Inspection on 16/07/07 for Marlstones Care Home

This inspection was carried out on 16th July 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Marlstones Care Home 24/07/06

Marlstones Care Home 22/02/06

Marlstones Care Home 15/10/05

Marlstones Care Home 18/03/05

Marlstones Care Home 01/06/04

Marlstones Care Home 17/02/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Marlstones Care Home Adgate Close off Rock Street Bulwell Nottingham NG6 8QU Lead Inspector Rob Cooper Unannounced Inspection 16th July 2007 10:00 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 Marlstones Care Home DS0000037295.V341112.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. Marlstones Care Home DS0000037295.V341112.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marlstones Care Home Address Adgate Close off Rock Street Bulwell Nottingham NG6 8QU 0115 9270629 0115 9760452 celia_broughton@nottinghamcity.co.ukc www.nottinghamshire.gov.uk Nottingham City Council 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) Mrs Cecilia Broughton Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Marlstones Care Home DS0000037295.V341112.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 8 service users may be under the age of 65 years, but over 55 years 24th July 2006 Date of last inspection Brief Description of the Service: Marlstones is residential care home for older people, owned and managed by Nottingham City Council. It is located to the north west of the city centre in the Bulwell area, and is close to local shops, pubs and churches. The building covers two floors, with the upper floor being accessed either via a staircase or a passenger lift; as a result people with restricted mobility can be accommodated, and can access all parts of the building. Marlstones is currently registered for forty-eight places of which four might be emergency/ short term care beds. Fees: £330 per week dependant on benefits and a social worker assessment. Marlstones Care Home DS0000037295.V341112.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit as part of the key inspection process – so that no one at Marlstones knew that the inspection visit was going to take place. The visit took approximately three hours through the middle of the day, with one inspector present. The method used to carry out this key inspection visit was to send out a preinspection questionnaire, which asked questions about the service, to gather statistics, such as how many service users there are, the numbers of staff etc. We also sent out a number of surveys to residents and relatives, however none had been returned by the date of this inspection. This was followed with a visit to Marlstones, where a method called case tracking was used; this involved identifying three residents and looking at their individual files and making a judgement about the quality of care they are receiving, and if their needs are being met. This was done by a partial tour of Marlstones, looking at the activities on offer, and talking to four residents and three members of staff about the quality of the service, and their experiences of living and working at Marlstones. In addition two relatives who were visiting Marlstones were asked for their views on the service being offered. The registered manager Cecelia Broughton supplied much of the information during the visit. On the day of this inspection there were forty-one residents in residence, including two on short-term-care. Prospective residents can also obtain information about residential care from the County Council’s web site at: www.nottinghamshire.gov.uk This web site contains a link to the Commission for Social Care inspection’s web site where the inspection reports for Marlstones can be viewed. What the service does well: There are plenty of activities for residents at Marlstones, and staff are actively fundraising to provide more and better activities. Residents who were asked spoke positively about living at Marlstones and said the staff treated them with respect and were kind and friendly. Security is taken seriously and there are good measures in place to ensure that both residents and staff are safe and secure within the building. Marlstones Care Home DS0000037295.V341112.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. The summary of this inspection report can be made available in other formats on request. Marlstones Care Home DS0000037295.V341112.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 Marlstones Care Home DS0000037295.V341112.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. JUDGEMENT – we looked at outcomes for the following standard(s): 123&6 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Prospective residents at Marlstones had sufficient information before they moved in to make an informed choice about where to live. Currently residents are well informed about the services Marlstones offers. Marlstones do not offer intermediate care. EVIDENCE: The statement of purpose and the service user guide for Marlstones were both seen. Both documents contained all of the information, which Care Homes Regulations say that they should, parts of the documents were in large print too, to help older people who might have failing eyesight. Evidence from residents at Marlstones showed that residents had a copy of the service user Marlstones Care Home DS0000037295.V341112.R01.S.doc Version 5.2 Page 9 guide. In addition Marlstones has a welcome pack, which contains the service user guide, and also contains photographs and other useful information. As part of the case tracking process three resident’s files were seen. Each file contained a copy of the terms and conditions of residence. Each resident’s file also contained a completed assessment of need, with one containing an Extended Community Care Assessment completed by the individual’s Social Worker, while the other two contained Shared Nottinghamshire Assessment Profiles (SNAP’s) which are Nottinghamshire’s preferred assessment tool for older people. Each of the assessments had been completed before the individual moved into Marlstones, and formed part of the admission process. Marlstones Care Home DS0000037295.V341112.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 & 11 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. The residents have their health and personal care well managed, supported and recorded by the staff at Marlstones. EVIDENCE: The three resident’s files seen all contained an individual plan of care, and details of health, personal and social care. Evidence was seen that the care plans were being reviewed on a regular basis, and showed evidence of having been signed by residents and or family representatives. All of the files that were seen contained care plans related to resident’s health care needs, and these were clear and detailed. Three residents were asked about seeing their doctor, and all said that they had a local doctor who either came to see them at the home (arranged through the staff) or they visited the surgery – depending on their particular need. Marlstones Care Home DS0000037295.V341112.R01.S.doc Version 5.2 Page 11 Boots (The Chemist) provide Marlstones with their medication. An inspection of the storage, and booking in and out procedures showed that medication is handled safely and there is a clear audit trail for medication from the point of ordering to administration and/or disposal. Administration records were inspected and found to be complete. The lunchtime medication round was partially observed, and there were no concerns seen in the administration procedures. No resident at Marlstones currently self-medicates. Boots have not provided any recent refresher training for the staff, and they should be contacted to arrange staff training as soon as possible. During the course of the inspection a number of staff to resident interactions were observed. These were seen to be polite and respectful, and staff were observed knocking on resident’s doors before entering. Three residents were spoken with during the inspection, and each one said that they thought the staff treated them well. One saying: “The staff are very good” while a second when asked if the staff were kind said: “Yes they are, very.” Each of the resident’s files contained a funeral plan with evidence that residents had been consulted about their wishes at the time of their death, and evidence of involvement from the resident’s families. Marlstones Care Home DS0000037295.V341112.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. 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. Residents at Marlstones have a lifestyle that reflects their cultural, social and religious interests, and needs. EVIDENCE: The entrance hall to Marlstones shows evidence of a number of activities, with photographs, posters together with a programme of activities on display. Staff at Marlstones are currently fundraising to contribute to the activities on offer, and have raised almost £1,000 through bring and buy sales and sponsored events, which contribute to the resident’s life at Marlstones. Two residents were asked about activities, and one said that they had been out for lunch, and that there was a trip to the Galleries of Justice too. The second resident said that there was a lot going on, and that the staff were very busy organising things. Discussions with two relatives showed that they were able to visit when they wanted, and that the staff were always welcoming, polite and helpful. Evidence was seen that family involvement meetings are due to start very Marlstones Care Home DS0000037295.V341112.R01.S.doc Version 5.2 Page 13 shortly, with invitations having been sent out. Two residents when asked said that their relatives came to see them, and there were no problems with arrangements for visiting. In the foyer there are a number of comment books for the use of visitors, and these had many positive comments from family and friends of the residents. Each of the residents spoken with said they thought there was a great deal of choice at Marlstones, and gave examples. The choices ranged from the food on offer in the menu, activities, trips out, and daily living. An increase in resident’s meetings and the focus of those meetings – they are much more about activities and making choices, has seen choice improve for residents at Marlstones. Observation of the lunchtime meal showed that the quantities and quality of the food were very good. Two residents when asked said that the food was: “Very nice, we’ve just had a lovely meal”, “it’s very good indeed, I do enjoy it here.” The menu showed a good variety and selection of food available, and all of the records relating to food storage and preparation evidenced that there was good and safe practice within the kitchen. Marlstones Care Home DS0000037295.V341112.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. 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. Residents at Marlstones are safe, and their complaints are taken seriously and dealt with. EVIDENCE: Marlstones have not received any complaints since the last key inspection. The complaints procedure is displayed prominently within the building, and forms part of the service user guide, a copy of which has been given to each resident. Discussions with two relatives showed that they knew how to complain, and whom to complain to, although neither had felt the need. Visitors are encouraged to comment in a comments book in the foyer. A review of staff training records showed that all members of staff underwent training in safeguarding adults’ procedures between November 2006 and January 2007. Discussions with two members of staff evidenced that they were aware of safeguarding adults’ procedures. Marlstones Care Home DS0000037295.V341112.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Residents at Marlstones live in a safe, clean and comfortable home, with their personal possessions around them. EVIDENCE: A partial tour of Marlstones showed it to be comfortable, well equipped and well maintained. Since the last key inspection new gates have been fitted and a closed circuit television (CCTV) system installed to add to resident and staff safety and security. A new Tunstall nurse call system has also been installed and this allows staff to respond to resident’s needs quicker and better. The falls specialist from the City Hospital has raised an issue about laminate flooring being fitted in bedrooms – this becomes very slippery when wet, and there had been an increase in falls at homes where this type of flooring had been laid. Marlstones have in the past fitted laminate flooring, but this is currently being replaced with carpet to address the potential ‘falls’ problem. Marlstones Care Home DS0000037295.V341112.R01.S.doc Version 5.2 Page 16 Staff were seen cleaning in various areas of Marlstones during the inspection, and the building was found to be clean. Two residents were asked about the cleanliness, and both said that they were quite happy, and that they thought the staff worked hard to keep the home clean and tidy. Marlstones Care Home DS0000037295.V341112.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. 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. Staff at Marlstones have been recruited professionally, and are competent and trained to do their jobs. EVIDENCE: The staffing rota for Marlstones was seen, and this indicated that there were enough staff on duty to meet the resident’s needs. The rota showed that the staff team had a structure, with some staff, more senior to others and able to take decisions and organise the work. Three members of staff who were asked all said that they thought that the staffing levels were sufficient, as did the three residents who were spoken with. The recommended standard training course for staff working in care is the National Vocational Qualification (NVQ) level II. Of the twenty-four staff members on the team, sixteen people have their NVQ level II, and five members of staff have their NVQ level III qualification. Ideally there should be 50 of the staff team qualified to a minimum of NVQ level II. Marlstones clearly have in excess of 50 , with currently only three members of the care staff without an NVQ qualification. Four staff files were seen, and each one contained all of the necessary documentation to indicate that staff had been recruited in a manner, which Marlstones Care Home DS0000037295.V341112.R01.S.doc Version 5.2 Page 18 would protect residents – this would include: written applications, formal interviews, two written references, and a criminal records bureau check. Each of the three members of staff who were spoken with said that they had been through a formal recruitment process, and had supplied references, and been criminal records bureau checked. A review of the staff training records showed that Marlstones does have a training plan for its staff, and that there are staff training courses planned for the coming months. The records showed that staff were receiving the skills training to be able to do their jobs, and discussions with three members of staff supported this view, and provided evidence of the different training courses staff had attended, including training in the mandatory areas – fire, food hygiene etc. Record keeping in relation to training had improved since the last key inspection. Marlstones Care Home DS0000037295.V341112.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 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. Marlstones is a safe, well-managed care home with good systems for ensuring its quality in place. EVIDENCE: The manager’s personal file was seen, and there was evidence of her experience and qualifications in the file. The Commission for Social Care Inspection has judged the manager to be ‘fit’ to be the Registered manager following an interview process. Marlstones have a quality assurance system in place based on questionnaires being sent out, and the comments received analysed. The current quality audit questionnaires have just been sent out, and the manager is awaiting Marlstones Care Home DS0000037295.V341112.R01.S.doc Version 5.2 Page 20 their return. Resident’s meetings take place at Marlstones, and the minutes of several meetings were seen – while the latest minutes were also displayed on the notice board. Resident’s at Marlstones have a small cash needs system for their cash needs. This is operated on their behalf by the staff, and four resident’s finances were sampled at random and checked. All cash balances tallied with the records, and receipts were kept, which enabled a clear audit trail of resident’s expenditure. Marlstones operate a supervision system, with staff having formal supervision approximately six times a year. Records relating to the staff’s formal supervision were seen and these indicated that staff members were properly supervised. Three staff members were spoken with about formal supervision and said that they were having a formal supervision session approximately every eight weeks. All of the staff spoken with said they felt they were very well supported by the management team at Marlstones. A range of health & safety records were seen, including fire records, Control of Substances Hazardous to Health records, and water temperature checks, and these were all found to be correct and complete, and indicate that both residents and staff at Marlstones are kept safe by the policies and procedures in place. Marlstones Care Home DS0000037295.V341112.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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Marlstones Care Home DS0000037295.V341112.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP9 Good Practice Recommendations Boots the Chemist should be contacted with regard to providing refresher/update training for all staff involved in the administration of medication. Marlstones Care Home DS0000037295.V341112.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 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 © 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 - 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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