Inspection on 30/06/08 for Marner House

This inspection was carried out on 30th June 2008.

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 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

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Tanglewood

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Harmony Care Home

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Beacon Centre For The Blind

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Bryndale Avenue, 41 Flats 13, 14 & 18

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Marner House Rear of 79 Fitton Street Nuneaton Warwickshire CV11 5RZ Lead Inspector Kevin Ward Key Unannounced Inspection 30th June 2008 07:50 Marner House DS0000070707.V367003.R01.S.doc Version 5.2 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 Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marner House Address Rear of 79 Fitton Street Nuneaton Warwickshire CV11 5RZ 02476 641492 02476 327499 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) Milbury Community Services Ltd Vacant Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8), Physical disability (8), Sensory of places impairment (8) Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender Either Whose primary care needs on admission to the home are within the following categories: Physical Disability (PD) 8 Mental Disorder (MD) 8 Sensory Impairment (SI) 8 The maximum number of service users to be accommodated is 8 2. Date of last inspection First Inspection. Brief Description of the Service: Marner House can accommodate up to 8 people and is designed to be in keeping with the local community. The home is sited near to Nuneaton city centre, behind Fitton Street and is approached via an access road. There is adequate nominated parking to the front of the property. There are eight single occupancy bedrooms all having en suite facilities. Bedrooms are well appointed and furnished There are two ground floor bedroom and six on the first floor. Two ensuite bathrooms have ceiling hoists fitted and all the other bedrooms having adaptations to the en suite bathroom doors, to enable the fitting of hoists should people need this equipment. The home is bright, airy and pleasantly appointed giving a homely and domestic feel despite the size of accommodation. The corridors are wide and provide good wheelchair access and there is a lift to enable people to get up and downstairs. There is a pleasant rear garden mostly laid to patio with additional small sensory garden to the front/side of the home. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 5 The home has an adapted vehicle to enable people to get out and about. The current fees are £ 1,360 per week. The people at the home are required to pay a contribution to the cost of their care, based on a personal financial assessment. People using the service are required to pay for personal items, such as clothing and toiletries and pay a charge of £8.08, per week, towards cost of using the home’s transport, Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use the service experience adequate outcomes. This was the first Key unannounced inspection of Marner House. A key inspection addresses the essential aspects of operating a care home. This type of inspection seeks to establish evidence of continued safety and positive outcomes for the people using the service. The inspection focused on assessing the main Key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. The manager completed and returned an annual quality assurance questionnaire, containing helpful information about the home in time for the inspection. Questionnaires were completed and returned by a person that lives at the home and a health professional, enabling them to give their views of the service. The inspection included meeting everyone living at the home and case tracking the needs of two people. This involves looking at people’s care plans and health records and checking how needs are met in practice. Other people’s files were also looked at, in part, to verify the healthcare support being provided at the home. Discussions were held with three staff on duty as well as the manager and the deputy manager. A number of records, such as care plans, complaints records, staff training certificates and fire safety records were also sampled for information as part of this inspection. What the service does well: The home has information for new people interested in moving to the home to help them to make an informed choice. People’s needs are assessed before they move in and they encouraged to visit and see what the home has to offer before they make a decision to live there. People are being supported to get out and about in the community and a vehicle is available to help people to do so. People are encouraged to venture out independently where it is safe for them to do so. The manager said he would be developing links with colleges and employment services to support people to access a range of opportunities in keeping with their aspirations. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 7 People at the home are being supported to maintain relationships with relatives and friends and visitors are made to feel welcome. Positive work has taken place to develop links with the local mosque and prayer mats and compasses have been provided for two people so that they can pray when appropriate. They are also routinely supported to purchase halal meat and have been provided with a dedicated food preparation area in keeping with their cultural needs. The staff are friendly and get on well with the people living there. One person said, “They are very friendly, they are all lovely”. Staffing is being increased as people move to the home so that there are enough to meet people’s needs effectively. Staff are being provided with training to enable them to support people in a safe manner and there are plans for staff to complete National Vocation Qualifications, to equip them for their work. The home is making appropriate use of health professionals to ensure that people’s needs are met. A community nurse visits the home to monitor the needs of a person with diabetes and people hare being supported to access the GP when necessary. There have been no complaints about the home since it opened. The home has complaints procedures for investigating any complaints. The home has received a number of compliments since it first opened. Staff are being trained to recognise and report any suspicions of abuse so that people are protected from harm. The home is well equipped for wheelchair users, with wide hallways, specialist bath and shower rooms and two en-suite bedrooms have track hoist fitted. There is a lift to help people to get up and down stairs. The house is nicely decorated and well furnished. Quality assurance measures are being put in place so that the work of the home may be effectively monitored. A senior manager visits the home each month to check that the home is running well. Suitable arrangements have been put in place for checking that equipment is safe to use and in good working order. Risk assessments are being developed to support a safe living environment. What has improved since the last inspection? What they could do better: Six people have moved in, during the last three months and staff have been recruited to try and keep pace with new admissions to the home. This has presented challenges for the management of the home, keeping up to speed with care plans and supporting new staff. The manager said that no more Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 8 people would be considered for the home during the next month. This is necessary to make sure that staff have all the information they need to support people sensitively and so that they are given time to get to know the current people well. Care plans are currently in the process of ongoing development with people. Care plans contain some good information to enable staff to support people but they also contain some gaps. The manager said that the gaps would be addressed during the next month, whilst new admissions are halted and the information would be shared with staff to support a consistent approach to people’s care. A person with communication needs is being assessed by a speech therapist. The manager agreed to seek the speech therapist assistance to devise a communication dictionary so that new staff can more easily become familiar with the non verbal gestures used by the person concerned. Some staff have had diabetes training. The manager said he would be seeking the support of the diabetes nurse to provide more specific training and to devise a more detailed protocol for staff to follow when meeting the needs of a person at the home. There is a need to devise protocols for giving out PRN (as required) medication so that staff are clear about the reasons for giving out medication and the circumstances under which it should be given. Records were not in place to account for PRN (as required) medication. Since the site visit the manager reports that he has taken prompt action to address this matter. One person has changing continence needs and would benefit from a skin care risk assessment. Staff should be provided with pressure area care training so that they are equipped to provide preventative care to safeguard against sores developing. There is a recommendation for equality and diversity training at the home. This training encourages staff to see people as individuals with their own specific needs and preferences to be respected. There is a general risk assessment for the use of gym equipment, however there is a need to ensure that specific risk assessments are in place for pieces of gym equipment that may present a risk of injury, or place a demand for extra staff training, such as weight lifting equipment. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will 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. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures are in place for assessing people’s needs and they are provided with suitable information and contracts so that they are clear about their rights and responsibilities at the home. EVIDENCE: A Statement of Purpose is in place at the home providing a description of the service provided at Marner House. Service user guides, summarising the service were also seen on two people’s files. Information is also on display in the main entrance area for people to read. A visiting relative confirmed that he had been provided with written information and had been appropriately involved in the admission and planning process. Two people confirmed that they had been provided with opportunities to visit as part of the admission process so that they were able to make a more informed choice to move in. The manager explained that the admission process also typically includes visiting people before they move in to assess their needs. Assessment information was seen on file (completed by organisation’s assessment team) as evidence that people’s needs are assessed before they move in. The manager also visited to people to continue the assessment process. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 11 Contracts are in place on people’s files detailing their responsibilities, fees and service entitlements. Contracts are being signed by the people at the home and the home manager, as evidence they have been agreed to and are valid. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. 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. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are supported to make everyday choices so that they can exercise some control over their daily lives. The rating for this group of standards has been compromised by some shortfalls in care planning information, following a busy period of admissions to the home. This could lead to people’s needs not being met effectively. EVIDENCE: The manager and deputy explained that care plans and risk assessments are still in the process of being developed for the people at the home and are being written with their involvement. The manager said that he has reached an agreement with senior managers that no new people are to be admitted to the home during the next month, to allow time to finish the care plans and consolidate practice. This is necessary to ensure that staff have all the information they need to meet people’s needs Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 13 properly, as 6 people have now moved into the home since April. This has presented a challenge to the manager and the new staff to familiarise themselves with people’s needs so that they can provide sensitive person centred support. Two care plan files were checked. Both files contained most of the information necessary to take account of people’s presenting needs. The manager and the deputy explained that several people’s needs differ in some respects from their original pre admission assessments; in part this is due to being in a different environment or subsequent changes to their health. There were some gaps in care plans where they did not contain sufficient detailed information to ensure that people are effectively supported, e.g. one person needed more information about their moving and handling support needs and another needed updating to take account of changes to a person’s recent health needs that had necessitated hospitalisation and support from the home. The manager confirmed an intention to ensuring that all the care plans are brought up to date during the next month. The day following the site visit the deputy manager confirmed that a new moving and handling risk assessment had been devised with the involvement from an Occupational Therapist, delivering training to staff. One person communicates by non-verbal gestures. A speech therapist is currently assessing this person’s needs and helping them to develop their nonverbal communication. Discussions with staff indicate that they have developed a good understanding of the person’s communication needs but there is currently little information in the care plan for staff to learn from. The manager said that he would discuss the development of a communication dictionary with the speech therapist to help new staff to understand the meaning of the individual signs and gestures that the person uses to communicate their needs. The deputy manager shared a new document devised for recording care plan reviews so that changes in people’s needs and developments in their lives can be tracked and monitored. Two people, spoken to, confirmed that they had been involved in review meetings with social workers to check that they are settling in satisfactorily. Everyone spoken to said that they are able to make everyday living choices about what they eat and what they do. A person’s file was seen to record court restrictions in place, limiting where they may go. The person concerned was aware of the restrictions and had received explanation from the manager and the social worker on this matter. People were seen to choose what they ate for breakfast and everyone said that they go shopping with staff to buy their own clothing, toiletries and other personal items. Residents meeting notes were seen, providing evidence that people are being consulted with about such matters as activities and whether Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 14 they are happy at the home. Several people confirmed that they enjoy shopping and choosing groceries. Two people are supported to shop and choose halal food in keeping with their religious, cultural needs. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. 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. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are being supported to gain access to the community and their food preferences are respected making for a positive experience of living at the home. There is scope for developing links with colleges and specialist employment services to increase future educational and employment opportunities. EVIDENCE: Comments by people at the home indicate they are being supported to venture out into locally into the community on a regular basis. The manager explained that the home has developed links with a voluntary organisation with a view to two people undertaking countryside work. He also said that links would be developed with colleges and employment services to assist people in their aspirations. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 16 As previously noted everyone said that they go shopping to choose personal items. One person is particularly keen on exercising and keeping fit and takes advantage of the running machine and other equipment in the home. They also ride their bike locally and enjoy running. The manager said that he intends to go on runs with the person concerned to provide further encouragement for this activity. One female said that she had enjoyed a beauty session the previous evening with support from a member of staff and explained her plans for a new hairstyle. This indicates that support and encouragement is being given for people to maintain a good self-image. One person said they enjoy listening to live music. People at the home confirmed that support is provided to attend a local venue at weekends that plays live music. On the day of the site visit people were supported to get out and about and enjoy everyday activities. One person went to town to get a tooth gem fitted and another went to visit their family. Two people went shopping for groceries and one person received a visit from a relative at the home. One person was supported to go to a health appointment. A relative visiting the home confirmed that they are made to feel welcome and are able to meet privately when they wish to do so. Two people explained that they take responsibility for cleaning their own rooms and are involved in other domestic tasks to retain their independence, such as laundry and ironing. One person was seen to do their ironing during the course of the day. A white board in the hallway is used to record plans and appointments to help people remember what they have planned for the day. This is particularly important as a number of people suffer from short-term memory loss and benefit from these prompts. The file of a person with communication support needs contains a small number of photographs. The manager explained that this is the start of an individual photo library, which will be used to help the person concerned to express their personal everyday choices. The manager explained that he has developed links with the local mosque on behalf of two people at the home. This has resulted in the provision of prayer mats and compasses, enabling the people concerned to carry out their religious commitments. This was verified by one of the people concerned. Support is also provided for the two people concerned to have a separate food preparation area and to purchase halal meat, in keeping with their wishes. People confirmed that they are supported to go take part in regular grocery shopping where they wish to do so to buy food for the home. A staff member explained that the menus are based on people’s food preferences recorded in Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 17 their care plans and current food requests. This was verified in conversations with people at the home. A member of staff explained that suitable measures are taken to provide a low sugar for a person with diabetes and special products such as diabetic ice cream, biscuits and chocolate bars are also provided. Encouragement is also given for people to eat more healthily with low fat products such as mayonnaise, butter and milk available in the home. Records were seen demonstrating that that food and fluid intake is being recorded for a person with diabetes so that their health can be monitored with support from the community nursing service. People confirmed that snack foods and fruit is always available if they want something to eat between meals. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. 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 home’s 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. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriate support is provided to meet people’s personal care and health needs and suitable arrangements are in place for storing and administering medication so that it is given safely. There is scope for developing care plans and medication protocols to ensure that people ‘s needs are not compromised. EVIDENCE: Everyone at the home confirmed that they are able to choose when they go to bed and when they get up in the morning. People were observed to rise at different times and to take breakfast when they were ready. Everyone indicated that they like the staff and find them to be respectful and friendly. People confirmed that their privacy is respected and staff were seen to knock bedroom doors before waiting and entering. The manager explained that one person had recently been admitted to hospital following a chest infection that had developed into pneumonia. The health notes indicate that appropriate action was taken to ensure that the person concerned was supported to access appropriate ongoing advice and monitoring Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 19 from the GP and was properly supported during their time in hospital. The manager said that the admission assessment had not raised any history of chest infections but said he would add relevant advice to the care plan so that staff are equipped in the event of future concerns. Three people’s health notes were seen. The entries indicate that support is being provided to enable people to access support from local health services, such as GP, dentist and community nurses. The manager said that people would be supported to gain access to other routine checks, such as well person’s checks and eye tests during the coming year. One person has difficulties communicating verbally and has been referred to a speech and language therapist for ongoing assessment and support. The deputy manager has devised a new format for recording monthly care plan reviews, so that changes in people’s needs and developments in their lives can be tracked and monitored. The deputy manager said he would include a space for summarising people’s attendance at health appointments along with prompts for forthcoming appointments, such as well person checks, eye tests etc. Suitable arrangements have been made for a person with diabetes to receive support from the GP and a community nurse to monitor their blood sugar levels following concerns that this was unstable. The nurse spoke positively about the staff at the home and indicated that communication is good and that the home takes heed of nursing advice. Prior to the nurse becoming involved the home was recording and monitoring the blood sugar levels of the person concerned (records seen). The blood samples were taken independently by the person with diabetes to support their independence. A protocol has been written up explaining when blood sugar levels should be taken and what level is safe. The protocol has not been written or signed by an diabetes nurse specialist and does not include the signs and symptoms that would be a cause of for concern and the actions to be taken. However a member staff explained that diabetes training had been provided and demonstrated a good understanding of the warning signs and symptoms that might indicate the need for another blood test, more exercise or paramedic support. The manager said he would promptly refer the person to the diabetes nurse specialist to devise a new protocol and provide extra training. A skin care risk assessment was not in place for a person with mobility needs who has just developed continence needs, which could affect their skin condition. The manager said he would introduce a skin care risk assessment imminently. Two staff on duty were able to demonstrate a good understanding of the medication procedures. The member of staff giving out the medication confirmed that staff have to be trained before giving out medication Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 20 unsupervised and said that she had been trained using the organisation’s computerised training programme. She explained that this includes answering test questions to ensure she has understood safe practices. The manager said that he now intends to assess new staff using a test questionnaire to confirm their ongoing understanding of the procedures. Current medication records were sampled. The records indicate that staff are recording people’s medication as it is given and are keeping notes to indicate any refusal by people to take their tablets. The manager said that he intends to seek GP advice for a person who is regularly refusing a laxative, to review their medication. The medication in blister packs is recorded into the home and accounted for on the medication sheets and any unused medication is returned to the pharmacist (record seen). There is currently no accounting procedure for PRN (as required medication). The manager agreed to keep a running record of PRN medications to ensure that it is correctly accounted for. The manager said that he also had plans to develop PRN protocols, detailing under what circumstances medication should be given and plans to add extra information sheets, detailing the side effects of people’s medication. As part of the shift handover process, when new staff arrive on duty, they check that medication has been given and that medication records have been signed. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are provided with access to suitable procedures and training to enable them to respond appropriately to any concerns they may hold, so that people are properly protected from harm. EVIDENCE: There have been no complaints to us about the home since the home opened this year. The manager reports that there have been no complaints directly to the home either. The manager confirmed that systems are in place for recording and tracking complaints should this be necessary in the future. The home’s complaints procedure is available in the Statement of Purpose and service user guide and an information pack is kept in the main hallway including the complaints procedure. People at the home confirmed that they were aware how to complain and indicated they felt happy to raise any concerns they had with the staff or the manager. Everyone said they believed their concerns would be taken seriously and followed up. A Prevention of adult abuse policy is available in the home. Two staff confirmed that they had been provided with safeguarding against abuse training and demonstrated a good knowledge of the organisation’s adult abuse policy, including recognising signs of abuse and how to report any concerns. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 22 Both were aware how they might raise any concerns regarding the running of the home should this be necessary. There have been no reported suspicions of abuse at the home since it opened that have required referral to Social Services. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. 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. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall the home is clean and suitably equipped home so that people benefit from an environment that meets their needs. EVIDENCE: The home is purpose built with wide hallways for wheelchair users and disability equipment in place for people who need it. There are two ground floor bedrooms and six on the first floor. Two en-suite bathrooms have ceiling hoists fitted and there is scope for fitting hoists in other bedrooms if required. The bedrooms are of a good size and were clean and suitably equipped and decorated. The home has specialist bathrooms and shower rooms. There is a walk in shower (wet room) and an adjustable bath for people with disabilities. The home has a lift to enable people to get between floors. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 24 There is a large and pleasantly furnished lounge and separate dining area in the open plan kitchen. Double patio doors open from the dining room into the rear garden. The main dining area has sufficient space for the current people, most of whom are mobile, with one person being a wheelchair user. The manager explained that he has plans to develop raised flowerbeds in the rear garden, in the coming months, to make it more interesting for wheelchair users. Arrows were seen in the upstairs corridor to support people with memory loss to find their bedrooms more easily. A member of staff explained that cleaning of en-suites and bedrooms is carried out each morning. A cleaning schedule is completed by staff to confirm that cleaning tasks have been carried out. As previously noted people at the home confirmed they are encouraged to take an active role in cleaning their own bedrooms. Aprons and gloves were seen to be available in the home for staff. Discussions with staff indicate that they are being provided with infection control awareness training, as part of the Health and Safety course provided at the home. A member of staff demonstrated a good awareness of how to handle continence laundry and dispose of it safely but this was based on personal knowledge and previous experience rather than current home policy. The manager said that he would arrange for guidelines to be put in place for the safe and discreet management of continence laundry in the home. The manager said that he had bought new red dissolvable bags to take account of a person’s changing continence needs. The manager said that he would make people aware of the new bags and how they are to be used. The manager said that there had been problems receiving delivery of a proper clinical waste bin and that he had temporarily provided a bin which he had made identifiable for this purpose. He was able to demonstrate that this matter was being followed up and stated that delivery was expected within the next few days. Since the site visit the manager has confirmed delivery of a suitable clinical waste bin. Suitable yellow bags for waste products were available in the home and being appropriately used. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. 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 home’s 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. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate recruitment procedures are in place so that people are supported by suitable staff. Staff are being provided with training to equip them to effectively meet the needs of the people at the home. This is ongoing. EVIDENCE: The manager explained that that there are a minimum of 3 staff on duty. This was verified in comments by staff and information on the current staff rota. Whilst staff recruitment has taken place some shifts have been covered by the manager and deputy which has had an impact on heir capacity to keep on top of their managerial duties, e.g. update care plans. As previously noted, the manager stated that agreement has been reached to cease any new admissions to the home, for the next month whilst managers catch up and consolidate their work. There are currently 6 people living at the home and the manager confirmed that staffing levels will increase to 4 staff on duty when there are 8 people at the home, to ensure everyone’s needs continue to be met properly. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 26 The rota shows that the home also provides one waking night worker and a sleep in worker. Staff confirmed that they have access to an on call manager in the event that they require extra support and advice. There are currently six male staff at the home, which is a good proportion of the team. This means that people at the home have access to the company and assistance of staff of both genders. The people at the home confirmed that staff are friendly and generally prompt in responding to requests for advice and assistance. The files of two new staff were checked. In both cases the records confirm that staff have been subject to Criminal Record Bureau checks, prior to starting work at the home. In both cases references had been sought by which to assess their suitability for the job. Supervision records were also seen, as evidence that staff are being provided with planned supervision to support their work and professional development. This was verified by two staff. Similarly staff confirmed that they had been provided with an induction, which included access to significant policies and procedures, such as fire procedure and whistleblowing procedure, via the organisations’ computerised training package. A staff training matrix provided by the manager summarising the training provided to existing staff and courses planned for new staff. Examples include first aid, food hygiene, moving and handling, fire, infection control, medication, safeguarding against abuse and epilepsy. Some staff have undertaken other care courses, such as person centred planning, communication, equal opportunities and supervision and appraisal training. On the day of the site visit a group of staff were provided with challenging behaviour training to equip them to respond to sensitively to challenges that may be presented from time to time. The manager reports that four staff have completed relevant National Vocational Qualifications (NVQ’S) and the remainder of the team will starting this training shortly, as soon as they have completed their probationary employment period. This training is necessary in order that staff are properly equipped to carry out their work effectively. The manager reports that a number of staff have received diabetes awareness training to provide a grounding in this subject. The manager said that he intended to seek training from the diabetes nurse to focus on the specific needs of a diabetic person at the home. The manager also said he would seek skin care training from the community nursing service to take account of the changing needs of a person at the home with continence needs. Equality and diversity training has not been provided as yet. This training encourages staff to see people as individuals with their own specific need and preferences. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 27 Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. 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 home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Quality assurance systems are being developed and implemented, so that people may benefit from a well run and safe home. EVIDENCE: The manager reports that he has over 10 years experience as a manager of residential services for younger adults and 15 years experience of working in the care sector. The manager states he will be undertaking his registered managers award and NVQ4 now and is actively pursuing further management training. The manager has applied to register with us and is awaiting an appointment to proceed with the registration process. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 29 The manager explained the organisation has a quality assurance sytem which includes a staff member from the quality assurance department visiting the home periodically to check the aministaration and files at the home. The manager said that this process should start very shortly now that the home has been open over 6 months. House meetings are held involving the people at the home. The records show that these meetings include discussing everyday living arrangements, such as activities and menus as well as checking that people are happy at the home. A senior manager has started visiting the home each month to check that the home is running satisfactorily. The reports of these visits indicate that this includes meeting with the people at the home and the staff to seek the views. As previously noted there is a shift handover process in place, wherby staff sign to confirm that essential tasks have been completed, such as medication and money checked. Monthly Health and Safety audits were seen demonstarting that the home is checked to support the maintenace a safe environment. A maintenace book was also seen providing evidence to indicate that repairs are followed up and monitored to ensure that work is carried out. In the annual quality assurance questionnaire the manager reports that all the essential Health and Safety maintenance checks have been carried out. The fire safety records were sampled. The fire log indicates that fire alarms are being routinely tested and suitably maintained. Three people at the home confirmed they knew the fire drill and where to gather in the event of a fire. Risk assessments are in place for supporting people to cook in the kitchen, which includes the presence of a member of staff to provide support and advice, where necessary. The manager said that the fire officer has recommended drag sheets, to support people with disabilities to get downstairs, in the event of a fire. The manager said that he intends to seek training so that staff are clear on the use of this equipment in the event of an emergency. A fire safety evacuation chair is currently in place for this purpose. Certificates and records were seen, providing evidence that gas and electrical equipment has been checked to ensure it remains safe to use. Lighting is fitted to the exterior of the home and on evacuation routes. A risk assessment is in place for the use of the in house gym, which includes a requirement for a member of staff to be in place at all times. Some extra information would be beneficial for some equipment and activities, such as lifting weights, to make sure that this is done safely. The manager agreed to address this matter. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 x 3 x x 3 x Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 31 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations A communication dictionary should be devised for the person with minimal verbal communication to help new staff to quickly understand the person’s no verbal gestures. Proceed with plans to complete and update the care plans of the 6 people currently living at the home before others move in so that staff have clear information to meet people’s needs. Seek the involvement of a diabetes nurse specialist to devise a protocol and provide additional training to ensure that the needs of the person with diabetes are met safely. Systems should be developed to account for PRN (as required) medication in order that all medication is accounted for. Proceed with plans to develop PRN (as required) medication protocols so that all staff are clear about the circumstances under which tablets should be given to people. DS0000070707.V367003.R01.S.doc Version 5.2 Page 32 2 YA6 3 4 5 YA19 YA20 YA20 Marner House 6 YA35 7 8 9 YA35 YA35 YA42 Skin care / pressure area care training should be provided to staff to ensure that they have the skills to monitor and address skin care issues to reduce the possibility of sores developing. Staff should be provided with equality and diversity training to further encourage staff to see people as individuals with their own specific needs and preferences. Proceed with plans to enrol staff on National Vocational Qualification training so that they are properly equipped for their roles. Risk assessments should be devised for the use of gym equipment to make sure it is used safely, in particular the use of any weight lifting equipment. This is necessary to reduce any risks of injury that are associated with weight lifting. Marner House DS0000070707.V367003.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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