CARE HOMES FOR OLDER PEOPLE
Marlowe House School Lane Hadlow Down East Sussex TN22 4HY Lead Inspector
Elaine Green Key Unannounced Inspection 6th June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Marlowe House Address School Lane Hadlow Down East Sussex TN22 4HY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01825 830224 01825 830924 AUM Care Limited Mrs Janet Moseley Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The maximum number of service users to be accommodated is 20 (twenty). Service users must be older people aged sixty-five (65) years or over on admission. This is the first Inspection of Marlowe House since AUM Care Ltd became the registered providers January 2006. Date of last inspection Brief Description of the Service: 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 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, two lounges – one on the ground floor and one on the second floor, a well-kept garden with some seating and off road parking. Fees are assessed on an individual basis and as of June 2006 they range from £340 to £410 per week. Included in the fees are all meals, laundry and ‘in house’ activities. Additional charges are made for Chiropody £9 and hairdressing the charges for which vary but typically is £9 for a shampoo and set. Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. As part of the Unannounced Inspection of Marlowe House a site visit took place to the home. This took place between 10 am and 4.30 pm on the 6th May 2006. The Inspector had a tour of the building, joined service users in the dining room for their midday meal and had the opportunity to meet with two visiting relatives and a visiting health care professional. The Inspector had discussions with the visitors, 4 service users, manager and members of staff team and their comments will be reflected within the report. A range of records and documentation were also examined and included some of the homes’ policies, procedures, guidelines and daily records, service users care plans, medication records and records pertaining to health and safety. Service user questionnaires were sent by the CSCI prior to the visit and feedback from the four completed questionnaires received will be included within the report. What the service does well:
The manager of the home appropriately assesses prospective service users prior to their admission to the home. Care plans contain detailed and informative information for staff to follow in relation to supporting service users appropriately. They also contain good pen portrait of the individual based on information gained from a personal questionnaire completed on admission. This helps staff and service users build good relationships. The health care needs of service users resident in the home are met and the medication policies and procedures adopted by the home are safe. All staff receive training in the administration of medication. The quality of the food provided to the residents of Marlowe House is good and all the comments received by the Inspector in relation to the food were positive. The food served for the midday meal on the day of the site visit was hot, homemade and of good quality, an alternative was available. Service users have a choice of what time they get up or go to bed and what time they have their breakfast. Many service users stated that they have their breakfast in their rooms and enjoy this. There is a varied programme of activities on offer at the home that the service users are happy with. Staffing are employed in sufficient numbers to meet the needs of the people who reside there and receive a comprehensive induction and training programme. The staff team are enthusiastic and open to new ways of working, appear relaxed and interact well with service users. The management of the home is open and transparent. Service users, visitors and staff feel the management are approachable. The health safety and welfare of service users and staff are largely protected and promoted.
Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4,5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are assessed prior admission however, not all service users are provided with the documented information they require to make an informed decision about whether or not to reside there. EVIDENCE: Preadmission assessment documentation was examined and found to be in order. The home has obtained copies of social services assessments where possible and this information had been transfered onto the care plan. In addition to the pre admission assessment the manager asks the prospective service user or their relative to complete a questionaire which provides the home with valuable information about serviuce history, family relationships, likes and dislikes. This information is useful for staff when getting to know the service user and helps the home ensure that they can meet the service users needs’ and provide activities and entertainment to their liking. Service users are able to visit the home to look round and the first months stay is on a trial basis.
Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 9 All service users whose placement in the home is funded by social services must be provided with a statement of their terms of conditions of residency prior to moving into the home. Currently the manager informs prospective service users verbally of whether or not the home can meet their needs. It is required that following a preadmission assessment, that the prospective service user is informed in writing of the outcome. In addition all prospective service users must be provided with an up to date service user guide and statement of purpose prior to moving into the home and exsiting service users should be provided with up to date copies. Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users care plans provide the guidance required for staff to support service users in their daily lives. EVIDENCE: Three Care plans were examined and found to be in order. The information provided is detailed and the plans have been signed by service users. Although the manager stated that the care plans are reviewed on a regular basis and ammended as and when needed a requirement is made for all care plans to be reviewed on a monthly basis and that the person undertaking the review signs to confirm this. Care plans include a section called ‘Care at a glance’ that gives a breif outline of the areas where support is required. They also include good background information specifying service users personal history, hobbies and likes and dislikes e.g. likes to have hair coloured, likes to spend time in own room etc. This kind of detail makes the care plans at Marlowe House very personalised. Medication records were examined and were in order however where service users have been prescibed ‘as and when required’ (PRN) medication there were
Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 11 no guidlines in place for staff to follow in relation to when this medication should be administered. In addition one care plan that was examined did not contain details of how stafff were to support the individual manage their diabetes. Staff were able to discuss how they did this with the Inspector however it is required that this information is documented. A visiting health care proffessional confirmed that appropriate referals are made, that they see service users in the privacy of their own rooms and that they had no concerns in regard to the care and support given to service by staff of the home. Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service are provided with the opportunity to participate in appropriate leisure and social activities. The food provided is wholesome and nutritious. EVIDENCE: The home provides service users the opportunity to participate in appropriate, enjoyable and stimulating activities. A visiting relative stated that there was always something going on and service users stated they were happy with the activities on offer and the frequency of them. It is recommended that the activity programme contained service users care plan is completed showing the activities they prefer to participate in, including how and when individuals like to maintain contact with their friends, relatives and the wider community. Activities currently on offer in the home includes, hairdressing, bingo, craft, garden activities, cooking, kareoke, sing along, nail and beauty. Three visitors came to the home on the day of the site vsit and all of them confirmed that they are welcomed into the home and that their visting times are not restricted. Service users stated that they have choice and control over their lives and are able to chose for themselves when to get up, go to bed, what they eat, when they eat, what to wear and whether or not they participate in the activities on offer in the home. On the day of the site visit
Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 13 several service users had chosen to have a lie in and were given the support they required when they requested it. The Inspector joined service users for their midday meal. The food served was hot, wholesome, nutritious and well presented. A choice was available and service users stated that they are asked on a daily basis what their preference is for the day. The homes’ menu was examined and confirmed that a varied diet is provided. Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected by homes adult protection and policies and procedures and service feel they are listened to. EVIDENCE: Appropriate safeguarding referrals are made by home when required and a visiting health care professional confirmed this. None of the service users currently resident in the home present a level of behaviour that is challenging however when this did occur the manager reassessed the individuals needs and a more appropriate placement was then found. The complaints that have been made to the management have been investigated appropriately. The homes complaints policies and procedures are satisfactory and service users stated that they confident in approaching the manager if they had any complaints. The home has a copy of the local adult protection policies, procedures and guidelines and provides staff with the appropriate training in recognising abuse. Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,25,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, homely, safe, well maintained and clean environment for service users to reside in. EVIDENCE: The Inspector had a tour of the building and grounds on the day of the site visit. Since AUM Care Ltd have become the registered providers of the home improvements have been made in respect of the home being considerably less cluttered than in recent years meaning the home is safer for service users and all areas of the home are now accessible. The home was clean and hygienic and all the requirements made following a recent visit by the Environmental Health Officer have been met. Some redecoration of the home has taken place and the manager explained that more is planned. Improvements have also taken place in the garden which is now more accessible to service users now that some of the bushes and trees have been cut back allowing safer access to the path around the rear of the
Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 16 property. The manager again explained that further improvements are planned for the gardens and patio areas of the home. Areas of the patio and driveway at the side and rear of the property are uneven and are in need of replacing or repairing. It is required that the home implements a programme of maintenance, redecoration and renewal and that these are included. Service users bedrooms are personalised and meet their needs. Some service users have brought their own furniture and others have chosen to use those provided by the home. Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are met by the numbers and skills of the well trained staff employed by the home. The recuitment procedures adopted by the home are safe. Not all staff hold the relevant qualifications. EVIDENCE: The staff employed to work at Marlowe House appear to be happier and more relaxed since the new providers took over in January this year. This is having a positive affect on the service they are providing to the service users resident in the home. This was evident to the Inspector and was commented on by two of the visitors on the day of the site visit. The home provides a comprehensive, induction and training programme for all the staff employed. The staffing rotas were examined and there are sufficient numbers of staff on duty at all times to meet the needs of the service users resident in the home. Service users stated that under normal circumstances that the staff are able to give them the support they require in a timely way and that they are never rushed. Staff stated that they felt the manager and deputy manager of the home supported them and that they are approachable. The manager stated that being a small home she found it affective to work alongside staff on duty and that she speaks to all the staff on duty each day.
Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 18 Observations of the staff practice on the day of the site visit confirm that staff are competent and confident. Several staff were able to detail the support required by individual service users and how this support should be delivered. The staff team as a whole appear positive, enthusiastic and open to new ways of working. Unfortunately the target of 50 of the care staff employed by the home achieving a national Vocational Qualification (NVQ) in Care at Level 2 or above has not been met so a requirement has been made. However, the manager did explain that this was due to the fact that the previous owner of the home had not supported the staff of the home to achieve these qualifications and that since the new providers had taken over plans have been put in place for some staff to be registered on the relevant courses later this year. Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.The manager is appropriatly experienced and qualified and runs the home in the best interest of the service users who reside there. The health safety and wellfare of service usuers and staff is largely protected and promoted. Staff do not receive formal supervision and shortfalls were identified in the amount of quality monitoring undertaken by the home. EVIDENCE: The manager of Marlowe House is qualified and experienced and has managed this home for a number of years. The service users, relatives and health care professional that the Inspector had discussions with on the day of the site visit all spoke highly of her management style and stated that they found her approachable. Two visitors stated that they are kept informed of any changes in the condition of the individual they visit.
Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 20 Staff stated that they felt supported by the manager and deputy manager and that they felt the home was running better since the new owners took over and that stress levels had dropped. However, though the manger does speak to all staff on a daily basis and the provider visits the home on a weekly basis, it is required that all staff, including the manager, receives formal documented supervision at least 6 times a year. As the provider of the home is now a Limited Company it is required that as part of the homes’ quality monitoring of the services it provides, arrangements are made for the provider to undertake monthly-unannounced visits to the home and provide a written report to the manager of the home and the Commission for Social Care Inspection. In addition to this it is required that the home expands the service users questionnaires already given following admission to include gaining service users views of the home on a yearly basis. Relatives questionnaires are given out annually and are used to help the home make improvements to the services they offer to service users. Health and safety records were examined and found to be in order. Water temperatures are monitored on a monthly basis and an in depth comprehensive fire risk assessment has been undertaken. In addition to this fire risk assessment of the home it is also required that a fire evacuation plan is implemented for all service users in the home that is based on individual risk assessments. Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X 3 X 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 X 2 Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5(1b) Timescale for action That all prospective service users 30/07/06 are provided with a statement of their terms and conditions, an up to date Service User Guide and Statement of Purpose prior to moving into the home. That all existing service users are provided with up to date copies of the above. That following the preadmission 30/06/06 assessment the manager informs prospective service users in writing of whether or not the home can meet their needs. This must occur prior to prospective a service user moving into the home. That care plans must be 30/06/06 reviewed on a monthly basis and the person undertaking the review must sign and date to confirm this. Guidelines must be written for 30/06/06 PRN medication and for how staff should support an individual service user with their diabetes. Areas of the patio and driveway 30/07/06 at the side and rear of the property are uneven and are in
DS0000066431.V292674.R01.S.doc Version 5.2 Page 23 Requirement 2. OP4 14(1d) 3. OP7 15(2ac) 4. OP9 13(2) 5. OP19 13(4ac) Marlowe House 6. OP33 24(1ab, 2,3) 26(2) 7. OP36 18(2) 8. OP38 23(4iii) need of replacing or repairing. It is required that the home implements a programme of maintenance, redecoration and renewal, stating timescales and that these are included. That the Registered Provider 30/07/06 makes arrangements for monthly-unannounced visits to the home to take place and for reports to be sent to the manager of he home and the CSCI. That the home introduces a quality monitoring system based on gaining service users views. All staff, including the manager, 30/08/06 receives formal documented supervision at least 6 times a year. That the home implements a fire 30/08/06 evacuation procedure for each service user based on an individual risk assessment. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations It is recommended that the activity programme contained on service users care plan is completed showing the activities they prefer to participate in including how and when individuals like to maintain contact with their friends, relatives and the wider community. Marlowe House DS0000066431.V292674.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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