CARE HOMES FOR OLDER PEOPLE
Marquis Court Residential Home Tunstall Village Road Silksworth Sunderland SR3 2BB Lead Inspector
Katie Tucker Unannounced 3 August 2005 10:00am 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Marquis Court Residential Home B52 B02 S15742 Marquis Court V219328 3 Aug 2005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Marquis Court Residential Home Address Tunstall Village Road Silksworth Sunderland SR3 2BB 0191 521 0796 0191 521 0796 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Silksworth Partnership Helen Kennedy Care Home only 47 Category(ies) of OP Old age (23) registration, with number DE Dementia (24) of places Marquis Court Residential Home B52 B02 S15742 Marquis Court V219328 3 Aug 2005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 27/01/05 Brief Description of the Service: Marquis Court is a purpose built care home and provides a personal care service for 41 adults over the age of 65 years. Any health needs are dealt with by the Community Nursing Services. The home is a two-storey building offering single bedrooms with en suite facilities. There is a passenger lift, which provides access to both floors of the home. There are 23 bedrooms on the ground floor for people with general needs and 24 bedrooms on the first floor for people with dementia type illness (memory loss). Lounges, dining rooms, bathrooms and toilets are located throughout the home. The office, kitchen and laundry are on the ground floor. A small garden is situated at the rear of the building. The car park is to the side and rear of the building. The owner has recently extended the facilities so more places can be offered at Marquis Court. A conservatory has been built and dining room extended as well as additional bedrooms being developed. Marquis Court is situated on the main road from Silksworth to Ryhope on the former site of the village creamery. It is very close to many local amenities such as shops, the post office, church, library, medical health centre, several pubs and bus routes. Marquis Court Residential Home B52 B02 S15742 Marquis Court V219328 3 Aug 2005 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection of Marquis Court and was conducted as part of the routine yearly programme. An inspector visted and spent 5 hours at the home talking with residents, relatives and staff. A sample of assessments, care plans and risk assessments as well as the complaints procedure and adult protection procedures were examined. The staff were asked about the care plans, the complaints procedure, access to training and any changes to working practices. The residents and relatives were asked about life at the home. The general maintenance of the building was checked. Marquis Court provides a service for older people and people with a dementiatype illness. (memory loss) On the downstairs unit people are fully able to make comments about the service being provided. On the upstairs unit the majority of people have difficulty making their views known. Therefore staff practice, attitude and approach were observed and judgements were made on how well the approaches that were used were working. This type of observation formed a part of the inspection process as well as what people said and was backed up through the examination of records, comments made by service users, staff, relatives and the manager. During this inspection key standards were focused on but not all were checked. What the service does well:
The manager has been in post for a number of years and consistently reviews her practice to ensure what she promotes meets the expectations of current good practice. Staff have reported that her management style allows people to put forward ideas about how to develop the service. Also staff regularly say she is very approachable. The relatives spoken to commented that manager and staff were extremely caring and considerate towards the people who live at the home and themselves. Under her leadership the staff team has remained stable and have constantly developed their practice. The manager actively promotes training and nearly all of the care staff hold the NVQ level 2 award. The manager and deputy manager have completed the registered managers award. A large number of the staff working on the unit for people with dementia have completed a recently produced distance learning pack on dementia care. All of the staff spoken to who had completed this course said they have found it extremely useful and gave them a very good understanding of people’s needs.
Marquis Court Residential Home B52 B02 S15742 Marquis Court V219328 3 Aug 2005 Stage 4.doc Version 1.40 Page 6 The Silksworth Partnership and manager have always made sure that the building has been maintained to a high standard. The recent extension that has been developed has enhanced the facilities and the manager is looking to develop further facilities on the upstairs unit. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Marquis Court Residential Home B52 B02 S15742 Marquis Court V219328 3 Aug 2005 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Marquis Court Residential Home B52 B02 S15742 Marquis Court V219328 3 Aug 2005 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 An assessment tool is in place that assists staff to gather the information they need to meet residents’ needs. EVIDENCE: The manager devised an assessment tool for the home and ensures these are completed. They provide a wide range of information about the people who use the service and are written in a style that is easy to understand. She also ensures that social workers provide full assessment information prior to agreeing an admission. The manager and staff continue to develop these assessments and are planning to provide fuller information about people’s life histories, diagnosis of the type of dementia and people’s skills. Some people have a dementia-type illness and the generation of life histories for these people is treated as a priority. Questions on the life histories are covering people’s personality traits, when they were younger, events that occurred and their feelings at that time, routines and jobs or roles. People with dementia tend to revert to previous routines and patterns of behaviour and having this information allows staff to work more effectively with people and reduce the challenges that may be presented. By understanding how people have lived and their lifestyles, what often seems to be unusual behaviour when
Marquis Court Residential Home B52 B02 S15742 Marquis Court V219328 3 Aug 2005 Stage 4.doc Version 1.40 Page 9 seen in the context of what people previously did becomes perfectly reasonable. Thus staff can work around a routine such as a person who has always worked nightshift may have what seems to be a disturbed sleep pattern but in fact it is the norm for this person. Therefore staff can ensure that meals and activities are provided during the night. Currently residents and relatives will provide information for staff to record in the assessment but they do not then necessarily see the finished work. By not seeing this document people are less able to provide further information, which will assist staff to meet resident’s needs. Marquis Court does not provide intermediate care but will offer a respite service for those who are considering whether they are ready to move into residential care. Marquis Court Residential Home B52 B02 S15742 Marquis Court V219328 3 Aug 2005 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 10 Some shortfalls remain within the residents’ records and this may prevent staff from fully meeting people’s needs. EVIDENCE: Staff have continued to develop their recording practices and plans are being put in place to meet people’s social and emotional needs. Staff are recording in a way, which sets out all of the actions that need to be taken to meet people’s needs. Those staff that are excelling in this area are sharing their skills with the other staff and this is ensuring that overall all of the files are developing well. Although people discussed how they had developed specific techniques to help people these were not written the care plans so this good practice could be lost. Also new staff were often unaware of these techniques because the information was not readily available. Residents and relatives commented that they never saw the care plans or risk assessments thus do not what the staff are doing. Residents and relatives will have a wide range of information that will assist staff and may have already tried some of the actions identified but found they do not work. Staff worked with people sensitively and consistently maintained people’s dignity.
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The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 14 The lack of dedicated activities staff limits the level of access to the community residents have and the range of stimulating activities available in the home. EVIDENCE: Since the last inspection formal resident’s meeting have started to take place. Also the people who live at Marquis Court are consulted on an informal basis about their lifestyle preferences. All of this information is used to shape daily routines at the home. Some service users have dementia needs and may not be able to effectively express their wishes and feelings. The staff discussed the approaches they use and were seen to adopt a person-centred style of care, which allows people to actively choose what they want to do. However there is no written evidence to show that the home uses reliable methods to gauge whether established routines meet with the satisfaction of these individuals. Staff provide access to activities during the day however access to the community is limited. Staffing levels often preclude residents being able to go out. Also activities have to be scheduled when all other care work is finished. The manager wants to employ an activity co-ordinator so dedicated time can be provided and the quality of the service in this area can be improved. Visitors commented that they were always made welcome and could visit at anytime. The only time this is over-ridden is when visitors have attempted to intimidate or threaten staff, which is an acceptable practice.
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The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The manager and staff at Homeside are able demonstrate that they understand how to ensure service users are protected and recognise the rights of people to raise concerns. EVIDENCE: The Silksworth Partnership has developed a complaints procedure, which complies with the requirements of both the national minimum standards and Care Home Regulations 2001. This is reproduced in the service user guide and made available to residents or their representative. The manager recognises the importance of dealing with minor concerns in a proactive manner. She has actively encouraged residents and relatives make their views known and during the inspection relatives said they were confident that anything they raised would be dealt with appropriately. Over the last year some people have raised concerns and made formal complaints to the social service department. These involved in looking at the complaints have been dealt with them appropriately but some issues remain unresolved although staff at the home have been found to have taken all of the necessary steps to meet people’s care needs. Marquis Court Residential Home B52 B02 S15742 Marquis Court V219328 3 Aug 2005 Stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 The design, layout and furnishings of Marquis Court meet the needs of the residents. EVIDENCE: Marquis Court has been extended to increase the number of available places at the home and the new rooms have been thoughtfully designed. The external access has also been improved, to incorporate a dropped kerb for wheelchair users. The home is fully accessible to those with a physical disability. All of the bedroom were seen and are decorated and furnished to a good standard. Residents are able to personalise their bedrooms and bring items of furniture in if they wish. Larger items will need to comply with fire precautions measures and the manager is aware of what action can be taken to meet this requirement. On the day of inspection the home was clean, warm, welcoming and comfortable. Marquis Court Residential Home B52 B02 S15742 Marquis Court V219328 3 Aug 2005 Stage 4.doc Version 1.40 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 Staffing levels are in place to meet the personal care needs of residents currently living at the home but need to be increased as people move in. The lack of dedicated activities staff inhibits the service being provided. EVIDENCE: Marquis Court has a minimum of 5 care staff during the day and 3 waking night staff. A senior care staff member forms part of the team on all shifts. The manager is supernumerary. As preparation for the opening of the extension the manager it was agreed that 6 care staff during the day and 4 night staff, including seniors were to be duty. Currently the places on this extension have not been filled and the manager is in the process of recruiting suitable staff to fill this gap. There are still 7 vacancies at Marquis Court and once these are filled 6 staff during the day and 4 during the night will be provided at all times. The home has dedicated kitchen, domestic and laundry staff. Staff provide access to activities during the day however access to the community is limited. Staffing levels often preclude service users being able to go out. Also activities have to be scheduled when all other care work is finished. The manager recognises that staffing levels either included dedicated hours for activities or an activities co-ordinator is provided to meet this need. At least eighteen of the twenty-four care staff hold a minimum of an NVQ level 2, which exceeds the requirements of this standard. The manager expects that all of the current staff will have at least and NVQ Level 2 by the end of 2005.Two staff are currently completing NVQ level 3 qualifications in care and the deputy manager has completed the Registered Managers Award.
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The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 37 and 38 The owner cannot demonstrate that formal oversight of the operation of the home is provided and that measures are being taken by them to address any pertinent issues that may affect the service. EVIDENCE: The Silksworth Partnership do not comply with a regulation requiring them to record on a monthly basis the outcome of visits conducted by them. The owner is aware of this requirement and has recently asked the manager for the format that she developed. This report will record the issues the owner is a ware of and action that is being taken. No health and safety issues were noted at the time of the inspection. Marquis Court Residential Home B52 B02 S15742 Marquis Court V219328 3 Aug 2005 Stage 4.doc Version 1.40 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 x x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 2 28 x 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x x x x x 2 3 Marquis Court Residential Home B52 B02 S15742 Marquis Court V219328 3 Aug 2005 Stage 4.doc Version 1.40 Page 17 Yes 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. 1. Standard 7 Regulation 15 (2) 12 92) Schedule 3 (3) (q) Requirement Staff must continue to extend the care plans to include all specific actions to be carried out by staff. Service users or their representatives must sign care plans and risk assessments. (required at the last inspection timescale 2.06.05) The assessment process must include individuals’ rights, decision-making skills and outline where they are limited. Staff must continue to develop life histories for people using the dementia care unit. Staff must have time allocated to 17.12.05 provide activities or a coordinator employed at Marquis Court (required at the last inspection - timescale 2.06.05) Silksworth Partnership must visit 11.08.05 Marquis Court in accordance with Regulation 26 of the Care Home Regulations 2001, then complete and submit a written report to the CSCI. (Requirement made at the first inspection in 2002)
Version 1.40 Page 18 Timescale for action 10.02.06 2. 14 16 (2) (m) 18 (1) (a) 3. 37 26 Marquis Court Residential Home B52 B02 S15742 Marquis Court V219328 3 Aug 2005 Stage 4.doc 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 12 Good Practice Recommendations Regular trips should be organised for service users. (Recommended at previous inspections) Marquis Court Residential Home B52 B02 S15742 Marquis Court V219328 3 Aug 2005 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection Baltic House Port of Tyne, Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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