Inspection on 03/03/05 for Marmion Nursing Home

Also see our care home review for Marmion Nursing Home for more information

Full report

Care Homes For Adults (18 65)Marmion Nursing HomeStretton Street Glascote Tamworth Staffordshire B77 2BHAnnounced Inspection3 March 2005 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Marmion Nursing Home Address Stretton Street, Glascote, Tamworth, Staffordshire, B77 2BH Email address Tel No: 01827 67953 Fax No: n/aName of registered provider(s)/company (if applicable) Grangemoor Care Homes Name of registered manager (if applicable) Steve Bridges Type of registration Care Home No. of places registered (if applicable) 24Category(ies) of registration, with (number of places) Mental disorder, excluding learning disability or dementia (24) Registration number E090000183 Date first registered 29 July 2002 Was the home registered under the Registered Homes Act 1984 as amended? Do additional conditions of registration apply ? Date of last inspectionDate of latest registration certificate 30 July 2002 yes NO 29/11/04 If Yes refer to Part CMarmion Nursing HomePage 1 Date of inspection visit Time of inspection visit Name of inspector 1 Name of specialist (e.g. Interpreter/Signer) (if applicable) Name of establishment representative at the time of inspection3 March 2005 10:30 am Mrs Sue MullinID Code075190Marmion Nursing HomePage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspectors Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & Findings National Minimum Standards for Care Homes for Adults (18 65) 1. Choice of Home 2. Individual Needs and Choices 3. Lifestyle 4. Personal and Healthcare support 5. Concerns, Complaints and Protection 6. Environment 7. Staffing 8. Conduct and Management of the Home Part C: Part D: D.1. D.2. D.3. Compliance with Conditions ( if applicable) Providers Response Providers Comments Action Plan Providers Agreement Sue Mullin 10 March 2005 Signature Sue mullinLead Inspector DatePublic reports It should be noted that all CSCI inspection reports are public documents.Marmion Nursing HomePage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the Commission for Social Care Inspection (CSCI) is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000 as amended. This document summarises the inspection findings of the CSCI in respect of Marmion Nursing Home. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Adults (18-65) published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the CSCI regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the Standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Providers response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The following inspection methods have been used in the production of this report. The report is based on the findings of the specified inspection dates.Marmion Nursing HomePage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Marmion care home with nursing accommodates service users with mental health problems from the age of 18 years and over. The home caters for 24 service users in total. The home is built on two levels accessed by a passenger lift and has communal areas, two lounges and a dining room. There are three bathrooms, including a shower facility and five separate toilets throughout the home. Five single rooms have en suite facilities. The home is situated less than one mile from the centre of Tamworth and has a bus stop 400 yards away.Marmion Nursing HomePage 5 PART ASUMMARY OF INSPECTION FINDINGSInspectors Summary (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.) The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users, determining aspects of care provision and meeting the national minimum standards. Some standards have not have been inspected on this occasion, and will have been covered at the earlier inspection of this service, which took place on 29th November 2004. For a full overview of the homes performance against standards in 2004/05, these reports should be read together. The home had 23 nursing residents at the time of the inspection, with one vacancy. Whilst the home met all the required standards assessed on this occasion with care planning, training, induction and supervision, the staff do not benefit from using an up to date comprehensive care planning/training/induction system. Discussion took place on this matter and the home would benefit greatly from implementing new systems in corporation with an available computer data base. Choice of Home (Standards 15) 4 of the 4 standards assessed were met The home was meeting the assessed needs of the service users and staff were aware of individuals needs and the support required. The Manager and senior staff demonstrated an up to date knowledge of care practices and legislation and continue to develop staffs skills. Service users have a contract by the placing authority detailing the terms and conditions of occupancy. The service user guide also includes terms and conditions, and care and support to be provided within the home. Individual Needs and Choices (Standards 610) 4 of the 4 standards assessed were met All individuals had a plan of care that included personal details, and details of health care and support for personal care, daily activities and community presence, and included assessment of risk for activities within the home and the community. The plans have been reviewed monthly. The plans of care recorded the support individuals require, with decision making and observation of practices demonstrated individuals were able to make informed choices and given opportunities to speak freely. Individuals have access to an Advocacy Service and details are available within the home. There are no service users who were using this service at the time of the inspection. Marmion Nursing Home Page 6 Service users are able to receive and be responsible for their personal allowance and a record of monies received was maintained. Support is given to help individuals budget and awareness of monetary value where required. The inspection included talking to many of the service users individually as well as seeing a number together. They all stated that they were provided with choices over their lives. For example they were able to choose whether to attend college/education etc. They chose when to get up and when to go to bed within the context of their agreed weekly schedules. The service users stated that they could choose an alternative if they did not like a meal presented. Service users were observed throughout the inspection making decisions over how to spend their time, deciding whether to spend time in their own rooms or in the communal lounges. Service users also stated that they were able to choose whether or not to join in organised activities. Service users subject to risk assessments were able to choose when to be at home or out of the homes environment. Several of the service users managed their own finances. Records showed that the home maintained records of all transactions and of money given to the service users. Files showed that the home had undertaken assessments relating to financial management and had identified the support needed by each service users. Service users are offered the choice of a postal vote in the elections and assisted where necessary by staff. Mail is received un opened and a pay phone is available in the home. Individuals plan of care included assessment of risk for activities within the home and the community. There were detailed assessments were on file, for managing risk and guidance for managing behaviours associated with mental health needs. Lifestyle (Standards 1117) 5 of the 5 standards assessed were met Staff support individuals to find suitable work or college placements. Some service users within the home have reached a point in their lives or/retirement age and do not wish to find employment or attend college. Their wishes are supported by the staff. Service users are able to access leisure activities independently following assessment of risk. Individuals are supported to maintain contact with friends and family, who can also visit the home on a flexible basis. Service users stated that the routines were quite flexibly. They stated they could get up and go to bed when they wanted. They could shower or bath as desired. Observation showed that staff knocked and waited to be invited into bedrooms and that service users also respected the privacy of other service users. Three service users engaged in conversation with the inspector asked for `Sky satellite systems to be available in the no smoking lounge and this is a recommendation of this report. Service users that did not have a key to their room had been given the opportunity of choice or had been assessed as not able to manage a key. Marmion Nursing Home Page 7 Service users confirmed that they had free access to all the communal rooms in the home and were able to go out whenever they wished having alerted the staff. Observation showed staff communicating in a relaxed manner with the service There is a main kitchen where all meals are prepared and service users were aware of the menu and can choose an alternative meal. Personal and Healthcare Support (Standards 1821) 4 of the 4 standards assessed were met Medication is kept within a locked medicine cabinet in the clinical room. Medication is administered by trained staff in line with NMC requirements. All medication is stored appropriately and MAR sheets checked were correctly completed. Local G.P. services are used by service users and documentation evidenced their involvement and appointments made. Where possible staff stated the key worker would attend medical appointments with individuals. Individuals are able to attend appointments independently where appropriate. The Plan of care records health needs and the support required. A record of visits to specialist health care services including opticians visits, dentistry, chiropody and psychiatry was maintained. Concerns, Complaints and Protection (Standards 2223) 2 of the 2 standards assessed were met No complaints had been raised within the home. Any complaints received would be dealt with by the manager. The home has a Whistle Blowing Procedure. POVA training was recommended. Environment (Standards 2430) 5 of the 5 standards assessed were met Accommodation is provided on two floors and both single and shared bedrooms are available. There two lounge areas one for smoking and a separate dining room. The premises were suitable for the service users. The home provided suitable bedroom and communal rooms and was decorated throughout in a domestic and homely style. The home was located in a residential area. The home was generally satisfactorily maintained and good quality carpets had recently been laid. There were no unpleasant odours detected throughout the home. The home was suitably heated for the weather and had suitable lighting. The home had a planned maintenance and decoration schedule. The main lounge which was available for smoking, was very congested with smoke throughout the inspection, despite only having the benefit of one expellair, which was constantly on. It is a recommendation of this report that a further expellair ( or something of the equivalent is situated ) is sited to reduce the lasting effects of smoke, particularly to Marmion Nursing Home Page 8 those who smoke less than others and those that do not smoke at all. Sky television was only available in the smokers lounge. Staffing (Standards 3136) 5 of the 5 standards assessed were met Staff had a very good relationship with individuals and were appropriately interacting with service users and providing support. Staff were aware of individuals plan of care and a committed to promoting independence and giving support required with mental health issues. Staffing hours were inspected and based upon the dependency levels of the service users resident on the day of the inspection, demonstrated the hours provided were adequate. Staff records contained evidence of good recruitment practices and staff received appropriate documentation. Staff were supported in their work. Records showed that staff received formal individual supervision sessions. The home also had staff meetings providing them with the opportunity to be briefed on developments and to discuss issues relating to the home and the service users. Conduct and management of the home (Standards 3743) 6 of the 6 standards assessed were met The Care Manager Mr Steve Bridges has the knowledge, experience and skill to be an effective manager. Mr Bridges has successfully completed the Registered Managers award. The staff team within the home spoke positively about the support and leadership of the manager. Staff continued to report that the emphasis of the home was to encourage a positive approach to care and promoting service users rights, empowerment and inclusion. The manager and his senior staff have been leading the team and delivering the training to enable development of the service. Risk assessments have been completed for the environment and required maintenance and servicing completed.Marmion Nursing HomePage 9 Requirements from last Inspection visit fully actioned? If No please list below Action is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements.YESCONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).MET (YES/NO) NAMarmion Nursing HomePage 10 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001, and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard * Requirement Timescale for action None madeMarmion Nursing HomePage 11 RECOMMENDATIONS Identified below are areas addressed in the main body of the report which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s). The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Refer to Good Practice Recommendations Standard * Three service users engaged in conversation with the inspector asked for `Sky satellite systems to be available in the no smoking lounge and this is a recommendation of the report. ( It was already available in the smokers lounge) The main lounge which was available for smoking, was very congested with smoke throughout the inspection, despite one expellair, which was constantly on. It is a recommendation of this report that a further expellair is sited to reduce the immediate and lasting effects of smoke inhalation particularly to those who smoke less than others and those that do not smoke at all. POVA training was recommended for all staff.1YA142YA243YA23* Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. YA10 refers to Standard 10.Marmion Nursing HomePage 12 PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct observation Indirect observation Sampling · Pre-inspection questionnaire · Records · Care plans / Care pathways · Meals · Activities · Other enter details here `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting professionals survey / feedback Tour of premises Formal interviews Document reading Additional inspection information: Number of service users spoken to at time of inspection Number of relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the responsible individual seen CRB check for the manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total No. of care staff employed (excluding managers) Total No. of staff with nursing qualifications employed Date of inspection Time of inspection Duration of inspection (hrs) YES YES YES YES YES YES NO NO YES YES YES YES YES YES NO NO NO YES NO YES 11 0 0 YES YES YES YES 11 9 03/03/05 10.30 4.5Marmion Nursing HomePage 13 The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Adults (18-65) have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No Shortfalls) (Minor Shortfalls) (Major Shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.Marmion Nursing HomePage 14 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · Prospective service users have the information they need to make an informed choice about where to live. Prospective service users individual aspirations and needs are assessed. Prospective service users know that the home they choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to `test drive the home. Each service user has an individual written contract or statement of terms and conditions with the home.Standard 1 (1.1 1.4) The registered person produces an up to date statement of purpose setting out the aims, objectives and philosophy of the home, its services and facilities and terms and conditions; and provides each service user with a service users guide to the home. The statement of purpose should clearly set out the physical environmental standards met by the home in relation to standards 24.2, 24.9, 25.3, 25.5, 27.2, 27.4 and 28.2; and a summary of this information should appear in the service users guide. 396 396 Range of fees charged From To £ £ (per week) YES Any charges for extras If yes, please state what the extras are Personal sundries 0 Key findings/Evidence Standard met? This standard was met on the previous inspection and has not been assessed on this occasion.Standard 2 (2.1 2.8) New service users are admitted only on the basis of a full assessment undertaken by people competent to do so, involving the prospective service user, using an appropriate communication method and with an independent advocate as appropriate. 3 Key findings/Evidence Standard met? Service users were assessed prior to being admitted in to the home. Both the local authority and the home undertake an assessment. This assessment covers the areas of health and personal care, social, leisure and occupational and educational needs. The assessment formed the basis of the service user plan.Marmion Nursing HomePage 15 Standard 3 (3.1 - 3.10) The registered person can demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 3 Key findings/Evidence Standard met? From inspection of records, discussion with service users and staff, and observation of staff practices demonstrated the home was meeting the assessed needs of the service users. Staff communicated effectively with service users and were aware of individuals needs and the support required. The Manager and senior staff demonstrated an up to date knowledge of care practices and legislation and developed staffs skills and knowledge through supervision and regular staff meetings. Standard 4 (4.1 - 4.5) The registered manager invites prospective service users to visit the home on an introductory basis before making a decision to move there, and unplanned admissions are avoided wherever possible. 3 Key findings/Evidence Standard met? Prospective service users are invited to visit the home to meet the service users and staff. The home have an introductory programme that can include day visits. All placements are made on a trial basis confirmed only after a review of the service user and other relevant people.Standard 5 (5.1 - 5.5) The registered manager develops and agrees with each prospective service user a written and costed contract/statement of terms and conditions between the home and the service user. 3 Key findings/Evidence Standard met? The staff confirmed that all service users have a copy of a contract by the placing authority detailing the terms and conditions of residency and fee level. The service user guide includes terms and conditions, and care and support to be provided within the home.Marmion Nursing HomePage 16 Individual Needs and ChoicesThe intended outcomes for the following set of standards are: · · · · · Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept.Standard 6 (6.1 6.10) The registered manager develops and agrees with each service user an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. 3 Key findings/Evidence Standard met? All individuals had a plan of care that included personal details, a photograph, and details of care and support for personal care, daily activities and community presence. The plans have been reviewed monthly and details of care management reviews are on file. The plan included any restriction on freedom and choice and rules of the home are also included in the Service User Guide. Inspection of records demonstrated new admissions have a detailed and comprehensive plan of care and has been developed with other professionals, where possible. All service user plans are developed to a good standard.Marmion Nursing HomePage 17 Standard 7 (7.1 7.7) Staff respect service users right to make decisions, and that right is limited only through the assessment process, involving the service user, and as recorded in the individual Service User Plan. 4 Key findings/Evidence Standard met? The plans of care recorded the support individuals require with decision making and observation of practices demonstrated individuals were able to make informed choices and given opportunities to speak freely. Individuals have access to an Advocacy Service and details are available within the home. There are no service users who were using this service at the time of the inspection. Service users are able to receive and be responsible for their personal allowance and a record of monies received was maintained. Support is given to help individuals budget and awareness of monetary value where required. The inspection included talking to all the service users individually as well as seeing a number together. They all stated that they were provided with choices over their lives. For example they were able to choose whether to attend college. They chose when to get up and when to go to bed within the context of their agreed weekly schedules. The service users stated that they could choose an alternative if they did not like a meal. Service users were observed throughout the inspection making decisions over how to spend their time, deciding whether to spend time in their own rooms or in the communal lounges. Service users also stated that they were able to choose whether or not to join in organised activities. Service users subject to risk assessments were able to choose when to be in or out of the home environment. Several of the service users managed their own finances. Records showed that the home maintained records of all transactions and of money given to the service users. Files showed that the home had undertaken assessments relating to financial management and had identified the support needed by each service users. Service users are offered the choice of a postal vote in the elections and assisted where necessary by staff. Mail is received un opened and a pay phone is available in the home.Marmion Nursing HomePage 18 Standard 8 (8.1 8.5) The registered manager ensures that service users are offered opportunities to participate in the day to day running of the home and to contribute to the development and review of policies, procedures and services. 3 Key findings/Evidence Standard met? Staff support service users to take an active role in the daily management of the home. Discussion with staff revealed individuals require encouragement but staff are committed to developing these skills. Service user meetings take place regularly and are recorded. ( 28/02/05) The meetings enable the service users to formally voice any concerns, make decisions on forth coming events and contribute to the management of the home. The meetings have also been used to discuss and plan activities The service user guide has been developed in line with the identified needs of the service users and this has been discussed to ensure understanding. Standard 9 (9.1 9.4) Staff enable service users to take responsible risks, ensuring they have good information on which to base decisions, within the context of the service users individual Plan and of the homes risk assessment and risk management strategies. 3 Key findings/Evidence Standard met? Individuals plan of care included assessment of risk for activities within the home and the community. There were detailed assessments were on file for managing risk and guidance for managing behaviours associated with mental health needs.Standard 10 (10.1 10.6). Staff respect information given by service users in confidence, and handle information about service users in accordance with the homes written policies and procedures and the Data Protection Act 1998, and in the best interests of the service user. 0 Key findings/Evidence Standard met? This standard was met on the previous inspection and has not been assessed on this occasion.Marmion Nursing HomePage 19 LifestyleThe intended outcomes for the following set of standards are: · · · · · · · Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate, personal, family and sexual relationships. Service users rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes.Standard 11 (11.1 11.4) Staff enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. 0 Key findings/Evidence Standard met? This standard was met on the previous inspection and has not been assessed on this occasion.Marmion Nursing HomePage 20 Standard 12 (12.1 12.6) Staff help service users to find and keep appropriate jobs, continue their education or training, and / or take part in valued and fulfilling activities. 3 Key findings/Evidence Standard met? Staff support individuals to find suitable work or college placements where appropriate. Some service users attends a local work placement, several times a week. Other service users have received advice and support on education and employment. Staff recognise that individuals require support with motivation and staff have been working closely with service users to acquire the confidence required to develop this skill. Some service users within the home have reached retirement age and stated they did not wish to find employment or attend college. One service user attends college for an horticultural course at Tamworth College and another attends cookery classes One service user attends the Nuffield centre 4 times a week and this is a paid activity. Transport is arranged for this. Several service users attend a local church drop in centre which has been closed recently for refurbishment, this is within walking distance.Standard 13 (13.1 13.5) Staff support service users to become part of, and participate in, the local community in accordance with assessed needs and the individual Plans. 0 Key findings/Evidence Standard met? This standard was met on the previous inspection and has not been assessed on this occasion.Marmion Nursing HomePage 21 Standard 14 (14.1 14.6) Staff ensure that service users have access to, and choose from a range of, appropriate leisure activities. 3 Key findings/Evidence Standard met? Individuals records show details of preferences and interests. Discussion with staff and service users revealed individuals visit local places of interests and use community leisure facilities and entertainment venues. Service users are able to access leisure activities independently following assessment of risk. Service users chose to visit places of interest during the summer months and day trips are organised. A range of activities have been planned but initial enthusiasm by the service users has diminished. It is pleasing to note that staff are investigating alternatives and continue to promote meaningful activities. The home provide a birthday celebration for each service user in turn and occasionally have a disco event using the recently acquired stereo system. Three service users engaged in conversation with the inspector asked for `Sky satellite systems to be available in the no smoking lounge and this is a recommendation of this report. The staff in the home also confirmed to the inspector that fund raising is ongoing throughout the year. Standard 15 (15.1 15.5) Staff support service users to maintain family links and friendships inside and outside the home, subject to restrictions agreed in the individual Plan and Contract (subject to standards 2 and 6 if necessary). 3 Key findings/Evidence Standard met? Service users maintain contact with relatives through visits, letters or telephone calls. Visits may be to the home or visiting a family home. Service users determine whom they wish to visit or who visit them.Marmion Nursing HomePage 22 Standard 16 (16.1 16.11) The daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual Plan and Contract (subject to Standards 2 and 6 if necessary). 4 Key findings/Evidence Standard met? Service users stated that the routines were quite flexibly. They stated they could get up and go to bed when they wanted. They could shower or bath as desired. Observation showed that staff knocked and waited to be invited into bedrooms and that service users also respected the privacy of other service users. Service users that did not have a key to their room had been given the opportunity of choice or had been assessed as not able to manage a key. Service users confirmed that they had free access to all the communal rooms in the home and were able to go out whenever they wished having alerted the staff. Observation showed staff communicating in a relaxed manner with the service users. Standard 17 (17.1 17.9) The registered person promotes service users health and wellbeing by ensuring the supply of nutritious, varied, balanced and attractively presented meals in a congenial setting and at flexible times. 3 Key findings/Evidence Standard met? There is a main kitchen where all meals are prepared. A rotational menu was prepared and service users were aware of meals served. Individuals stated they are able to inform the cook on each day if they wish an alternative meal and alternatives are available.Marmion Nursing HomePage 23 Personal and Healthcare SupportThe intended outcomes for the following set of standards are: · · · · Service users receive personal support in the way they prefer and require. Service users physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the homes policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish.Standard 18 (18.1 18.11) Staff provide sensitive and flexible personal support and nursing care to maximise service users privacy, dignity, independence and control over their lives. 3 Key findings/Evidence Standard met? The main needs of the service users was for support and encouragement to maintain their own personal care needs. As identified previously the service users stated that they were able to get and go to bed when they chose and they were no restrictions on service users having baths and showers. Staff would provide support with hair and nail care where needed. Service users confirmed that they had their own clothes and that the staff provided support when necessary to buy clothes. The home operated a key worker system.Marmion Nursing HomePage 24 Standard 19 (19.1 19.5) The registered person ensures that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. No. of incidents where service users have been taken to Accident & Emergency during last 12 months No. of service users with pressure sores at the time of inspection (from information taken from care notes) 013 Key findings/Evidence Standard met? Local G.P. services are used by service users and documentation evidenced their involvement and appointments made. Where possible staff stated the key worker would attend medical appointments with individuals. Individuals are able to attend appointments independently where appropriate. The Plan of care records health needs and the support required. A record of visits to specialist health care services including opticians visits, dentistry ( all service users are registered with an NHS dentist) chiropody and psychiatry was maintained. Two consultants share the review and care of service users in the home on a regular basis. Standard 20 (20.1 20.14) The registered manager and staff encourage and support service users to retain, administer and control their own medication, within a risk management framework, and comply with the homes policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines. 3 Key findings/Evidence Standard met? The treatment room was inspected and found to be clean and tidy. The home have comprehensive medication administration policies. Procedures for ordering and disposal of drugs is available to all staff. The MAR sheets were seen and all were completed in line with NMC requirements. There were appropriate current drug reference books in the home. There were photographs of service users and a specimen signatures of staff administering drugs and signing the MAR sheets. All medication is administered by qualified first level nurses. All service users have a lockable facility in their room if self medicating. However at the time of the inspection no service users were self medicating. No service users are currently taking insulin and there was one service user in anti-biotics for a chest infection.Marmion Nursing HomePage 25 Standard 21 (21.1 21.8) The registered manager and staff deal with the ageing, illness and death of a service user with sensitivity and respect. 3 Key findings/Evidence Standard met? Discussions with the senior staff illustrated that they maintained a sound knowledge of the effects of enduring mental heath needs. The home has had no recent deaths at the home. The home has links with health care professionals and would be able to access relevant support in the event of the ill health of a service users.Marmion Nursing HomePage 26 Concerns, Complaints and ProtectionThe intended outcomes for the following set of standards are: · · Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm.Standard 22 (22.1 22.7) The registered person ensures that there is a clear and effective complaints procedure, which includes the stages of, and timescales for, the process and that service users know how and to whom to complain. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to CSCI Percentage of complaints responded to within 28 days 0 0 0 0 0 0 X 3 Key findings/Evidence Standard met? The home have on display an appropriate complaints procedure which includes all the CSCI details.Marmion Nursing HomePage 27 Standard 23 (23.1 23. 6) The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, or inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policy. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the DOH Guidance No Secrets No of staff referred for inclusion on POCA/POVA lists Key findings/Evidence The home has a Whistle Blowing Procedure. YES0 Standard met? 3A detailed record of all financial transactions was maintained within the home and accompanied by receipts. Service users receive their personal allowance and signing for all monies received. A recommendation was made to introduce POVA training to all staff.Marmion Nursing HomePage 28 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · Service users live in a homely, comfortable and safe environment. Service users bedrooms suit their needs and lifestyles. Service users bedrooms promote their independence. Service users toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic.Standard 24 (24.1 24.13) The homes premises are suitable for its stated purpose; accessible, safe and well maintained; meet service users individual and collective needs in a comfortable and homely way; and have been designed with reference to relevant guidance. 3 Key findings/Evidence Standard met? The premises were suitable for the service users. The home provided suitable bedroom and communal rooms and was decorated throughout in a domestic and homely style. The home was located in a residential area. The home was generally satisfactorily maintained and good quality carpets had recently been laid. There were no unpleasant odours detected throughout the home. The home was suitably heated for the weather and had suitable lighting. The home had a planned maintenance and decoration schedule. However, the main lounge which was available for smoking, was very congested with smoke throughout the inspection, despite one expellair, which was constantly on. It is a recommendation of this report that a further expellair is sited to reduce the lasting effects of smoke, particularly to those who smoke less than others and those that do not smoke at all. Sky television was only available in the smokers lounge.Marmion Nursing HomePage 29 Standard 25 (25.1 25. 11) The registered person provides each service user with a bedroom, which has useable floor space sufficient to meet individual needs and lifestyles. Total no. of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1st April 2003) single bedrooms below 10 sq.m usable space or additional compensatory space Total no. of wheelchair users accommodated for in rooms at least 12 sq.m Total no. of wheelchair users accommodated for in rooms less than 12 sq.m Total no. of shared rooms at least 16 sq.m Total no. of shared rooms below 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total no. of single bedrooms Number of single bedrooms with en suite Total no. of double bedrooms Number of double rooms with en suite NO NO YES 14 5 5 0 14 00 0 5 03 Key findings/Evidence Standard met? Rooms were suitable for the service users and this standard is met by direct observation.Marmion Nursing HomePage 30 Standard 26 (26.1 26.4) The registered person provides each service user with a bedroom that has furniture and fittings sufficient and suitable to meet individual needs and lifestyles. Key findings/Evidence Not assessed on this occasion Standard met? 0Standard 27 (27.1 27.6) The registered person provides service users with toilet and bathroom facilities which meet their assessed needs and offer sufficient personal privacy. 3 Key findings/Evidence Standard met? The home had suitable toilet and bathroom facilities. There were separate toilets upstairs and downstairs. There was a bathroom upstairs and a bathroom with shower over downstairs. All of these facilities were lockable.Standard 28 (28.1 28.3) A range of comfortable, safe and fully accessible shared spaces is provided both for shared activities and for private use. 3 Key findings/Evidence Standard met? The home had suitable communal rooms that were all decorated in a domestic manner. The home had two lounges ( one smoking ) and a separate dining room. The home had a domestic style kitchen and a small laundry . The home had a pleasant garden area with outdoor furniture.Marmion Nursing HomePage 31 Standard 29 ( 29.1 29.8) The registered person ensures the provision of environmental adaptations and disability equipment necessary to meet the homes stated purpose and the individually assessed needs of all service users. 0 Key findings/Evidence Standard met? Not assessed on this inspection.Standard 30 (30.1 30.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation, published professional guidance and the purpose of the home. 3 Key findings/Evidence Standard met? Observation showed that the home was clean throughout. There were no unpleasant odours in the home. The home had procedures in place to ensure that standards of hygiene were maintained. The home provided gloves and aprons and procedures were in place to advice staff on infection control measures. The home had a small laundry with washing machines able to thoroughly wash the laundry. The home had very little clinical waste.Marmion Nursing HomePage 32 StaffingThe intended outcomes for the following set of standards are: · · · · · · Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the homes recruitment policy and practices. Service users individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff.Standard 31 (31.1 31.7) The registered manager ensures that staff have clearly defined job descriptions and understand their own and others roles and responsibilities. 0 Key findings/Evidence Standard met? Not assessed on this occasion.Standard 32 (32.1 32.6) Staff have the competencies and qualities required to meet service users needs and achieve Sector Skills Council workforce strategy targets within the required timescales. 3 Key findings/Evidence Standard met? Staff were observed to have developed a good relationship with individuals and were appropriately interacting and providing individual support. Staff revealed an awareness of individuals plan of care and a commitment to promote independence and support required with mental health issues. Staff were observed communicating with service users and managing potential areas of conflict. There are no staff working in the home under the age of eighteen.Marmion Nursing HomePage 33 Standard 33 (33.1 33.11) The home has an effective staff team with sufficient numbers and complementary skills to support service users assessed needs at all times. Staff numbers/hours relating to the needs of service users are based on guidance recommended by the Department of Health. Personal Care No. service users High needs No. service users Medium needs No. service users Low needs Total no. of hours needed No. of staff with NVQ level 2 or above No. of Trainees registered on Sector Skills Council training programme 23 0 0 X 0 No. of full time equivalent Staff with nursing qualification (where applicable) No. staff hours allocated No. staff hours allocated No. staff hours allocated Total Hours Provided X X X X Nursing X X XX93 Key findings/Evidence Standard met? As this is a care home with nursing registered prior to April 1st 2002 agreed staffing levels are maintained. There is always a qualified nurse on duty over a twenty-four hour period. Additionally there are: Early shift = 7.30 2.30 pm with 2 care assistants Late shift = 2.30 9.30 pm with 2 care assistants Night shift = 9.30 7.30 am with 1 care assistant There is also another carer five days a week who helps out from 7.30am 10.00am. Staffing levels are based on the dependency levels of the service users in their care. No agency is used and there is a good supply of bank staff and staff willing to undertake extra shifts. Kitchen and domestic staff are adequate and care staff do the laundry. Maintenance/gardener as required Administrative work is undertaken by the owners No staff are employed under the age of 18 years. This standard is satisfactorily met.Marmion Nursing HomePage 34 Standard 34 (34.1 - 34. 8) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 3 Key findings/Evidence Standard met? The home operated the companys recruitment and selection procedures. One member of staff was selected and the inspector examined her personnel file. This showed that application forms were completed properly. Two references were present on file and there was evidence of a CRB check. Copies of job descriptions and staff contracts had been provided to all staff.Standard 35 (35.1 - 35.8) The registered person ensures that there is a staff training and development programme which meets the Sector Skills Council workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 3 Key findings/Evidence Standard met? The homes training and development plan was incorporated into the companys plan. All staff had received induction training and all new staff had completed an induction training programme. The home had in place a range of mandatory training for staff including health and safety, moving and handling and basic food hygiene. Standard 36 (36.1 - 36.8) Staff receive the support and supervision they need to carry out their jobs. 3 Key findings/Evidence Standard met? Staff were supported in their work. Records showed that staff received formal individual supervision sessions. The home also had staff meetings providing them with the opportunity to be briefed on developments and to discuss issues relating to the home and the service users.Marmion Nursing HomePage 35 Conduct and Management of the HomeThe intended outcomes for the following set of standards are: · · · · · · · Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self- monitoring, review and development by the home. Service users rights and best interests are safeguarded by the homes policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service.Standard 37 (37.1 37.4) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Registered manager qualified to level 4 NVQ in Management and care [by 2005]. YES4 Key findings/Evidence Standard met? The Care Manager Mr Steve Bridges has the knowledge, experience and skill to be an effective manager. Mr Bridges has successfully completed the Registered Managers award. The Care Manager was responsible for ensuring the home met the necessary standards and legislation.Standard 38 (38.1 38.6) The management approach of the home creates an open, positive and inclusive atmosphere. 4 Key findings/Evidence Standard met? The staff team within the home spoke positively about the support and leadership of the manager. Staff continued to report that the care manager created a positive approach to care and promoting service users rights, empowerment and inclusion. The manager and provider have been leading the team and delivering the training to enable development of the service.Marmion Nursing HomePage 36 Standard 39 (39.1 39.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. 0 Key findings/Evidence Standard met? Not assessed on this occasionStandards 40 (40.1 40.6) The homes written policies and procedures comply with current legislation and recognised professional standards, covering the topics set out in Appendix 2 of the National Minimum Standards for Adults (18-65). 3 Key findings/Evidence Standard met? The home have a range of policies and procedures in place which covers employment and staff issues as well as matters relating to care practices. As part of staffs induction they were expected to read all policies and procedures. All polices were kept in the office and were accessible to all staff and service users.Standard 41 (41.1 41.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 3 Key findings/Evidence Standard met ? Service users files are kept in a locked office Service users stated they were aware of where there records were stored and were able to access them upon request. Discussion with staff revealed they were aware of the need for confidentiality and would obtain individuals consent prior to divulging any information.Marmion Nursing HomePage 37 Standard 42 (42.1 42.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 3 Key findings/Evidence Standard met? Fire tests have been undertaken weekly. Emergency lights are tested monthly and fire equipment annually. (13/07/04) Fire risk assessments have been recently completed for the environment and for individuals. Hot water temperatures are tested monthly and these are recorded. Staff are provided with personal protective equipment where required. The home had a health and safety policy and risk assessments in place for safe working practices. Staff had undertaken training in manual handling, fire training, infection control, health and safety and food hygiene. The home reported that the home had a valid electrical installation certificate dated 4/04/04 and a gas installation check dated 17/08/04. Portable appliance tests have been completed. The home had a procedure for the control of hazardous substances and the substances were kept locked away. Standard 43 (43.1 43.7 ) The overall management of the service (within or external to the home) ensures the effectiveness, financial viability and accountability of the home. 3 Key findings/Evidence Standard met ? The home had valid insurance cover and there was no reason to request sight of the financial viability of the home.Marmion Nursing HomePage 38 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceCondition CommentsCompliancePART DMarmion Nursing HomePROVIDERS RESPONSE TO IDENTIFIEDPage 39 STATUTORY REQUIREMENTSD.1 Registered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the Inspection conducted on 3 March 2005 and any factual inaccuracies: Please limit your comments to one side of A4 if possible We are working on the best way to inlude provider responses in the published report. In the meantime responses received are available on request.Action taken by the CSCI in response to provider comments: Amendments to the report were necessary Marmion Nursing Home NO Page 40 Comments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateNONote: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. D.2 Please provide the Commission with a written Action Plan by 7 April 2005 , which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request.You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required YESAction plan was received at the point of publicationNOAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planOther: enter details here Marmion Nursing HomePage 41 D.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.D.3.1 I of confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or D.3.2 I of am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons:Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.Marmion Nursing HomePage 42 Marmion Nursing Home / 3 March 2005Commission for Social Care Inspection 33 Greycoat Street London SW1P 2QF Telephone: 020 7979 2000 Fax: 020 7979 2111 National Enquiry Line: 0845 015 0120 www.csci.org.ukS0000022350.V134566.R01© This report may only be used in its entirety. 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