Inspection on 08/07/09 for Marmora Residential Home

This inspection was carried out on 8th July 2009.

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

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

Marmora Residential Home 17/07/07

Marmora Residential Home 10/01/07

Marmora Residential Home 30/05/06

Marmora Residential Home 10/02/06

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 08/06/2011.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Marmora Residential Home 4/6 Penfold Road Clacton On Sea Essex CO15 1JN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Laker     Date: 0 8 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Marmora Residential Home 4/6 Penfold Road Clacton On Sea Essex CO15 1JN 01255422719 01255423830 kcarson@fsmail.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Salsar Ltd care home 27 Number of places (if applicable): Under 65 Over 65 27 old age, not falling within any other category Additional conditions: 0 Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 27 persons) Date of last inspection Brief description of the care home Marmora is an older style detached property situated very close to the sea front in Clacton and within walking distance of all local amenities and the town centre. There is parking available to the front of the property and well-maintained attractive gardens to the rear. The home provides care and accommodation for up to 27 people mostly in single rooms, with the exception of 2 double rooms. Accommodation is provided on three floors, with access to the upper floors by means of a passenger lift and stairs. Communal areas include two pleasant lounges and dining rooms. The home charges between 389.00 pounds and 450.00 pounds per week with additional charges for hairdressing or chiropody services and for personal items such Care Homes for Older People Page 4 of 31 Brief description of the care home as newspapers, sweets and outings. This information was provided to us in July 2009. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this home is one star. This means that people who use this service experience adequate quality outcomes. This key unannounced inspection looking at the core standards for care of older people took place on a weekday between 10:00 and 16:00. The registered proprietor and staff were present throughout and assisted with the inspection process by supplying records and information. This report has been compiled using information available prior to the visit such as surveys sent out, evidence found on the day of inspection and the annual quality assurance assessment (AQAA), which is required by law and is a self assessment completed by the service. The AQAA provides an opportunity for the service to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that some improvement be noted as this contributes to the Care Homes for Older People Page 6 of 31 inspection process and indicates the homes understanding of current requirements, legislation changes and own audited compliance. This document will be referred to as the AQAA throughout the report. During the day the care plans and files for four of the residents were seen as well as three staff files, the policy folders, the medication administration records (MAR sheets), some maintenance records and the fire log. The manager also supplied a copy of the duty rota, the menus, and other pertinent documentation which was required. A tour of Marmora was undertaken and six residents, five members of staff as well as the proprietor, administrator and chef were spoken with. The home was clean and tidy offering homely accommodation to the residents. The residents seen were relaxed and clearly felt at home in the environment using all areas of the building. All the records and files were generally well maintained and easily accessible. Interactions between staff and residents were friendly and appropriate. What the care home does well: What has improved since the last inspection? What they could do better: People moving into the service should have all their needs, strengths and aspirations documented. This will ensure that the service is fully aware of these and how they will support them before they agree to the admission. The management team should continue to develop care plans and risk assessments. Each person should have a comprehensive plan of care which should be person centred and indicate the assistance required to aid the persons predominant needs such as physical, social and healthcare needs. These should correlate with the daily evaluations to ensure all service users individual care needs are met and that staff are aware of these needs. Transcribed medications should evidence two signatures to ensure service users receive their correct medication. A clearly documented staff rota should be available at all times showing the designation of staff, their names and the person in charge. The programme of activities could be further developed to ensure that each individual living in the home receives the stimulation they need to have an interesting and fulfilled lifestyle. The home should have a formal recording system in place for complaints that clearly evidences their processes and records not just the complaint but the actions taken and the outcome with dates. Staff rotas and staff numbers should be representative of the home staffing requirements and dependency levels, showing contracted hours worked, names and designations, person in charge and NVQ qualifications. This will ensure there are enough staff on duty to meet individual care needs with no time constraints. Care Homes for Older People Page 8 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. People moving into the home can expect their needs to be identified although they cannot be confident that their needs will be documented so staff are confident that these needs may be met. Evidence: Information received in the Annual Quality Assurance Assessment (AQAA) submitted by the home states that a thorough pre-assessment procedure is carried out prior to admission and all information is recorded on their pre-admission form. People who are admitted through the social services referral process also have a COMM 5 assessment carried out by the local authority before admission. A sample of three care plans examined confirm that a dependency assessment and a manual handling assessment is carried out, however dates signatures were missing and in the case of one person Care Homes for Older People Page 11 of 31 Evidence: their name was missing. On the day of the inspection there were twenty seven people living at Marmora. The primary care needs of these people related to their old age. The admission process was discussed and considered with the proprietor who was present at the inspection, and sampled paperwork was not in all cases seen to support a comprehensive assessment and admission process. An initial assessment had not been conducted before admission to the home in one case, although supporting evidence of assessments completed by health professionals and social workers were present. This does not concur with the homes AQAA which states A thorough pre-assessment procedure is carried out prior to admission with all information relayed onto our PreAdmission form. The majority of Service Users admitted are referred by ECC (Essex County Council) and a COMM5 form is received prior to admission. This document is integrated into the care plan. Our assessment continues over a 28 day period as per our policy. Another person who was noted to have been in the home for a respite stay and another who had been in the home longer than 28 days, had also not had a pre admission assessment undertaken by the home. We were told by the home that family and relatives are encouraged and had been part of the admission processes for the sampled admissions. This statement was not supported by the documentation reviewed on the day of inspection. The AQAA acknowledges in response, If the service user does not have the mental capacity to be a part of the process we should ask the family member if they would like to take part. One relative survey received highlighted that although they felt the home met the care needs of their relative they could have been more involved with the admission process and another spoken with on the day of inspection could not remember being part of the admission process. Records examined all contained some evidence that the assessments are reviewed, however this had not been consistent in all cases and people are not always protected by the risk assessments formulated from the COMM 5 or pre admission assessment carried out by the home. For example one person had a risk assessment formulated some five days after admission for diabetes which just said hypos and the action required was To have breakfast and tea after DN has done insulin the inappropriateness of this risk assessment was discussed with the proprietor who agreed that more specific and appropriate detail was required. If detailed pre admission assessments are undertaken by the home prior to admission in addition to receipt of a COMM 5 this will ensure the home is able to meet and understand the needs of the people they care for. No intermediate care is offered at Marmora. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that they will receive the care identified in the assessment of need although they can expect to receive the health care support as needed. People who use this care service can be assured that their care needs are generally met through the management of medication and they are supported to access health professionals as needed. Evidence: The admission procedures in the home did not in all cases provide sufficient introductory information. From this information the home would be able to determine whether they could meet the identified needs and commence an individualised plan of care. The care plans of three people living at the home were sampled and inspected and they were used to case track care in the home. An assessment of needs is usually identified covering, health, personal and social cares needs. Within one of the three Care Homes for Older People Page 13 of 31 Evidence: care plans sampled, care plans had been created which covered topics such as personal hygiene, food and drink, mobility, night care, elimination, social, communication, interests and medical awareness. Of the other two sampled, one had not been developed at all and the other was only partially in process and had a generic emergency care plan in place which did not identify the persons individual needs, only potential ones and was not even completed. The homes AQAA refers to Residents having a comprehensive individual care plan produced based on assessed needs. This was noted to not be the case in all care plans reviewed. For example one service user who was identified as being partially blind did not have a care plan formulated and another service user who was receiving oxygen therapy and had a medical condition had no individualised care plan formulated. One service user spoken to stated I havent seen my care plan Another stated I know I have one and they tell me but I havent read it. Care plan detail was seen in one of the three care plans and goals/objectives and agreed actions were noted. Monthly reviews were evident or when a persons needs change but this had not been a consistent trend with the care plans reviewed. Some good details were evident though, such as choices identified where someone likes the light on at night for sleeping. Positive language is generally encouraged and staff are guided to encourage people to do what they can for themselves. We were informed on the day that the home aims to ensure all care plans become more person centred with life maps being completed and background information being completed by the resident. The proprietor discussed the key worker system whereby care plan reviews and updates would be their responsibility. This is yet to begin but is viewed as good practice to ensure consistency. Records examined also contained weight charts and records of visits by health professionals such as doctors, district nurses, chiropodist, optician and the osteoporosis nurse. A visiting district nurse states that they have confidence in the home and they contact community nursing services promptly if they suspect the start of skin breakdown. Community nursing services are working towards training senior carers to support people with diabetes within the home. They have contacted the PCT but this is still to be implemented fully however some staff have already had some training on monitoring blood glucose levels. A visiting healthcare professional who completed a survey said they A good home that acts within the best interests of their service users and receptive to any requests Alongside the care plans, risk assessments were seen in place. The risk assessments generally considered areas such as Self-Medication, Prevention of Falls, Diabetes, Smoking, Going out of the Home unaccompanied, Challenging Behaviour, Manual Handling and Nutrition & Health. The risk assessments seen in the care plans reviewed were noted to not all be appropriate or safely developed. For instance one person who was vegetarian had a risk assessment formulated for just veg, and another had one developed for just falls and the actions noted to be taken were look for buzzer. This Care Homes for Older People Page 14 of 31 Evidence: was discussed with the proprietor who agreed they needed a review to ensure they were both appropriate and identified a specific risk and action to follow for staff. In addition to this the daily evaluations were brief and non specific with quotes such as no problems and slept well used. Staff did not highlight any problems with care planning when spoken to. However it was noted that depending on who had completed the care plan determined how much time and detail was involved when documenting the entry. Training in care planning was discussed with the proprietor as the care plan is currently failing to reflect the current care required. The home uses a blisterpack system of medication that is dispensed by a local pharmacy and delivered to the home weekly. The storage and administration of medication was examined. Medicines are stored in a securely locked trolley. Any medication that needs to be stored in a controlled temperature is kept in a refrigerator that is solely for medication. On the day of the inspection a senior member of staff was observed administering medication at breakfast time. Good practices were followed and the member of staff was able to demonstrate knowledge of the medication being administered. Medicine Administration Record (MAR) sheets were examined and were generally found to be in order. Some transcribed medications did not evidence two signatures and gaps were noted in the use of the omissions code. MAR sheets did however contain photographs of individuals to reduce the risk of errors in administering. People living in the home were asked about their experience of living in Marmora. All those spoken with feel that they are treated with dignity and respect. One person was able to give an example of how the home listened to their wishes around their social interactions and personal care so that they are able to maintain their dignity. The person is also supported by having their dog live with them in the home. Observations of interactions between staff and people living in the home confirm that people are treated with respect. The home states in the AQAA that staff are trained to show respect and dignity at all times and they undergo ongoing training around ensuring people are treated as individuals. The home believes that the calibre of staff is high and this is reflected in the positive responses received through the homes own quality assurance surveys. A completed survey sent to us by a visiting health professional states, Care staff always take care with residents privacy and all are seen to be treated with courtesy and respect. Staff and residents spoken with said that Residents are looked after well and staff are kind and caring. It was also evident that the people living at Marmora were also able to express their individuality in their accommodation, and there was evidence of personal possessions, small pieces of furniture and photographs in their rooms. The home supports people appropriately in the final stages of life. The home had had a Care Homes for Older People Page 15 of 31 Evidence: death on the day of inspection and this was seen to be dealt with sensitively and discreetly. There is a comprehensive policy in place around death and dying. During the inspection we were able to observe staff going about their duties and as they approached and spoke with the people living at Marmora, it was pleasing to see that they were both respectful and sensitive to their needs and there was lots of friendly chatting and joking going on between staff and residents. Staff approach to privacy is good and relatives confirmed this on the day. Interaction between staff and residents was seen and heard to be friendly, caring and respectful. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Generally staff are aware of the need to support residents to develop their skills, including social, emotional, communication, and independent living skills. Residents are consulted or listened to regarding the choice of daily activity, but this process could be improved. People living in the home benefit from maintaining good contact with family and friends and they are provided with wholesome, appealing meals that they enjoy. Evidence: At the time of the last inspection improvements had been made to activities available in the home and this continues to be the case. The AQAA states We continue to hold regular meetings with Service Users and staff and they still do not identify any major faults or lack of quality provision. We continue to provide one to one stimulation. Service Users are still being encouraged to get involved with daily tasks such as folding laundry, laying tables. As the Manager I speak to all Service Users regularly to ensure their needs are continually being met. people spoken with on the day of inspection confirmed that they are encouraged to get involved in household tasks such Care Homes for Older People Page 17 of 31 Evidence: as folding the laundry and laying tables. People spoken with confirmed they do things around the home; one person said they do help with folding the laundry and napkins. Although there were no organised activities taking place on the day of this inspection, people were socializing and the atmosphere throughout the home was relaxed. One relative survey and one service user survey returned both stated the need for more activities is required. This was discussed with the proprietor on the day of inspection who stated the home provides person centred activities based on their own personal choice. Examples of this were a recent fashion show and a trip to the garden centre although not much interest was shown. Additionaly we are informed that one service user who chooses to walk their dog every morning by the sea has a small workshop in the conservatory where they make matchstick models. Staff spoken with stated We dont force them to become involved but sometimes we would like more staff so we can provide more one to one activities. The AQAA also details that the home would like to do better by Having tried to encourage more interaction with the local community and not be very successful we need to find other ways of providing interaction with the outside world. One relative spoken with on the day did confirm that activities were piecemeal at times and it would be nice if more outings were planned. Despite this overall activities offered do seem to meet most peoples needs, but some people may benefit from more stimulation or different activities. Social interactions and one to ones are not recorded clearly in plans of care and the proprietor stated on the day of inspection that there were plans to introduce psychosocial care plans with a person centred approach to address this. Visitors spoken with all said they are made welcome in the home. There is a small conservatory that can be used to meet visitors in private if people wish. The AQAA states that families are regularly invited to attend functions. People spoken with said they can choose what they want to do. One person said that you have to accept that things are different than in your own home, but even if you lose your independence there are still things that you can make choices about such as when you go to bed or what you eat. Overall the person is very positive about being able to make choices in the home. The home continues to offer a varied diet that is well cooked and enjoyed by the people who live there. Menus examined are worked out on a three-weekly rotational basis. All the food is home cooked and the emphasis is on traditional meals such as roast beef or sausages with onion gravy. The evening meal is a choice of sandwiches, soup or a light meal such as burgers. The cook leaves prepared cakes and snacks out for supper. Themed nights and the occasional take away are also provided and a weekly order of fresh fruit and vegetables is delivered. Food stocks and storage were examined during a tour of the premises and there is evidence that plenty of fresh vegetables and meat are used. People spoken with confirmed that the food is good. One person said that if a particular meal is not to their taste, there is always an alternative. Dining rooms are pleasant and well appointed. Surveys completed by people living in the home are complimentary about the food. Care Homes for Older People Page 18 of 31 Evidence: Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. People who use the service have access to a clear and understandable complaint procedure that ensures that they are listened to. The home operates good practices and procedures to ensure the protection of the people who live there. Evidence: The AQAA states that there is a comprehensive complaints policy in force and they ensure everyone at the home is aware of the procedure. The complaints policy for the home was noted to have been updated in May 2009. People living in the home and relatives spoken with are all confident that they would know what to do and who to speak to if they have a complaint. One person spoken with stated I have never made a complaint but do know who to speak to and another stated What do I have to complain about they listen and are very caring thats all I need. The AQAA also tells us We have introduced an in house training programme which we believe gives staff the opportunity to continually update their knowledge. We have listened to external agencies comments and now ensure that minor complaints are investigated and evidenced. Records seen recorded concerns but did not evidence actions taken or the outcome of the same. People living in the home are protected by the homes processes around safeguarding people. The AQAA states that all staff are given a copy of Protection from Abuse and Care Homes for Older People Page 20 of 31 Evidence: receive training around Safeguarding of Vulnerable Adults (SOVA). Records examined confirm that staff have received SOVA training with the next course planned noted to be planned for the 27th July 2009, and Criminal Record Bureau (CRB) checks are carried out on staff. The home has a whistle blowing policy in place so that staff can be confident they will be protected if they were to report any suspected poor practices or abuse. Staff spoken with were able to expain processes involved around safeguarding vulnerabl adults and the actions required to ensure people remained safe. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. People living in Marmora benefit from a safe and well-maintained environment that is clean and pleasant. People may be confident that their bedrooms are comfortable and they are surrounded by their own possessions and their independence is promoted. Evidence: Information received in the AQAA states that We carry out routine maintenance throughout the home. All external grounds are kept in good order. We are continually striving to provide a homely environment. We listen to our service users requests for change. i.e. garden in the front. Colour schemes are their choice in their own rooms. the home has undergone significant refurbishment. A tour of the premises confirms that improvements have been made since the last inspection and the work is continuing to the outside of the home. Specifically we were told by the proprietor that the front garden has been enclosed, the kitchen renewed, the lift refurbished and new blinds installed. Also a visit by the fire authority highlighted a best practice recommendation to install self closers on all doors and have fire proof strips put inside the doors. This has been done. Furnishings throughout the home are domestic in nature and overall there is a homely feel throughout. People spoken with said they like the homely atmosphere. There is Care Homes for Older People Page 22 of 31 Evidence: new furniture in communal areas and evidence that many rooms have been redecorated and others are in the process of being painted. A tour of the premises shows that there are appropriate adaptations and equipment in place including hoists and assisted baths. One bathroom was quite cluttered and appeared to be used for storing equipment, this was discussed with the proprietor on the day of inspection who agreed to relocate the items stored. There is a small step outside the front door and since the last inspection a ramp has been installed to aid those service users negotiating their walking frames over the step to get into the home. A lower doorbell has also been installed as it was previously noted that people could not reach the doorbell to get someone to help them and needed to ask for assistance. Individual bedrooms are well furnished and contain ample evidence of personal possessions. One person spoken with liked their room so much that they did not take up the offer of a larger room with better facilities when one became available. A tour of the premises shows there is a good standard of cleanliness throughout the home. There are no odours and the carpets are clean and replaced when required. The laundry is suitable for the size of the home and contains appropriate equipment. The flooring is impermeable to help ensure good infection control and there are handwashing facilities. There are liquid soap containers in toilets for washing hands and hand dryers are being installed throughout the home to replace the existing paper towel system. The cook is using the Safer Food Better Business pack provided by environmental health to record kitchen activities such as cleaning and maintenance. Kitchen records such as fridge temperatures were examined and are completed appropriately. A recent EHO inspection on the 24th April 2009 highlighted no problems with the home. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive the care they need by a staff team who have skills and knowledge to support them. The homes recruitment procedure provides the safeguards to ensure that appropriate staff are employed and service users are protected. Evidence: The numbers of staff on duty are generally sufficient to meet the needs of people living in the home. Staff rotas examined show there are either three or four staff on duty. It was observed that staff are kept busy and work hard, although people do not appear to have to wait excessively when they need support. The AQAA states We make our staff feel valued resulting in a very low turnover of leavers. We work with our staff to try and provide a healthy work life balance. Staff spoken with on the day of inspection confirmed that the morning shift was short that day but some staff had extended their shift to ensure there were enough staff to meet service users needs. Overall surveys completed by people living in the home are positive about the staff. One said, The manager and staff very kind and helpful. Although another commented, We need more staff at times and it would help if the rota was planned further ahead than just one week. One service user stated The carers do their best Care Homes for Older People Page 24 of 31 Evidence: but they can get very busy and you have to wait sometimes On the day of the inspection, staffing levels although short did not appear to impact on care being compromised although some tasks may have taken longer. The home has a training planner/matrix in place and the proprietor informed us she intends to employ the homes own trainer to aid training schedules. Information provided in the AQAA shows that 6 out of the 14 care staff employed by the home have completed or have almost completed a National Vocational Qualification (NVQ) at level 2 or above. The home has an appropriate recruitment process in place. A sample of three staff files examined contain all the required documents including photographs, proof of identity, two written references and Criminal Records Bureau (CRB) checks. Staff files are well organised with a checklist at the front. There have been improvements in staff training since last inspection. The homes training matrix was examined and shows that all staff have had training in manual handling, food hygiene and fire awareness, the mental capacity act, deprvation of liberty and nutrition. There is also a rolling programme that includes Health & Safety and infection control. Records examined confirm senior staff have had training in drug administration. There is also evidence that some staff have received training around diabetes and Alzheimers awareness and funeral bereavement training. Certificates were prominently displayed on the wall in the dining room area. Staff spoken with made positive comments about training. The homes AQAA states that they have maintained their current staff team for over a year and feedback suggests they feel valued. Specifically it states There have been very few changes. We now provide in house training which fits in with individual staffs personal lives. This has resulted in high attendance levels. More staff have come forward for NVQ training than in any other year. We will continue to listen to our staff and offer up to date training, regular supervision and appraisal to help them to grow into care sector professionals. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Marmora is well run by a competent management team and people living there can be confident that the home is run in their best interests. There are health and safety systems in place to ensure the welfare of both individuals and staff. Evidence: The home has a registered manager but they were not on duty on the day of inspection. Previous inspections have evidenced that they are able to demonstrate an awareness of good management practices and also show an enthusiasm and commitment to continuing to raise standards in the home. The manager has recently completed an NVQ level 4 Registered Managers Award and discussions on the day of the inspection with the proprietor confirmed that the manager is well supported by the proprietor who was present at this inspection. Staff and residents spoken with feel the manager is very approachable and runs the Care Homes for Older People Page 26 of 31 Evidence: home well. One person said, The manager does listen and the staff understand the residents well. The homes quality assurance process has been further developed since the last inspection. Records examined show that the home consults people living there and their relatives and they are using the feedback to make improvements to the home. For instance residents recently highlighted that they would like larger televisions in the lounge so flat screen ones are to be purchased. The AQAA states that there are regular meetings with people living in the home and any major faults or lack of quality provision have not been highlighted. As noted at the last inspection, the home does not manage the finances of anyone living there and only personal allowances are handled. Records examined confirm that all monies are kept individually and securely and there is appropriate documentation and receipts for amounts spent. The home has processes in place to ensure people living there are protected by safe working practices. Health and Safety records examined confirm that appropriate checks are carried out such as Portable Appliance Testing (PAT), servicing of gas appliances, lifts, hoists and fire fighting equipment. The proprietor is able to demonstrate a good awareness of the homes responsibilities in keeping people safe. The AQAA states that the manager carries out a weekly audit to ensure the home is safe and all equipment is regularly serviced and maintained. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Full and detailed pre 31/10/2009 admission assessments by the home must be undertaken prior to a service user moving in. This will ensure the home is confident they can meet and understand the needs of the people they care for 2 7 15 Staff must ensure that 31/10/2009 where possible residents and/or their representatives have input into the care planning system. Staff need to ensure that residents care plans are a clearly documented daily record of the care delivered and be person centred to evidence that staff appreciate the diversity of individual residents To evidence that staff appreciate the diversity of individual residents. Care Homes for Older People Page 29 of 31 3 8 13 Appropriate risk 31/10/2009 assessments must be in place for more dependant residents especially where service users are at risk of falls and other health problems which present risk, and staff must maintain detailed records of such and review appropriately so that service users are safe at all times. So that service users are safe at all times. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Any transcribed medications must be clearly documented with evidence of two signatures to ensure the risk of medication errors being made are reduced. People living in the home would benefit if the home reviews the range of range of social and recreational activities available so that everyone has something that will provide stimulation and enhance their lifestyle. The home should have a formal recording system in place for complaints that clearly evidences their processes and records not just the complaint but the actions taken and the outcome with dates. 2 12 3 16 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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