Inspection on 18/10/08 for Marlowe House

This inspection was carried out on 18th October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Marlowe House 23/09/09

Marlowe House 06/11/07

Marlowe House 06/06/06

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Marlowe House School Lane Hadlow Down East Sussex TN22 4HY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alexis Reilly     Date: 1 8 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Marlowe House School Lane Hadlow Down East Sussex TN22 4HY 01825830224 01825830924 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Janet Moseley Type of registration: Number of places registered: AUM Care Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Service users must be older people aged sixty-five (65) years or over on admission. The maximum number of service users to be accommodated is 20 (twenty). Date of last inspection Brief description of the care home Marlowe House Residential Home is registered to accommodate up to 20 older people. The home is a substantial detached property that has been converted and extended for its current use. It is situated on the outskirts of Hadlow Down village near the town of Uckfield. The home is arranged over three floors, service users accommodation is provided on the ground and first floors and staff accommodation is on the second floor. There is a chair lift and two staircases between the ground floor and first floor. The home provides fourteen single and three shared rooms, has a conservatory, dining room, two lounges - one on the ground floor and one on the second floor and a wellkept garden with some seating and off road parking. The majority of the staff team are well established at the home. In house activities are provided for service users such as Care Homes for Older People Page 4 of 27 Over 65 20 0 Brief description of the care home motivation sessions and quizzes. Fees are assessed on an individual basis and range from £355 to £500 per week. Additional charges include hairdressing and chiropody. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Our inspection began at 8.30am and finished at 3pm. As part of the inspection the inspector examined three care plans, risk assessments and supporting information such as health care input and reviews. The record of staff supervision, team meetings and policies in relation to administration of medicines in the home were also examined. The inspector also examined staff recruitment files and looked at the list of training which included NVQ training and mandatory training. The inspector interviewed two care staff and spent time with the Registered Manager. The inspector also spent time and had lunch with all the residents in the dining room. A partial environmental tour was carried out of the service and this included the garden. Care Homes for Older People Page 6 of 27 Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: The Registered Manager must ensure they have a controlled drugs register to record the administration of controlled drugs in the home, and also a sample signature of staff who administer medication should be available to view with the MAR sheets. The Registered Manager must ensure the induction for staff used in the home matches the NTO specification induction. Staff have not updated their mandatory training in moving Care Homes for Older People Page 8 of 27 and handling and this is now overdue. Although supervision and team meetings are carried out in the service they are not dated or collated. The Registered Manager must ensure these are organised in a way so a clear audit trail can be provided. The Registered Manager was unable to show the inspector any quality assurance systems in the home, this is a piece of work which must be completed to ensure the service evaluates and builds on quality outcomes in the home. Marlowe House has a front and rear garden and once in the front garden there is a front gate which leads directly onto a busy main road, this has resulted previously in a fatality from the home. The Registered Manager must risk assess the front gate, in relation to the service users in the home, and if necessary erect a warning sign or use a lock to ensure no one wanders on the main road. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential service users are able to access information about the home before making a decision to move in and their needs are fully assessed before a place is offered. Prospective service users are able to visit the home prior to making a decision to live there and once this visit has been made are provided with the relevant contracts and information. Evidence: As part of the inspection the inspector case tracked three residents in the home, one of these was a recent admission. The inspector also looked at the statement of purpose and service user guide, gained views about the home from the residents, two staff and spent time with the Registered Manager. The home has a statement of purpose and service users guide; these are now made available to prospective service users and their families, and service users or their representatives are informed of the offer of a place in writing. The service user guide and statement of purpose has now Care Homes for Older People Page 11 of 27 Evidence: been amended to give up to date contact details of the CSCI. The manager carries out an assessment of each potential service user and in the case of service users funded by social service a copy of this assessment is also sought. Following admission there is a trial period of three months before a place is made permanent. Comments received from service users in the home were I looked round the home twice before I came to live here. In response to did you get a contract and enough information about the home prior to moving in the answer was yes oh yes. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are clear and reviewed regularly, evidence is supporting to show that the input of health care professionals are sought when needed. In discussion with the Registered Manager and staff it is clear they have a good understanding of the needs of the residents placed in the home. Residents were happy and staff were seen interacting with them positively on the day of the inspection. However the medication practices in the home need to be reviewed. The inspector acknowledges improvements have been made but the home must ensure they follow the correct procedure for administering medication and all staff are aware were it is stored. Evidence: As part of the inspection process the inspector examined the care plans and supporting documentation of three service users,and also examined the medicine storage and a sample of medicine administration sheets and policies for administration of medicines in the home. The inspector can confirm that care plans were clear and regularly reviewed and that health care input had been gained where needed. For example one resident had recently had a full review as their care needs had changed. If residents Care Homes for Older People Page 13 of 27 Evidence: are able and would like to, they complete a assessment/questionnaire document themselves on admission and this forms the historical information included in the care plan. A recently admitted resident was in the process of doing this. In relation to the administration and storage of medication in the home. The inspector can confirm that the home was not using a Controlled Drugs register for administering controlled drugs in the service. Medication policies had been reviewed on 4/4/2008 and included Administration of Controlled Medication, Key Management, Record Keeping, Storage of Medication, Verbal Orders, Ordering Medication, a policy on Self Medicating, and Medication Errors, Refusal to Take Medication and Surplus Medication. The inspector can confirm a controlled drugs cupboard was in place but the home were using MAR sheets to record administration of this medication and not the controlled drugs register. There was also an issue of a dose of medication being missed as the night staff could not locate where the medication was stored in the home. The service has a previous recommendation at the last inspection to include a list of care staff qualified to administer medication to be included in the MAR sheet folder, this was not in place at the time of the inspection. The inspector could also not find a list of staff sample signatures for administering medication. Through the care notes various recording in relation to a client was present, this was found to be judgmental and was discussed with the Registered Manager on the day of the inspection who agreed and stated she had already addressed this with the staff concerned. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have a good knowledge of individuals in the home and genuinely care about the residents living there. The residents appeared happy and well cared for, Residents have a good diet and are consulted on what they eat. The home has introduced some activities into the home, however people could be provided with a lot more opportunity to access the community. Evidence: As part of the inspection the inspector examined three care plans, interviewed two staff, had lunch with the residents and spent time with the Registered Manager. It is evident through conversation and documents in the home that the service users are well supported, happy and enjoy life in the home. Staff have a good knowledge of individuals in the home and genuinely care about the residents. Relatives and visitors are welcome in the home and people are treated as individuals and their rights and independence promoted. The Registered Manager has introduced a weekly activities sheet to show staff names and days of week, so that staff are allocated to ensure a set activity is carried out each day. The Registered Manager had recently brought a selection of games for the home, bingo game and prizes, domino and frustration. The local vicar visits the service the first Tuesday of the month and residents enjoy this as Care Homes for Older People Page 15 of 27 Evidence: he has violins and carries out a service. Residents do a lot of self lead activities such as knitting, tapestry, four have newspaper everyday, and a singer comes into the home once a month for a hour. One resident has been taken to Uckfield twice over the last month, and a befriend has been arranged for a resident from age concern. The home also has a motivation company who visit the home once a month to do physical movement. The residents had only good things to say about the staff and about living in the home. However also evident was that more activities could be done in the home and this would be greatly aided if the service had a vehicle to transport people in, which they used to have access to. This view was confirmed by various comments throughout the day. yes we could take the residents out more,staff are reluctant to take residents out in their cars incase they are not covered by their insurance. The inspector enjoyed a lovely lunch at the home, food was well presented and prepared with fresh ingredients, residents were given a choice of food individually in the morning. Comments received about the food during lunch were all positive, further comments were they never forget your birthday, you have a bell to ring in your room if you want anything, the staff come up they are very good, you could cook cakes if you wanted to,the staff are very good very patient. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have access to a complaints procedure and feel confident that they can raise concerns with staff and will be listened to. Staff have completed a short training session in adult protection, and are aware of the procedure to follow in the event of a safeguarding alert. Staff are subject to a CRB and POVA check prior to starting work at the home. However complaints would be clearer to trace if they were recorded in a dedicated complaints book. Evidence: Staff have completed a short questionnaire and watched a 20 minute video on Adult Protection in the home. Staff spoken to did have knowledge of the correct procedure to follow in the event of a referral to Safeguarding. The home does keep a record of complaints but this is in a daily correspondence book, this would be clearer and easier to track if the complaints were record in a complaints book in the service. The complaints which were record were in relation to a resident being unable to have a bath as the bathroom was being painted, and the other complaint was in relation to a resident being concerned about the safe storage of her jewelery. Both complaints were dealt with effectively by the Registered Manager. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable and was clean on the day of the inspection. The Registered Provider has addressed all the areas which require improvement in the environment and it is now a safe place to live. However the front gated entrance into the road must be risk assessed. Evidence: On the day of the inspection the inspector carried out a partial environmental tour, all areas of the home and garden were inspected apart from two bedrooms where residents were asleep or in bed. During the inspection the inspector was sufficiently concerned to leave an immediate requirement to ensure that risks in the environment were addressed within 48 hours. These were specifically with regard to radiator covers which were rusty and with a lose top, uncovered pipes and exposed pipes which have been left following removal of a sink. Also potential dangers were loose carpet and carpet bars which had been used inappropriately. However subsequently following the inspection the Registered Manager confirmed by phone all the issues in the environment had been addressed and this work had now been done. Since the last inspection the service has had new carpet in hallways, passageways, the lounge and dining room and these areas have been redecorated. Three bedrooms have been repainted and new curtains have been purchased for the lounge. New pictures have been brought for the home also. Care Homes for Older People Page 18 of 27 Evidence: The house has a fence surrounding it and a you can obtain entrance to the house through a shared drive and a front gate. The front gate opens onto a busy main road and this has in the past lead to a fatality in the home. In discussion with the Registered Manager they informed me that they have no one in the house who is likely to wander in the garden and is at risk. However this risk should be comprehensively assessed in relation to all the residents in the home and if appropriate signage used or some sort of secure lock on the gate to ensure residents are not at risk of being run over. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training has improved since the last inspection and now all staff are enrolled or have completed NVQ training. Staff receive supervision and attend team meetings. However there needs to be a process in place to ensure supervision notes and team meeting minutes are dated, collated clearly and available to view. Evidence: As part of the inspection the inspector spoke with two staff and the Registered Manager, looked at a variety of staff files including two recruitment files, supervision sheets, list of staff training and team meeting notes. Staff are well supported, confident in their roles and like working at the home. Staff have now completed NVQ training, and all staff are enrolled for dementia care training. In addition all staff have just completed a medication course through the college Safe handling of medication. Manual Handling training for all staff is overdue in the home. The home uses a induction package but it is not the Skill for Care specific induction, therefore the Registered Manager must ensure the induction used matches the NTO induction specifications. Since the last inspection the home has recruited a further cook so now employees two. The rota showed the following staff on duty in the home. Monday to Friday 3 members of staff are on duty, 8 - 9.30am then the third member of staff at 9.30 - 2pm is deployed on cleaning duties. Two staff members are on duty in the afternoon 2pm - 8pm then 1 sleep in member of staff and 1 waking staff member is on Care Homes for Older People Page 20 of 27 Evidence: duty. No formal cleaning is carried out at the weekends as their is no dedicated cleaning staff, light duties are carried out such as tidying. In discussion with staff and also evidencing the activities available in the home it is clear that with more staff residents would be able to do more activities in the home. Although residents spoken to were happy that if they wanted to do anything in particular staff would spend time with them and help them complete it, such as baking a cake. The Registered Manager does complete supervision sheets with staff, and also has team meetings. The team meeting notes were on display in the notice board of the home. However supervision sheets were not dated and it was impossible to find a trail of dates to match for staff supervision, and this was also the case for team meeting notes, there was no trail available to show these are regular. Staff are employed following POVA first and CRB checks. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run with the best interests of the service users in place and they appeared happy and settled in the home. The Manager of the home appeared approachable well liked and works with the best interests of the residents. However the systems for recording and storing information and evaluating the service are poor, therefore affecting the overall running of the home. Evidence: As part of the inspection the inspector examined three care plans, spoke to two staff members and the Registered Manager, spent time with the residents in the home, and looked at a variety of records. Residents are well looked after and appeared happy in the home, they had only good things to say about the staff and also about the food and things on offer in the home. However it is evident that if more staff were on duty then more time could be spent with residents engaging in activities or indeed taking them into the community. The Proprietor has invested money into the home and has improved the environment and dealt with the immediate requirements in the home, Care Homes for Older People Page 22 of 27 Evidence: which were in relation to exposed pipes, rusty radiator covers and loose carpet. Staff appeared supported and confident in their roles within the home. Care plans were informative and health support had been accessed for residents appropriately. The Registered Manager does carry out supervisions and team meetings with staff however these need to be recorded in a more formal way and dated so that a clear audit trail is available. Improvements also need to be made in the way complaints are recorded within the home, again these are dealt with and recorded but they should be in a dedicated file or book, complaints should not be recorded in the daily log. The inspector could see no evidence of a maintenance plan for the home and no record of quality assurance systems in the home. The Registered Manager did confirm that the proprietor visits weekly, carries out a tour of the home and meets with her. This has improved since the last inspection but again no formal written record was available to confirm this on the day of the inspection. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 30 18 That staff receive and are up 01/01/2009 to date with all mandatory training. To ensure service users are protected and their needs are met. 2 33 35 The Registered Manager 01/01/2009 must ensure there are quality assurance systems in place, and formal ways to gain the views of service users, relatives and any other interested parties in the home. To ensure the service evaluates and builds on quality outcomes. 3 33 35 Where the Registered 01/01/2009 Provider is an individual but not in day to day charge of the care home he shall visit the care home unannounced at least once a month and supply a copy of the report required under paragraph 4 C. Care Homes for Older People Page 25 of 27 To ensure the service evaluates and builds on quality outcomes. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 The Registered Manager obtain a Controlled Drugs Register to record the administration of controlled drugs in the service. The Registered Manager must ensure a sample list of staff signatures is available to view with the MAR sheets, and a list of staff trained to administer medication is available. The home does have a record of complaints and the outcomes. However the Registered Manager must ensure they use a dedicated book to ensure information is kept confidentially and also to ensure complaints and the outcome of complaints can be clearly traced and audited. The Registered Manager risk assess the gated front entrance in relation to the service user in the home, and if necessary erect a warning sign or use a lock to ensure no one wanders on to the main road. The Registered Manager must ensure the induction used within the home matches the NTO specification induction. The Registered Manager must ensure staff meeting notes are recorded and collated so a clear trail can be followed. The Registered Manager must ensure staff supervision sheets are dated and collated so a audit trail of supervisions can be followed. 2 9 3 16 4 19 5 6 7 30 32 36 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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