal area and this is not big enough for dining and a lounge. Furniture had to be moved around before and after the meal and residents could not return to their lounge chairs until everyone had finished and the dining tables put away. Staff had to squeeze behind chairs to serve residents and there was not sufficient room for staff to sit with residents and help them with their meal. The situation was difficult for staff and residents. The other ground floor unit has a conservatory area for dining. Consideration is being given to building additional space for this unit also. It is essential that some action is taken to address the problems of sharing the dining and lounge space. There must be room for residents and staff to safely manoeuvre and staff must be able to sit with residents when helping them to eat. The procedures for handling of soiled laundry are not appropriate and staff and service users are put at risk of cross infection. A new procedure, which is designed to reduce risks, must be introduced. Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 21 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): Quality in this outcome group is good. However, further improvements are needed in reviewing staffing levels and staff training. This judgement is based on information received about the home and evidence seen during the inspection visit. Staffing levels at night do not reflect the needs of residents and must be reviewed. Recruitment and selection procedures are appropriate. Further staff training in some areas is needed. EVIDENCE: The staff team at Marling Court are fairly stable with a low staff turn over. Some of the staff have worked at the home for many years and they demonstrate a commitment to the home and the residents that they care for. At the time of the inspection there was a small number of staff vacancies which were being recruited to. The staff who spoke to the Inspector said that they were generally happy and were well supported. They said that the systems of communication between staff worked well and that they were always made aware of changes when they came to work. Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 22 There are only two waking night staff at the home working across four units. The home is registered to care for up to twenty-five residents who have dementia. The staff and other professionals have raised concerns that staffing levels at night are dangerous and that the needs of residents cannot be met by only two staff. There are times during the night when residents require attention and if staff are occupied with one resident then they are not always aware of the needs of other residents. Some of the residents do not sleep well and like to be awake at night. Residents who are confused may find it difficult to sleep and do not want to stay in their rooms. The staffing structure at the home should allow for this. One staff member said that when they were administering night medication this required two members of staff and therefore no other staff were available to meet the other needs of residents. The Area Manager said that she felt staffing levels were sufficient. However staffing should not be based on financial restraints but on a full risk assessment of the needs of the home. A recent complaint at the home partly related to the needs of one resident at night. In the Manager’s response to the complaint, she wrote that 5am was a very busy time in the home for night staff. The staffing situation should be regularly reviewed and consideration should be given to the needs and safety of residents. The organisation has decided to change the structure of staffing at this and their other homes. Some of the staff will be promoted into a keyworking role, so that all carers share equally responsibilities on an equal pay scale. The Area Manager spoke about this and said that she hoped the new structure would free up staff time for more individual activities and improvements with care planning. Staff who spoke to the Inspector were generally pleased with this change, particularly where it meant promotion and higher salaries. However, the staff seemed unsure of what their new responsibilities might be. A number of staff said that they thought keyworking was making sure their residents had a bath and updating care plans. It is important that the keyworking system is used to support person centred planning and individual care. For this to work the staff must have training and support to understand their role. There are appropriate procedures for the recruitment of staff and staff files contain evidence of pre employment checks. Some of the staff at the home have not had any training in dementia. Other staff have only had very basic training. Training for all staff in this area is a condition of registration it has also been made as a requirement at the last three inspections. Two professionals, who support the home with the care of residents who have dementia, felt that staff and managers lacked understanding of dementia and the needs of residents. Observations at this and previous inspections and feedback from other parties is that staff are caring and try to meet the needs of residents. But they clearly do not understand about different needs of people with dementia. Observations during mealtimes and in providing activities showed a lack of understanding which could be detrimental to the residents. Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 23 The Area Manager who met with the Inspector said that the organisation had purchased a training package about dementia and hoped to employ someone to deliver this. This work is a priority and all staff should receive the training, information and support they need to be able to effectively work with residents who have dementia. The requirement is restated and failure to comply may lead to enforcement action being taken. It would be useful for some of the senior staff to have training that would enable them to offer staff in house training. During the inspection the Inspector felt that there were some areas where staff practice could be improved with basic in house training, such as helping people at mealtimes. If the senior staff had the training and support to feel confident in delivering this it would mean that staff could receive appropriate training in the work place and in small groups. The organisation has had some difficulties with different NVQ training providers. However, they now have arranged for a suitable agency to support staff to achieve these qualifications and hope that the staff will be able to undertake this training. Three staff were due to start NVQs the week following the inspection and four more later in the year. During the inspection, interviews for the Manager were taking place. These involved a formal interview and a written exercise. In addition to this a group of residents prepared and asked questions in their own interview of the candidates. They fed back to the interview panel and their views formed part of the selection criteria. This practice is commendable and shows the residents that their views and opinions are valued. There are regular team meetings and individual supervision for all staff. These are recorded. The organisation has a training programme designed to offer a range of training for staff from different providers. Training records indicate that some staff need to renew their manual handling and first aid training. Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 24 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, 32, 33, 35, 36 & 38 Quality in this outcome group is good. This judgement is based on information from the home and evidence viewed as part of the inspection visit. The management approach is open and inclusive. Accurate records are maintained and regular checks on health and safety are made. EVIDENCE: The Manager retired from her post earlier in the year but agreed to stay working at the home part time until a new Manager was recruited and to help with their induction. At the time of the inspection senior managers were interviewing candidates for the position of Manager. They successfully recruited and the new Manager was due to start shortly after the inspection. Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 25 This person must make an application to be registered with the Commission for Social Care Inspection. Staff at the home spoke very positively about the current management and support from senior staff. They felt that they could raise concerns and have their opinions listened to. Some staff said that they felt the senior management within the organisation did not always address concerns and sometimes imposed changes which they did not like or agree with. The organisation arranges for monthly quality audits of the home. include checks on key areas. These The organisation arranges for an external advocacy service to visit the home annually and to meet with all residents. They ask residents about their experiences and make observations as part of a quality monitoring assessment. The report of their findings includes recommendations for improvements. This year’s visits were due to take place shortly after the inspection. The home does not support service users with general financial management and private arrangements have been made by all residents. Small amounts of cash are held securely by the home so that residents can make minor purchases and pay for additional services, such as hairdressing. There are individual records for all money held on behalf of residents. These are regularly checked and audited. There are records which show that regular checks on health and safety, including fire safety and equipment are made. Records are well organised and the home has been commended for its health and safety by the organisation who provides information and support in this area. Records of fridge temperatures on two units indicated that the fridges were too cold. The Registered Person should make sure fridge temperatures remain within an acceptable range and that staff report any changes in temperature so that appropriate action can be taken. Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 2 3 2 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 2 Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 27 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 OP7 Regulation 15 Requirement Timescale for action The Registered Person must 31/07/06 make sure photographs of residents are available on the units. Previous 31/03/06 requirement 2. OP7 15 The Registered Person must 30/09/06 make sure information in care plans is clear, accurate and uses appropriate terminology. The staff should work towards a person centred approach and individual preferences should be clearly recorded within care plans. 3. OP7 13 15 The Registered Person must 31/07/06 make sure risk assessments are reviewed following changes in need, medication, equipment or after a fall. Risk assessments must be in place where ever residents are Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 28 put at risk and must be developed following any incidents where this has been identified. 4. OP9 13 The Registered Person must 15/07/06 make sure all medication received is recorded. Staff must only use approved symbols on administration records. The Registered Person must 15/07/06 make sure staff respect the privacy and dignity of residents at all times. This includes using appropriate terminology and consulting them about all aspects of their care and access to their bedrooms. The Registered Person must 15/07/06 make sure residents are offered regular baths and that this is recorded. The Registered Person must make sure problems identified (such as skin care) are followed up and accurate records maintained. 7. OP12 12 13 16 23 The Registered make sure: Person must 30/09/06 5. OP10 12 6. OP10 12 1. There are activity resources available for residents to use at any time within their units. 2. All organised activities should be planned so that they are fulfilling and designed to meet the needs of residents. Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 29 3. Staff must be proactive in seeking information on personal preferences, likes and dislikes, cultural needs, life experiences and social interests so that individual needs can be identified and met. 8. OP15 12 16 The Registered make sure: Person must 31/07/06 1. Residents are offered snacks between meals if they wish for them. 2. Residents are given a choice and variety of food. 3. Residents requiring support at mealtimes are allocated a dedicated member of staff who sits with them for the duration of the meal. 9. OP18 13 18 The Registered Person must 30/11/06 make sure all staff are trained in the protection of vulnerable adults. The Registered Person must 31/08/06 reassess the environment, in consultation with appropriate professionals. Consideration must be given to how to support better orientation. Previous requirement 30/08/05 & 31/08/06 11. OP20 13 23 The Registered Person must 31/10/06 make sure there is enough room DS0000017382.V289525.R01.S.doc Version 5.1 Page 30 10. OP22 12 13 23 Marling Court for residents and staff to safely manoeuvre in the dining areas and staff must be able to sit with residents when helping them to eat. 12. OP26 16 23 The Registered Person must 31/08/06 review the procedure for handling soiled laundry and introduce new measures to reduce the risk of cross infection and to make sure staff and residents are safe. Previous 31/01/06 13. OP27 18 requirement The Registered Person must 31/08/06 undertake a review of staffing levels at the home and must make sure that the needs of residents can be safely met. A copy of this review and action plan must be forwarded to the CSCI. Previous 31/03/06 requirement 14. OP4 OP30 18 The Registered Person must 31/08/06 make sure that staff are supported to have a better understanding of dementia and the needs of residents, through training, staff discussions, cascaded information and support of professionals. (Requirement made 21.10.04, 30.10.05 & 31/03/06 condition of variation November 2004) Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 31 15. OP30 18 The Registered Person must 31/10/06 make sure all staff receive updated training in manual handling and first aid. The Registered Person must 31/07/06 make sure fridges used for storing food and medication are maintained at the right temperature and action is taken if changes to temperatures are noted. 16. OP38 13 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 OP1 Good Practice Recommendations The Registered Person should consider updating the Statement of Purpose, Service User Guide and home’s Aims and Objectives to record changes in the service and to look at how these documents can be made more accessible to residents. The Registered Person should make sure pre admission assessments are as detailed as possible and give information on observations made during the resident’s visit to the home. The Registered Person must make sure that all staff have a good understanding of their new roles and of how to give individualised care through keyworking. The Registered Person should consider supporting senior staff to undertake training for trainers courses so that they DS0000017382.V289525.R01.S.doc Version 5.1 Page 32 2. OP3 3. OP27 4. OP30 Marling Court can provide in house training for care staff. Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 33 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Marling Court DS0000017382.V289525.R01.S.doc Version 5.1 Page 34 - 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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