Inspection on 10/02/06 for Marmora Residential Home

This inspection was carried out on 10th February 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Marmora Residential Home 08/07/09

Marmora Residential Home 17/07/07

Marmora Residential Home 10/01/07

Marmora Residential Home 30/05/06

Marmora Residential Home 24/03/05

Marmora Residential Home 26/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Marmora Residential Home 4/6 Penfold Road Clacton On Sea Essex CO15 1JN Lead Inspector Unannounced Inspection 10th February 2006 08:30 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 Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 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. Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Marmora Residential Home Address 4/6 Penfold Road Clacton On Sea Essex CO15 1JN 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) 01255 422719 01255 423830 Salsar Ltd Manager post vacant Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 27 persons) 8th July 2005 Date of last inspection Brief Description of the Service: Marmora is a care home for older people accommodating a maximum of 27 service users. The building is of an older style, with two lounges on the ground floor and bedroom accommodation which, with the exception of two double rooms, is made up of single rooms provided on three floors, with lift access to all bedroom accommodation. The property is detached and situated within walking distance of all local amenities within Clacton town centre. The home is in close proximity to the sea front at Clacton. The home has a garden area to the rear of the building and parking is available at the front aspect. Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report that collates information in respect of the visits from 8th July 2005, 30th September 2005 and 10th February 2006. These were unannounced inspections and included review of documentation, observation of staff and service user interaction, discussions with staff and service users. During the visit of 8th July 2005 significant concerns were raised in respect of the ethos, conduct and behaviours of staff working at the home and the rights of service users. Specifically the inspector was made aware of allegations of abuse that had not been robustly dealt with by the home and was witness to discussions that indicated that complaints were repressed. These concerns were raised with the proprietor and home’s manager immediately following the inspection in the form of an additional visit letter and an action plan required of them to address these issues. Subsequently the manager left her position and the proprietor sought advice from a consultant in care management to review the service. The action plan developed included a full review of the way in which the service operated and resulted in radical changes to the working day. As a result a large number of staff resigned immediately, placing the service in a severe staffing crisis. Initially this has had a detrimental affect on the service and caused concern to the service users living at the home. This has since been managed through agency staff and recruitment of new staff to the service, although the home is still recovering from the effects of this action and a large number of requirements remain in place. What the service does well: Service users commented on the good standard of food provided and the general approach of staff that was described as kind and helpful. The observations of staff’s interactions with service users were positive with close attention being paid to the individual’s needs. Staff recruitment procedures are robust and support the protection of service users. Systems supporting the medication administration to service users were carried out competently and adhered to good practice guidance. Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 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. Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 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 Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 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): 3 and 6. There is improvement in the quality of assessment made of new service users’ needs prior to moving into the home. There is no intermediate care provided at the home. EVIDENCE: The files of four service users were sampled during the inspection visits. They demonstrated an evolving process in developing the documentation required to understand and deliver the individual care required. This included the initial assessment forms, which had been reviewed and replaced by the consultant, Ms Carson. The new document contains reference to a range of information that would provide the service with a full picture of the individual’s previous life and their presenting abilities and needs. Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 9 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 and 10. Care plans varied in their content and were subject to revision. Service users were confident that their health care needs were addressed. The medication system is suitable and consistently managed. Service users’ rights were upheld by the staff’s conduct. EVIDENCE: Previous inspections had been critical of the level of documentation held in respect of care planning. These had not been fully completed and did not provide an understanding of the individual’s needs and how these could best be met. The care plans sampled during the inspection indicated that attempts were being made to update current documentation to ensure that a fuller picture of how staff should supplement and meet service users’ needs had been undertaken. Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 10 This had not been fully implemented at the time of the inspection, however once this had been carried out they would provide the basis for staff’s interaction with the individual service user. Discussions with service users indicated that they felt they received suitable attention to their health needs. They were clear that they had access to health professionals as requested and that staff were responsive to their health needs. Daily records contain reference to the visits of health professionals and comments regarding service users’ physical health and wellbeing. The monitoring of health needs, such as fluid intake, bowel movements, weight, etc, was not always present, and care plans should be updated to ensure they are reflective of the individual’s health needs and how staff should meet these. Medication is dispensed through a monitored dosage system. Observation of staff dispensing medication at the midday meal suggested that they understood and carried out the task appropriately. However some omissions in records did not evidence a consistent approach to the management of medicines in the home. During the inspection conducted in July 2005 service users had reported some experiences of staff conduct which did not appear to uphold their rights to treatment with respect and dignity. The discussions with service users at subsequent inspections on 30th September 2005 and 10th February 2006, identified that this was not the experience of all service users and service users stated that staff knocked on doors and addressed them in a manner they preferred. Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 11 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 and 15. Some service users are provided with social stimulation, but this is not consistent. The home supports service users’ relationships with family members. There are some areas where service users are able to exercise choice. The home provides a variety of nutritious meals. EVIDENCE: The service users spoken with during the inspection were aware of opportunities to take part in activities, however these had been greatly reduced in preceding months. They felt that there were attempts being made to address this, such as the recent organisation of dominoes games. However there did not seem to be a consistent approach to this by staff in the home. Nor did the activities reflect knowledge about the individual’s preferences. The service users spoken with described how their family and friends were welcomed to the home and encouraged to maintain contact. During the visit, families visited throughout the day. Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 12 Those service users spoken with identified areas of their lives where they were able to exercise choice. This included when they got up and went to bed, how they spent their day in the home, what they ate for meals. They also felt that this opportunity was not extended to all service users, especially those more dependent on staff assistance for essential daily care, such as going to bed, etc. The meals provided by the home were the subject of positive comments from all service users spoken with. Despite the difficulties in retaining catering staff experienced by the home. Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 13 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 and 18. The service users were aware of the complaints procedure. The protection of vulnerable adults policy and procedure was not reflective of local guidance in the matter. EVIDENCE: Discussions with service users indicated that they were aware of the complaints procedure and whom they should speak with. Some service users said that they had made informal representations to the provider and these had been addressed. The inspection carried out in July 2005 identified areas where staff’s behaviours and the culture of the home appeared to support abusive conduct. Examples included the suppression of a service user’s complaint, the lack of empathy in their approach to service users’ abilities by staff and the general acceptance of this behaviour. This was addressed with the company’s Responsible Individual immediately following the inspection and an action plan required from them to address the issues highlighted. The action plan has been developed and is ongoing, however subsequent events such as a large portion of the staff resigning have overshadowed the initial issue. The Responsible Individual and the consultant brought into the home to address the issues were reminded of the need to ensure this area is fully addressed through policy and staff training. Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 14 The POVA policy is not reflective of the current local guidance in that it instructs staff to commence investigation prior to notifying authorities. The Responsible Person was made aware of the changes required. Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 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 and 26. The premises are suitable for their purpose and are maintained. The home appears clean and free from odour. EVIDENCE: The premises have not changed substantially since previous inspections, however some areas of the home have been refurbished and new flooring laid as part of the planned maintenance of the building. Prior to the inspection some concerns were raised with the Commission by visitors to the home, in respect of the maintenance of hygiene and cleanliness of service users’ rooms. They were aware that the housekeeping staff had left the home and felt that this had adversely affected the standards delivered. The inspector could not find any area of the home that did not appear to be cleaned thoroughly and there were not any noticeable odours. Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 16 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 and 30. The staffing levels do not meet the expectations of service users. The home’s recruitment procedures are not robust. Staff training is not complete. EVIDENCE: The action plan developed by the Responsible Individual and consultant in response to the inspection visit of 8th July 2005, detailed an expectation that staffing levels had been reviewed and was responsive to meet service users’ needs. A calculation using the residential forum was used to arrive at the numbers of hours required. These were maintained at three care staff, one of which was in charge during hours of 08.00hrs – 20.00hrs. This had been reduced from the previous start and finish time of 07.00hrs to 22.00hrs; it was stated this was due to the reduced demand on staff outside of these hours. From discussions with service users however they identified that outside of these hours when care staffing reduced to two staff, they felt there was insufficient availability of staff and meant that staff had to commence assisting service users into bed from 18.00hrs. This requires review to ensure that it satisfies both the individual’s choices as detailed in care planning, and that the current staffing levels do reflect the needs and daily living expectations of the service users. Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 17 The service has suffered from a substantial staff turnover since the inspection carried out in July 2005. The staff team present at the home were made up of newly recruited staff, temporary and agency staff. The three senior care staff are the longest established in this group. It was generally acknowledged by the Responsible Individual and consultant that this had affected consistency in the quality of care provision, but was unavoidable given the circumstances. The files of staff members examined during the visit did not contain documentation required by Care Homes Regulations 2001, 19, Schedule 2. This included CRB, two written references, identification documents, etc. This opens the service up to the risk of recruiting candidates who are unsuitable to work in the care field. Of particular concern is the lack of CRB/POVA checks before staff commence employment. The issue had previously been identified by the Responsible Individual and consultant as a consequence of the crisis management of the reduced staffing levels following the on mass resignation of the staff team. They stated that there had been a risk assessment process carried out prior to arriving at this action, however no evidence of such considerations was found on files. A staff training programme has been developed for the coming year with core skills training in health and safety, medication, moving and handling, etc. This will need further development to include issues identified from supervision, etc. Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 18 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, 33, 35 and 38. There is not a registered manager in post. There is a basic quality assurance system operating in the home Service users’ finances are not managed by the home. The records in relation to health and safety were present. EVIDENCE: The registered manager’s post has been vacant since July 2005, and the Responsible Individual reported that the company had been unsuccessful in recruiting a new manager. They stated that in the interim Mr Sarno as RI was carrying out the role of manager with the assistance of the consultant Debbie Carson. Mr Sarno will need to submit application for registration as a manager to the Commission. Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 19 There is a basic quality assurance audit sheet that identifies progress in recording in care planning, medication sheets and the accident book. This does not however include full anonymous feedback from stakeholders such as service users, family members and health staff. The staff supervision records were not present on staff files, and the Consultant confirmed that the supervision process was not yet in place. The last staff meeting minutes relate to August 2005, and this was confirmed as the last formal meeting but that regular informal contact was made with staff on a day-to-day basis. The records relating to the maintenance and quality checks required for health and safety were examined and the following items present were in date; fire alarms and emergency lighting 01/06, lift maintenance certificate 11/05, assisted bath maintenance 04/05, gas safety certificate 09/05 and hoist maintenance certificate 09/05. The certificate in relation to fire extinguishers was out of date at 06/04. Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 20 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 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X x 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X N/a 1 2 3 Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES 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 4,5 Requirement The registered person must ensure that service users are provided with a statement of terms and conditions. This standard was not assessed at this visit and is therefore carried over to the next inspection. 2 OP3 14 The registered person must ensure that all service users have a needs assessment prior to admission. 30/06/06 Timescale for action 31/08/06 3 OP7OP8 15 The registered person must ensure that there is a care plan for each service user which provides instruction to staff in how to meet the individual’s assessed needs. 30/06/06 4 OP9 13 The registered person must ensure that medication is administered according to policy and procedures. 31/05/06 Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 22 5 OP12OP14 13 The registered person must ensure that service users’ opportunities to exercise choice in their daily lives and activities is maximised and that these areas are recorded in care planning. The registered person must ensure that staff adhere to the home’s policy and practice in respect of protection of vulnerable adults, and that this policy is reflective of local guidance. The registered person must ensure that the staffing levels and arrangements are responsive to the assessed needs and choices of service users. The registered person must ensure that the home’s recruitment procedures are robust and protect service users, specifically that documentation required by Regulation 19 Schedule 2 is obtained prior to appointment. The registered person must ensure that the home has a staff training programme that meets national training workforce targets. The registered person must ensure that there is a strong management ethos being adopted in the home, which supports staff and service users in the delivery of policy and practice. 31/08/06 6 OP18 13 31/05/06 7 OP27O 18 31/05/06 8 OP29 18,19 Schedule 2 31/05/06 9 OP28OP30O 18 P38 30/06/06 10 OP31OP32 8,9,12 31/05/06 Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 23 11 OP33 24 The registered person must maintain a system which reviews the quality of care at regular intervals, and provides an action plan in response to the findings of the consultation. The registered person must ensure that staff receive formal line management supervision consistently. The registered person must ensure that records required by regulation are maintained. 31/08/06 12 OP36 18(2) 30/06/06 13 OP37 17 30/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Marmora Residential Home DS0000060575.V283225.R01.S.doc Version 5.1 Page 25 - 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. 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