CARE HOMES FOR OLDER PEOPLE
Marquis Court Residential Home Tunstall Village Road Silksworth Sunderland SR3 2BB Lead Inspector
Mrs Katie Tucker Key Unannounced Inspection 09:30 21 September and 5th October 2006
st X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Marquis Court Residential Home DS0000015742.V309231.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 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 DS0000015742.V309231.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Marquis Court Residential Home Address Tunstall Village Road Silksworth Sunderland SR3 2BB 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) 0191 521 0796 F/P The Silksworth Partnership Ms Helen Kennedy Care Home 47 Category(ies) of Dementia (24), Old age, not falling within any registration, with number other category (23) of places Marquis Court Residential Home DS0000015742.V309231.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 7th February 2006 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 fees charged at the home range from £359 to £374 per week. 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 DS0000015742.V309231.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 2 days. One inspector spent 8 hours at the home speaking to people using the service, staff and visiting relatives. Prior to the visits the inspector also received comments from relatives and spoke to other professional that visit the Marquis Court. Several residents were identified. The care they received was tracked through discussions with all concerned and by looking at the service user plans. Marquis Court provides a service for older people and people with a dementiatype illness. Some of the people experienced difficulty communicating their views verbally. Therefore staff practice, attitude and approach were watched and judgements made on how well staff worked with people. All of the available information was used to make decisions about the quality of service. During this inspection all of the key standards were checked. What the service does well:
The manager has been in post for a number of years and she is very good at her job. Under her leadership the staff team are very stable and have constantly improved their practice. The manager sees the benefit of training and motivates staff to complete all sorts of useful courses. Staff have completed distance-learning packs around dementia care. Through her encouragement 91 of the care staff have gained NVQ awards. Plus, the catering and domestic staff have completed job related NVQ awards. Staff have reported that her management style allows people to put forward ideas about how to develop the service. Resident’s meeting take place and residents said ‘the meetings work well and recently we were asked if would like to make the conservatory the main lounge. So we gave it a go but really did not like it so told the manager and now we are using our usual lounge. So you can say staff really listen to and respect our opinions’. Also staff continue to say that the manager is very approachable and takes on board their comments. Relatives said the manager and staff were very caring and considerate towards the people who live at the home and themselves. Staff work well with residents and clearly care a great deal about them. Staff chatted with residents and listened to people’s views. There was lots of friendly banter going on through the day, which everybody enjoyed. The Silksworth Partnership and manager have always made sure that the building has been maintained to a high standard. Last year the building was Marquis Court Residential Home DS0000015742.V309231.R01.S.doc Version 5.2 Page 6 extended and this has improved the facilities. 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 DS0000015742.V309231.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Marquis Court Residential Home DS0000015742.V309231.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. The assessment information is improving but contains insufficient information to demonstrate that the home can care for the person. EVIDENCE: Case tracking showed that the information contained in the assessment was limited. It consisted of the information the social worker provided, the pre assessment the manager completed and a series of care plans, which covered mainly daily living skills. Staff have not recorded information about people’s social, cultural, spiritual and emotional needs. Staff also need to record whether a particular physical condition actually affects the person, or limits their ability. This has led to difficulties in identifying the areas of need that were most pressing. The home cares for people with a dementia and although staff recognised the importance of people’s life histories, this information was not recorded very well in the assessment. At the last inspection it was noted that some of the
Marquis Court Residential Home DS0000015742.V309231.R01.S.doc Version 5.2 Page 9 residents within the dementia care unit were referring to traumatic events in their past. These were discussed in present terms and time was taken to establish whether they were referring to staff behaviour, which they did not appear to be. Although this matter was discussed at the last inspection staff have not taken any action to update the assessment, or record this in the life history. Without doing this staff cannot show that they have considered what they are being told service users. Marquis Court Residential Home DS0000015742.V309231.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. Although staff care practices are very good the service user plans do not reflect the care that is offered at Marquis Court. EVIDENCE: Case tracking showed that the flaws in the assessment document have led to staff not completing care plans around people’s greatest needs. When writing care plans staff include the full amount of information needed to show how to meet someone’s needs. However, they staff tend to concentrate on physical healthcare needs when often residents’ main needs relate to social or emotional needs. This was very evident in one person’s plan whereby their main need centred around how they could be overbearing yet all the plans referred to their personal care needs. In practice staff were meeting resident’s needs and were very aware of the best way to work with people but this was not recorded. Therefore, their good practice was not evidenced. Currently residents or relatives do not record that they have been consulted about the proposed care and agreed to the plan.
Marquis Court Residential Home DS0000015742.V309231.R01.S.doc Version 5.2 Page 11 Although risk assessments are being generically used, where assessments of acceptable risks need to be extended. Risk management strategies must also be applied more widely. These types of plans show the strengths people have and the common day risks they can continue to safely take. Staff impose limitations on some residents because of their dementia or physical health needs, such as needing to be accompanied when outside the home. When limitations are imposed for a particular individual this needs to be recorded. When residents have to follow Marquis Court’s house rules can be recorded in a standard contract. Discussion was also held about the expectations of the Mental Capacity Act, which holds the expectation that staff will always adopt the least restrictive practices when people lack mental capacity. The manager started to explore how they will evidence that the practice of preventing residents leaving the unit upstairs via the stairs has been closely considered. This action has been taken with the best interests of residents in mind. Staff have made sure the medication is stored, recorded and given out properly. In addition, staff have also had accredited medication training. Staff and residents had formed good working relationships and this assisted and contributed to the pleasant atmosphere that was present. During this visit staff had made sure that everybody’s personal care needs were met. Staff constantly respected people’s privacy and discreetly attended to people’s care needs. Marquis Court Residential Home DS0000015742.V309231.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. Staff provide support to residents and want people to lead fulfilling lifestyles. EVIDENCE: An activities co-ordinator has recently been employed and is starting to make a difference to residents’ lives. Residents and relatives were extremely positives about the changes she has made so far and the ones that are planned. Residents talked about their renewed interest in hobbies such as knitting and clippie mat work. Visitors and residents said ‘the staff were excellent and were always friendly’. People said they were kept abreast of changes in their loved ones healthcare. Residents had formed good relationships with one another and there was a real sense of community within the home. Staff promoted and support residents to take an interest in each other and people really cared for one another. The catering budget is very generous and meals that are provided are nutritious. The manager and staff are aware of practices that will make sure people eat sufficient food.
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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 the following standard(s): 16 and 18 Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. The manager proactively deals with complaints and concerns and therefore, has robust systems in place to protect service users from harm. EVIDENCE: The complaints procedure is made available to residents and relatives through the service user guide. Residents said ‘the staff listen to what you say and if your worried about something or something is not right will sort it out’. They felt the manager was open and willing to listen to concerns people may have. Case tracking showed that when people had raised concerns, even minor irritations the manager treated these seriously and took action to resolve the issue. Staff did not dismiss people’s opinions and this was evident in how they worked with people to negotiate the care that would be provided at Marquis Court. Marquis Court has an appropriate protection of vulnerable adults policy and follow Sunderland Social Services Department guidance. Staff are fully aware of how to use the procedures. The Social Service Department has a continuous programme of training for all the staff working in care. Staff receive regularly training and up dates. Marquis Court Residential Home DS0000015742.V309231.R01.S.doc Version 5.2 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is excellent. This judgment has been made from evidence gathered both during and before the visit to this service. The home is clean, warm and well maintained offering residents a homely and safe environment in which to live. 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. The bedroom are decorated and furnished to a good standard. Residents are able to personalise their bedrooms and bring items of furniture in if they wish. On the day of inspection the home was clean, warm, welcoming and comfortable. Staff have received infection control training. The laundry facilities meet the needs of residents.
Marquis Court Residential Home DS0000015742.V309231.R01.S.doc Version 5.2 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. The manager has sufficient, well-trained staff in place to meet residents’ needs. EVIDENCE: Marquis Court now has as a minimum 6 care staff on duty 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. Currently the manager is in the process of recruiting suitable staff so she can increase staffing to 6/7 care staff during the day and 4 staff at night. The home has dedicated kitchen, domestic and laundry staff. The manager actively promotes staff training and people have regular access to a range of courses. 91 of the twenty-four care staff hold at least an NVQ level 2, which exceeds the requirements of this standard. The remaining staff are completing this qualification and some staff are currently completing NVQ level 3 qualifications in care. The deputy manager has completed the Registered Managers Award. The staff files include the appropriate information. The manager has made sure the application form meets requirements of the Disability Discrimination Act 1995 and a health statement is completed.
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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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. The overall management systems work well and make sure residents’ needs are met. EVIDENCE: The manager is a very competent. She has completed the registered managers award. And constantly makes sure her and staff practices are line with recognised good practice. The owners have made sure a quality assurance system is in place. A part of these procedures included paying a consultant to develop the fire risk assessment, which the fire authority recently deemed satisfactory. Marquis Court Residential Home DS0000015742.V309231.R01.S.doc Version 5.2 Page 17 The personal allowances were in good order. Only small amounts of money are held on behalf of residents. The manager has a system for regularly auditing these records and this is consistently used. No health and safety issues were noted. Marquis Court Residential Home DS0000015742.V309231.R01.S.doc Version 5.2 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Marquis Court Residential Home DS0000015742.V309231.R01.S.doc Version 5.2 Page 19 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement The home must introduce a full assessment record, which includes information about all social, emotional and cultural needs. Life histories must enable staff to gather useful information for the care of people with a dementia. Service users or their representatives must be involved in the writing of assessments. Staff must regularly up date the 16/04/07 assessment and make sure changes in people’s behaviour is recorded (Required at previous inspections timescale 13.06.06). Staff must also record information about people presenting challenging behaviour or being vulnerable (Required at previous inspections timescale 13.06.06). Service users or their representatives must sign care plans and risk assessments (Required at previous inspections - timescale
DS0000015742.V309231.R01.S.doc Timescale for action 16/04/07 2. OP3 14 (2) 3. OP7 15 (2) 12(2) Sch3 (3) q 16/04/07 Marquis Court Residential Home Version 5.2 Page 20 2.06.05). Staff must outline why individuals rights, decisionmaking skills are limited (Required at previous inspections - timescale 13.06.06). Staff must continue to develop life histories for people using the dementia care unit (Required at previous inspections timescale 13.06.06). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations Regular trips should be organised for service users. (Recommended at previous inspections) Marquis Court Residential Home DS0000015742.V309231.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection South Shields Area Office Baltic House South Shields Tyne Dock NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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