Inspection on 09/06/05 for Marling Court

This inspection was carried out on 9th June 2005.

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 02/06/06

Marling Court 15/12/05

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 Announced 9 June 2005 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 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 G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Marling Court Address Bramble Lane Off The Avenue Hampton Middlesex TW12 3XB 020 8783 0157 020 8783 0078 Telephone number Fax number Email 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 Care Home 37 Category(ies) of Physical disability over 65 years (PD(E)) registration, with number Old Age (OP) of places Dementia (DE) Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit one named female service user aged 63 years. 2. The Registered Person must ensure that all staff are appropriately trained in dementia care. Date of last inspection 21st October 2004 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 Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 9th June 2005, and was announced. The Manager was present throughout the inspection. The Inspector met with service users, staff on duty and visitors throughout the day, and was made welcome by all. The Inspector was invited to share the midday meal with service users from one unit. The food was tasty and the meal a pleasant social occasion. The Commission for Social Care Inspection routinely asks service users and their representatives to complete written questionnaires on a service prior to an announced inspection. On this occasion fifteen questionnaires were returned. Eleven were from service users, two were from relatives of service users and two were from health care professionals who have an input into the home. Eight service users reported that they liked living at the home and three service users stated that they sometimes liked living at the home. Ten service users stated that they were well cared for, staff treated them well and that their privacy was respected. One service user reported that these were the case sometimes. Nine service users reported that the home provided suitable activities. Four service users stated that they liked the food and the rest said that they sometimes liked the food. All service users reported that they knew who to speak with if they were unhappy about their care. One service user reported that access to chiropody was infrequent and that this caused problems. One service user reported that the laundry service was not always acceptable and that items of clothes had been placed in other service user’s wardrobes for several weeks. Both relatives wrote that they were made welcome at the home, able to see service users in private and were appropriately informed about the care of their relative, the home’s complains procedure and inspections. Both relatives stated that they were satisfied with the overall care. One visitor wrote, ‘all the staff make you feel very welcome. Nothing is too much trouble’. They also wrote that they were able to use the facilities on the unit to make drinks for their relative. They wrote that the staff treated their relative well and that they were happy with their care. The other visitor wrote that there was limited staff to provide activities for service users within the units. This area is discussed further under Section 3 of this report. They also wrote that they felt more healthy eating options should be available within the menu. They wrote that they were happy with the overall care at Marling Court and that the management was ‘exceptional’. Both health care professionals who completed questionnaires stated that the home communicated clearly and worked in partnership with other agencies. They both wrote that they were able to see service users in private, that senior Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 6 staff were available and that management made appropriate decisions when they could no longer manage the needs of a service user. One health care professionals felt that staff had a clear understanding of care needs of service users. The other health care professionals felt that staff did not and wrote that the home made inadequate assessments of service users and that staff lacked an understanding of the needs of some service users with dementia. This was discussed with the Manager and under Section 1 of this report. There is an identified need for further staff training in dementia, this is a condition of the variation granted to the home in November 2004 and has been made a requirement at previous inspections. Although some staff training has taken place, all staff must receive sufficient training to have an understanding in this area. Shortly before the inspection, Richmond Churches Housing Trust arranged for an independent advocacy organisation to visit the home and meet with service users individually. Service users were asked about their experiences at the home and the services that they received. Thirty-one service users met with the Advocates. A report from these interviews has been made available to the home, and a copy was provided to the Commission for Social Care Inspection. The report is comprehensive and includes suggestions for change, directly from service users and also from observations made by the Advocate. The report is a useful tool for the home to develop practice and the findings of the quality report and are referred to in this inspection report. The Manager started work at the home in June 2004. At the time she made an application to be registered with the Commission for Social Care Inspection. However, this application was withdrawn by Richmond Churches Housing Trust in October 2004. A new application for registration must be submitted by the Manager without delay. Thirty-five service users were living at the home at the time of the inspection. Service users were due to move into the vacant rooms shortly after the inspection. The atmosphere at the home was relaxed and calm. During the afternoon, a number of service users were seen to be enjoying music, singing and dance in the main lounge. Staff supporting this activity were enthusiastic and supporting service users to express themselves. Interactions throughout the day were generally positive and staff demonstrated a genuine affection towards service users. A small number of incidents, which were observed did not give due respect to choice, dignity or privacy. These are discussed in more depth in the main body of the report. These incidents were discussed with the Manager, who acknowledged that staff had acted inappropriately. The Manager agreed to address the issues raised with staff. What the service does well: In general the house is well managed and service users are well cared for. The Manager has a good knowledge of the service and the staffing structure is designed to ensure a supportive workplace. Service users reported that they Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 7 are happy living at the home and that, in general, their needs are met. Records are well organised and appropriate checks on health and safety are maintained. There is a wide range of information for service users and regular service user meetings are held. The majority of service users enjoy the food at the home and the Chef is enthusiastic and dedicated to his role. Visitors are welcome at the home and are able to contribute to the care of service users where appropriate. The Manager reported that some visitors participate in activities with service users. What has improved since the last inspection? What they could do better: The home was granted a variation in November 2004 to increase the registered places for people with dementia. Since this time there has been limited training for staff to increase their awareness. Further work in this and in assessing the environment, staffing levels, dietary needs and activity provision must take place. In general, service user plans are well designed. Some plans would benefit from greater clarity and better recording of changes in need. In general interactions between staff and service users were positive and reflected genuine fondness. However, a small number of incidents warranted concern. Two such incidents indicated that some ‘institutionalised’ practices took place. Changes in practice must take place to ensure that individual needs are met by staff. Medication storage and recording was generally good, but a small number of improvements are necessary. The Manager must make an application to be registered with the CSCI. Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 8 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 G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 9 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 Standards Statutory Requirements Identified During the Inspection Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 10 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 standard(s) 1, 2, 3, 4 & 5 Service users are provided with information about the home and other services available to them. Prospective service users are given information and are able to spend time at the home before making a decision about whether to live there. There is a thorough process of assessment and a period of trail stay, which enable the home to make a judgement about whether they can meet individual needs. Service users are issued with a statement of terms and conditions, and they or their representatives sign this as a record of their agreement. In general the home meets the needs of service users. However, further staff training in dementia, a review of some practices and improvements to activity provision are necessary. The home does not provide intermediate care; therefore Standard 6 is not applicable. EVIDENCE: There is a comprehensive Statement of Purpose and Service User Guide at the home. These include required information and copies of the terms and conditions of residency. The Manager reported that these documents had not been changed since the last inspection. Both documents are accessible and Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 11 are made available to prospective service users. Copies of these documents and other information, such as the complaints procedure and information about advocacy services are available on notice boards in communal areas. The announced inspection was well advertised in the home and service users had been made aware of the inspection process. Copies of service user and relative comment cards and the home’s last inspection report were available in the entrance foyer. 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 issued to service users and a copy is held at the organisation’s head office. The Inspector saw a signed record, which acknowledged receipt of licence agreements, within three service user files examined. There is an appropriate procedure for the assessment of service users. The Manager meets with the prospective service user and their representatives to conduct an assessment of need. The Inspector saw examples of these held on file. Placing authority social work assessments are also in place for service users funded by the authority. One health care professional who works closely with the home reported that they felt assessments of need were sometimes inadequate. This was discussed with the Manager. The Manager acknowledged that in the case of some recently admitted service users, the assessment process had not adequately identified all needs. However, she felt that this was not due to deficiencies within the assessment process but moreover that representatives of the service users had not given a full picture of needs during the assessment process. The Manager reported that for all assessments, relatives, previous placements, health care professionals and funding authorities were contacted. The Manager acknowledged that one recently admitted service user’s needs were more diverse than the original assessment had identified and that it was identified that this service user’s needs could not be met within the first few weeks of their stay. The Manager spoke about this at length and was able to explain the actions taken at the time, which were appropriate. It is important that the home takes all steps possible to gain information about prospective service users. This includes visits to the home, where the assessor can make observations about need, as well as speaking with the service user and their representatives. The home must continue to do this and to seek information from relevant professionals. However, it is acknowledged that the assessment process cannot identify all an individual’s needs and relies on correct and full information from all parties. All service users are admitted on a six week trail stay. Following this a review of needs is conducted involving the service user, their representatives and staff from the home. During this Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 12 process a decision is made about whether the home can continue to meet the needs of the service user. Minutes from these review meetings were seen within three service user files examined. These indicated that all parties were able to contribute their views and that there was a re-evaluation of the needs and whether these could be met at the home. Assessments of need are appropriately translated into service user plans. There was evidence of annual review meetings within service user files examined. Service user plan are subject to monthly reviews and a basic reassessment of care needs is recorded every quarter. The home offers a service to up to twenty-five service users who have dementia, following a variation to the registration categories in November 2004. A condition of this variation was that all staff received training in dementia care. The Manager recorded in the pre-inspection questionnaires that over the past twelve months only five staff have undertaken dementia training. The Manager reported that training for more staff had been organised during the summer of 2005. Further training for staff must take place. In order to affectively meet the needs of the majority of service users in the home there should be a better understanding around dementia needs for the whole staff team. Basic training in dementia must be complemented by information and training for staff to have a better understanding of all aspects of caring for service users with dementia. These should include dementia mapping, health, diet, environmental needs, activities, communication, behaviour and relationships. Where training is given to small numbers of staff, they must cascade the information they have gained to improve understanding within the whole staff team. It is unacceptable that only five staff had received basic dementia training. One health care professional who completed a questionnaire on the service felt that staff were not appropriately informed regarding dementia care. (Refer also to Section 6 – Staffing). Staffing levels within the units have not been increased to reflect a change in registration categories. The Manager reported that the majority of changed category registered places were not yet occupied by service users with dementia. The staffing levels must be kept under review as service users with different and more diverse needs are admitted to the home. (Refer to Section 6 – Staffing). The Inspector saw examples of where specialist equipment and health care needs had been met and service user plan reflected these specialist needs. Refer to Requirement 1 Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 7, 8, 9 & 10 Individual needs are recorded in a clear and accessible format. Service users and their representatives are involved in the development and review of their plans. The majority of information was appropriately recorded, however some changes in need were not sufficiently detailed and some statements were open to misinterpretation. There was insufficient recording of the assessment process regarding a potential restriction on one service user. Assessments of risk were in place to support service users to move around their environment and to manage their own medication safely. Service users have access to a range of medical services, although some service users feel their medical needs are not fully met. The medication procedure is designed to safe guard service users. Staff on duty demonstrated a good understanding and awareness of medication issues and how certain medicines affect service users. Practices around medication storage, recording and administration are generally good, although some developments are necessary to minimise risks to service users. Personal care needs of service users are either not being met or not being appropriately recorded in some cases. In general service users were treated with respect, however some practices at the home did not show due respect to the privacy and dignity of service users. Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 14 EVIDENCE: Individual service user plans are in place for all service users. These are clearly designed and give detailed information. Plans had been signed by service users or their representatives as a record of their agreement. Plans are subject to monthly review which is recorded. The Inspector examined seven service user plans. Some service user plans contained detailed life histories provided by relatives, keyworkers should be actively pursuing this information for all service users. These life histories support staff to have a better understanding of individual needs and a holistic view of the people with whom they are working. This aspect of care planning is essential where service users are confused or are unable to tell staff about their own lives, likes and needs. In one of the plans examined the phrases and terminology used were insufficient and inappropriate. The service user plan referred to action staff should take if a service user became, ‘too friendly’ with another service user. This terminology requires staff to make a judgement about what they regard as ‘too friendly’. The judgements of different staff may be diverse and the outcome for the service users could be adversely affected. In addition the plan did not adequately record why this restriction had been established. There must be a full assessment of risk in place to record the decision making process where any restrictions are used. The assessment should incorporate the views of all service users involved, and where appropriate other professionals or representatives. As with all risk assessments, this must be kept under regular review. The Manager spoke about the changes in need for one service user, who was at risk of falling. There was insufficient detail in the service user plan regarding this change need and the support staff should offer to reduce this risk. The majority of risk assessments seen had been subject to regular review. However the risk assessment in one service user plan had not been reviewed since February 2004. Service users 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 a range of health care professionals. Details of consultation and interventions are recorded. Health care needs, including information from health care professionals, is recorded within service user plans. One service user reported that the chiropody service that they receive is infrequent and inadequate. One service user plan examined recorded regular appointments with the chiropodist. Another one showed long gaps between appointments. The Manager must ensure that keyworkers support service Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 15 users to access the chiropody service when needed and advocate on behalf of the service user if the service provided does not meet their needs. The Manager demonstrated a good awareness of the individual health care needs of service users and was able to answer questions about specific service users raised by the Inspector. There is an appropriate medication procedure. Medication is stored securely. Medication within two units was examined. All medication was appropriately labelled with the exception of one medicated bubble bath, where the label had worn away. Assessments of risk are in place for all service users who manage their own medication. Medication administration records were mostly accurate, although there was a small number of gaps where administration had not been recorded. In a high number of cases the evening dose of PRN (as required) medication had been recorded as refused. Staff on duty reported that the medication was generally not given because the service user had been asleep. The medication administration records should accurately reflect this and rather than stating the medication was refused. The allergy section on two medication administration records had not been completed. The quantity of medication held was generally recorded on medication administration sheets. However, where stocks of medication had been carried over from one month to another this had not been recorded. One service user uses herbal remedies. This has been discussed and approved by the GP. Staff on the unit reported that they had looked up information on these individual remedies and the potential side effects so that they could have a better understanding of this service users’ chosen medication. This is commendable. One staff member reported that they had recently attended medication training. They spoke about how useful this had been and how they had used their knowledge in their role and to gain a better understanding of the different medication needs of service users within the unit they worked. Personal care needs are recorded and monitored in service user plans. These indicate personal choices. These indicate that service users are able to rise, retire and take meals at the time of their choosing. Each service user is allocated a keyworker who offers specialist support, including support with purchasing personal shopping and toiletries. Service users confirmed that they were able to rise and retire when they wanted. One service user plan recorded that the keyworker should was the service users hair weekly. Bathing records indicate whether the service user’s hair had been washed. In this case the last recorded hairwash was in April 2005. In another service user plan there were gaps of up to thirteen days between baths. In a third service user plan there were regularly gaps of up to eight Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 16 days between baths. There was no record to state that baths had been offered and refused. In another service user plan the last recorded bath was in February 2005. The Manager stated that she felt this was an error in recording rather than a lack of care. The independent advocate’s report on the home states that one service user reported they were not offered baths as often as they wished. The Registered Person must ensure that all service users are able to bathe or shower as often as they wish and that this is recorded within their service user plan. In general observations of practice were positive and interactions between staff and service users were appropriate. A small number of incidents indicated that staff did not always show due respect to the privacy and dignity of service users. The staff member supporting one service user to eat their meal stood next to the service user rather than sitting with them. In another incident, two staff members standing at opposite sides of a communal room discussed the behaviour of one service user in front of a number of other service users. The conversation could be heard throughout the room. In another incident, a service user was prevented from entering the kitchen in the unit in which they lived. Two staff members were present and they told the service user that the kitchen was too dangerous for them and they were told to sit down again. The Inspector felt that the staff believed that they were acting in the best interest of the service user and that they were concerned about their well-being. They demonstrated a genuine concern for the service user. However, the service user clearly wanted to walk in the kitchen. With two staff present, there may have been little risk to the service user, and it would have been appropriate for staff to assess the risk at that time. No alternative activity was offered to the service user, who has dementia. The Inspector sees this incident as an indicator of how important it is for staff to have a better understanding of the needs of people who have dementia. Asking the service user to return to their seat at this time was not meeting their need and may have left them frustrated, angry, upset or confused. Two further incidents which showed institutionalised and unacceptable practices were observed. In one unit the Inspector was offered a hot drink by a staff member. The staff member was then asked by several service users if they could have a hot drink. They replied that they could only have a cold drink at this time. In another unit, a service user asked a member of staff for a cup of tea at 14.45. The member of staff replied, ‘you know the time, tea is served at 3pm’. Service users are entitled to receive whatever drink they require at any given time and staff should support this. Refer to Requirements 2, 3, 4, 5, 6, 7 & 8 and Good Practice Recommendation 1 Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 17 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 standard(s) 12, 13, 14 & 15 The planned programme of activities offers some regular and widely enjoyed events. However, participation in many of the activities is low and further developmental work around activity provision is necessary, so that service users are able to choose from a wider range of activities designed to meet individual needs. The environment and practices around receiving visitors are appropriate and visitors report that they feel welcome. Service users are able to see visitors in private. The menu offers a choice of wholesome food and is varied. Service user opinion on food is mixed, although the majority of service users like the food at the home. Service users should be offered the opportunity to have a greater choice of vegetables at the time of serving. EVIDENCE: The home does not employ an Activities Officer. There is a planned programme of activities designed to be implemented in each unit. Some weekly activities, such as music and movement, singing, entertainers and outings are designed for service users from the whole house. On the day of the inspection a music session was held in the main lounge, many service users were seen enjoying this and staff were actively supporting them. In addition, a trip to the theatre had been organised for eight service users. Staff Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 18 and service users who spoke with the Inspector indicated that these organised activities were a success. The general activities programme includes quizzes, craft work, reminiscence, fortnightly church services and weekly visits by a hairdresser. Service users and staff on the units reported that in general activities were organised on an ad hoc basis according to wishes and needs on the day. This flexibility is important and should continue. However, throughout the day, the Inspector did not observe any activities on any of the units. The majority of service users spent time sitting in the lounges. A small number were seen reading, however the majority were doing nothing or were asleep. Staff on the units generally interacted positively with service users but spent their time attending to other tasks. Although staff in most units were seen to offer choices of music to be played in the communal lounge, other activities such as reading, knitting, quizzes or even conversations were not offered. Interactions were polite and showed due respect but were short and in passing rather than staff actually sitting down with service users. Staff on the units reported that many service users did not want to join in activities. This lack of participation could be a result of several factors and this should be investigated. Staff are not allocating sufficient time to activity provision, and are spending the majority of their time attending to other tasks. A reallocation of how staff spend their working day within the units may be beneficial. Although the main activities for the whole house occur as planned, many of the other activities on the programme do not take place within the units. If as staff report, this is generally because service users do not wish to participate, then there should be a full review of the programme and consideration should be given to implementing different planned programmes for different units designed to meet individual and small group needs. The activity programme for June 2005 included some days where Hairdressing was the only planned activity. A review of this programme should ensure that other activities are also organised on these days. Only one activity per day was recorded on the programme. It is important that service users are offered choices each day. It is important that someone oversees activity planning and provision. The success of activity provision should be monitored and the programme reviewed to reflect the wishes of service users. The needs of service users at the home are changing with the changes to the registration categories of the home. The staff at the home need training and support to understand the needs of people who have dementia. The recent service user consultation exercise by an independent advocacy group outlined some suggestions from service users for improvements to activity provision. Further work to gain the views of service users in this area should be undertaken as part of the review of the activities programme. Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 19 Photographs of a group trip to the river and a local park were on display in one corridor. A record in one unit was designed to record how often service users were supported to leave the house. The record indicated that on the week preceding the inspection two service users had gone to the shops during the week and two service users had gone to the park. One service user had not left the home. The previous week two service users had been to the park and one to the shops. The home is located next to a park and a small parade of shops. It is essential that service users are offered regular opportunities to access the community. One service user who spoke with the Inspector reported that they received a daily newspaper. This service is organised for any service user who requires. Another service user told the Inspector that they accessed the community independently. One service user had recently completed a distance learning qualification. Service users spoke fondly of the garden and several said that they enjoyed watching the wildlife in the garden. The Manager reported that a new individual library service was being set up for five service users. The Manager reported that a summer fete and barbeque had been organised. One service user told the Inspector that the organisation were creating a newsletter. They reported that they were having an article published. There is a flexible visitors procedure. Visitors who completed questionnaires about the service reported that they were made welcome. One visitor stated that they were able to use the kitchen on the unit to make drinks for the service users and themselves when they visited. The recent service user consultation has led to an interesting and useful guide for the home. This report should be used to imitate changes in response to the wishes and needs of service users. Further consultation work should continue on an individual basis. The Manager reported that she ensures that she meets with all service users on a daily basis. Monthly service user meetings are organised. These are not widely attended but service users who do participate feel that they are useful. The recent consultation work highlighted that some service users found larger groups difficult. Smaller unit meetings should be organised in addition to these larger meetings. This would allow all service users to be part of a group discussion about the service in a less intimidating environment, should they wish to participate. There is a varied menu offering choices at each mealtime. Service users make choices about their meals the day before. The Inspector was invited to join service users in one unit for their midday meal. Food is delivered to the units in heated trolleys. The food was tasty and well prepared and the atmosphere in the dining room was calm and relaxed. However, service users sitting with the Inspector could not remember the choices that they had made. Some Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 20 service users were brought rice, others potatoes and a variety of different vegetables from the choices they had made the previous day. However, when the food was brought to the table some of the service users did not want what they were given and voiced this to the Inspector. It was noted that additional vegetables, potatoes prepared in two different ways and rice were available within the heated trolley, some left uneaten at the end of the meal. The Inspector recognises that advanced orders are necessary when catering for larger numbers, however feels that more choice could have been offered to service users at the time of the meal as this food was already available within the heated trolleys. The recent service user consultation revealed that the majority of service users liked the food. Responses from service users to this inspection indicated that opinion was quite mixed. Ideas of developments to the menu are included within the consultation. The involvement of a dietician in the review and development of menus should be considered, given the large numbers of frail and confused service users. Refer to Requirement 9 & Good Practice Recommendations 2 & 3 Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 21 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 standard(s) 16, 17 & 18 There is an appropriate complaints procedure, which is accessible to service users. All service users have a representative external to the home. Procedures designed to protect service users are in place. EVIDENCE: There is an appropriate complaints procedure, which details timescales and information on contacting the Commission for Social Care Inspection. There have been no complaints since the last inspection. The Manager reported that all service users had representatives external to the home. There is information for service users on local advocacy services and all service users were invited to participate in a recent consultation process with an independent advocacy group. The Manager reported that service users were registered to vote. 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 G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 22 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 standard(s) 19, 20, 21, 22, 23, 24, 25 & 26 The environment is safe and well maintained. There is a pleasant homely atmosphere and service users are able to personalise their rooms. There are adequate facilities available within individual units. Some service users feel restricted by locked internal doors between units and in accessing the garden. There needs to be further development to support orientation for service users who are confused, so that they become familiar and secure with their environment. 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, photographs and ornaments throughout the home add to the general Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 23 ambience. There is a programme of maintenance and since the last inspection a number of rooms have been decorated and new carpet has been laid within ground floor communal areas. The carpet on the first floor is beginning to look worn and would benefit from replacement. Since the last inspection the home has been registered to accommodate more service users with dementia. The Registered Person must give consideration to how the environment can be improved to support service users to have a better understanding and recognition and of the layout of the building. The service user consultation report highlights that although the majority of service users reported that they were appropriately assisted to access the garden, two service users commented that they were not able to access the garden as often as they would like. Other service users spoke about wanting to use the garden more often, when questioned about activity provision. This sentiment was echoed at the inspection visit, when one service user told the Inspector that they could not use the garden as often as they liked because they could not go downstairs without support. Whilst it is acknowledged that these comments are from a minority of service users, it is important that all service users feel able to access the garden and all communal facilities as often as they wish. This is particularly pertinent during the summer months and staff should be aware of individual needs and wishes and ensure that appropriate support is available. The service user consultation report also highlights that some service users felt restricted as some exits from units were controlled by digi pad locks. The Advocate comments that ‘several service users (in one of the units) actively tried to move out of a restricted area during the visit’. The Advocate comments that this implies service users were not happy with their confinement. The report makes suggestions for creating more freedom of movement whilst still ensuring safety. In consultation with appropriate professionals, the Registered Person must reassess the current situation, giving consideration to the advocates report and suggestions. The home was clean and odour free throughout. There are appropriate procedures to ensure infection control and Control of Substances Hazardous to Health (COSHH). One service user reported that the laundry service could be improved and that one item of clothing was placed in another service user’s room for a number of weeks. Refer to Requirements 10 & 11 and Good Practice Recommendations 4 & 5 Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 24 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 There is an organised staffing structure and staffing levels are designed to ensure that service users are safe. With an increase in the number of places registered for dementia, a review of staffing levels is necessary to ensure that all the needs of service users are met. There is a programme for staff to achieve qualifications and to undertake training. However, some key areas of staff training have not taken place and staff may not have the knowledge or skills to meet all the needs of service users. There is an appropriate procedure of recruitment and selection of staff, which is designed to safe guard service users. EVIDENCE: The staff team is structured into three teams, each led by a senior member of staff and supported by the Manager, Deputy Manager and two Assistant Managers. The staff team is relatively stable and some staff have worked at the home for many years. The staffing structure is well organised and staff demonstrated a good understanding of their roles and responsibilities. One service user told the Inspector that the staff were very good and caring. The Registered Person must ensure that staffing levels are reviewed in line with the admission of larger numbers of service users who are confused. The review of staffing should give consideration to the Inspector’s comments about the use of digi-pad controlled doors and activity provision at the home. Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 25 The home has experienced difficulties with the NVQ provider they were using. At the time of the inspection only four staff (16 ) were qualified to NVQ Level 2 or above. The Manager reported that a new provider had been found and it was hoped that staff would be able to complete the qualifications that they begun some time ago. The organisation must show a firm commitment to supporting staff to achieve these qualifications. The Manager spoke positively about the staff team, commending their hard work and dedication. There is a comprehensive programme of training available or staff. There is evidence of recent and planned training in manual handling, food hygiene, first aid, fire safety and risk assessment. Not all staff have received training in these key areas or in abuse awareness and they must do so, in order for them to have the skills and knowledge to perform their role. The home was required to ensure that all staff received training in dementia at the last inspection. This was also a condition of the variation to registration categories approved in November 2004. Records provided by the Manager indicate that only five staff had undertaken this training in the past 12 months and no specialist training on dementia mapping, activities, diet, environmental needs, behaviour or relationships has taken place. The Registered Person must be more proactive in developing staff training and awareness in this area. In order to effectively meet the needs of twenty-five service users who have dementia the staff team must develop their knowledge and skills in this area. The service user consultation report highlighted that most service users were happy with the staff at the home and that they were polite and caring. Some concerns about inappropriate dress, use of mobile phones and communication were raised. The Registered Person should ensure that these concerns are addressed. Regular team meetings are held for the staff, including senior meetings. Minutes of these indicated that the staff were appropriately informed and consulted about the day-to-day management of the home. There is an appropriate procedure for the recruitment and selection of staff. Three staff recruitment records were examined and were seen to contain the required information, evidencing thorough pre employment checks. Refer to Requirements 1 & 12 Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 26 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 & 38 The home is managed by a suitably experienced and qualified person. The Manager must apply to be registered with the Commission for Social Care Inspection The home organised for comprehensive independent consultation with service users about their experiences at the home. Procedures are in place to ensure regular checks on health and safety equipment. EVIDENCE: The Manager is experienced in her role and has previously managed another Richmond Churches Housing Trust home. She is currently undertaking NVQ Level 4. She demonstrated an in depth knowledge of the service including individual service user needs. and Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 27 The Manager has been in post since June 2004. Although she applied for registration with the Commission for Social Care Inspection, this application was withdrawn. A new application to be registered must now be made. The organisation arranged for an independent advocacy organisation to consult with all service users and produce a report on their findings. The consultation took place with Advocates speaking individually with service users. They questioned service users about food, activities, staff, the environment, complaints and other facilities. The report is thorough and gives a good representation of the views of service users. The report also provides suggestions for change. This piece of work is positive and has allowed all service users to have an equal say about their experiences at the home. The Registered Person must now ensure that developmental work to reflect the needs and wishes of service users takes place. Further consultation and recorded monitoring should continue so that the opinions of service users considered with regards to all aspects of service delivery. There are well organised clear health and safety records which evidence regular checks on fire, water, gas and electrical safety. Refer to Requirement 13 Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 28 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 2 3 N/A 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 3 COMPLAINTS AND PROTECTION 2 3 3 2 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 x 3 x x x x 3 Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 29 YES Are there any outstanding requirements from the last inspection? 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. OP4 OP30 18(1)(c) The Registered Person must ensure that staff are supported to have a better understanding of dementia and the needs of service users, through training, staff discussions, cascaded information and support of professionals. (Requirement made 21.10.04 & condition of variation November 2004) 2. OP7 15 The Registered Person must: 1. Ensure that changes in need are appropriately identified within service user plans. 2. Ensure that information is clearly recorded and not open to misinterpretation. 3. Ensure that where possible detailed social histories are in place to give staff a better understanding of the individual service users. Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 30 Standard Regulation Requirement Timescale for action 30/10/05 30/08/05 3. OP7 12(4) & (6) 15 The Registered Person must: 1. Ensure that a full recorded assessment of risk is in place for any restrictions placed on service users. 2. Ensure that risk assessments are subject to regular review. 4. OP9 13(2) The Registered Person must: 1. Ensure that medication administration records are accurate. 2. Ensure that the allergy section on medication administration records is completed. 3. Ensure that all medication is appropriately labelled. 5. OP10 12(1) The Registered Person must ensure that service users are able to bathe whenever they wish and that this is recorded. The Registered Person must ensure that staff do not discuss service users needs in front of others. The Registered Person must ensure that staff who support service users at meal times sit with the service user. The Registered Person must ensure that service users are able to receive hot or cold drinks at any time of the day or night. 15/07/05 15/07/05 31/07/05 6. OP10 12(4)(a) 15/07/05 7. OP10 12(4)(a) 15/07/05 8. OP10 12(4)(a) 16(2)(i) Marling Court 15/07/05 G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 31 9. OP12 16(2)(m) & (n) The Registered Person must ensure that the activity programme offers a choice of stimulating activities meeting individual and group needs. Activity participation and enjoyment should be recorded, to support continued development of this service. 30/08/05 10. OP19 OP22 12(1), The Registered Person must: (2), (4)(a) 1. Reassess the environment, in 13(4) consultation with appropriate professionals. Consideration 23(2)(a) must be given to how to support better orientation. 2. A full assessment of risk must be developed for the use of locked doors between units, to ensure that these restrictions are only in place where necessary for ensuring safety. Copies of both assessments must be forwarded to the CSCI. 11. OP26 16(2)(e) & (f) The Registered Person must ensure that service users clothes are not misplaced during laundering. The Registered Person must ensure that the staff are offered the opportunity to under take NVQ. The Registered Person must ensure that the Manager makes an application to be registered G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc 30/08/05 15/07/05 12. OP28 18(1) 31/10/05 13. OP31 9 31/07/05 Marling Court Version 1.30 Page 32 with the CSCI. 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. OP8 The Registered Person should ensure that service users are supported to access medical services when they require them. Staff should advocate on behalf of service users where they feel their needs are not being met by medical services. The Registered Person should consider organising regular small service user meetings, in order for those who find the larger meetings difficult to participate. The Registered Person should ensure that service users are offered greater choices at the time of serving meals. The Registered Person should consider replacement of the first floor carpet. The Registered Person should ensure that all service users are able to access the garden when they wish to. Refer to Standard Good Practice Recommendations 2. OP14 3. OP17 4. OP19 5. OP19 Marling Court G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 Page 33 Commission for Social Care Inspection 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 G54-G04 S17382 Marling Ct V227526 090605 Stage 4.doc Version 1.30 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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