CARE HOMES FOR OLDER PEOPLE
Marquis Court Residential Home Tunstall Village Road Silksworth Sunderland SR3 2BB Lead Inspector
Mrs Katie Tucker Unannounced Inspection 7th February 2006 8:15 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.V254014.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Marquis Court Residential Home DS0000015742.V254014.R01.S.doc Version 5.1 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 0191 521 0796 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.V254014.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th August 2005 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 DS0000015742.V254014.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Marquis Court inspection was carried out as part of the routine yearly programme. No one was told that the visit was to take place. An inspector visted and spent half a day at home. The inspector looked at the residents’ records, medication and staff information. The staff were asked about the residents’ records, the guidelines for dealing with complaints, training, staffing levels and changes to working practices. The residents were asked similar questions. Marquis Court provides a service for older people. A number of people could share their opinions on the quality of the service. Some people have memory loss and were less able to share their views. So staff practice, attitude and approach were also watched and judgements made on how well staff worked with people. 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 she is extremely competent. Under her leadership the staff team has remained 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. Through her encouragement all but one of the care staff have gained NVQ awards. Plus, the domestic staff have started to completed job related NVQ awards. A large number of the staff working on the unit for people with dementia have completed a 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. 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. 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. Marquis Court Residential Home DS0000015742.V254014.R01.S.doc Version 5.1 Page 6 The Silksworth Partnership and manager have always made sure that the building has been maintained to a high standard. Last year the building was extended and this has enhanced 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.V254014.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Marquis Court Residential Home DS0000015742.V254014.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 An assessment tool is in place that assists staff to gather the information they need to meet residents’ needs but they must be fully completed. 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. It was noted that some of the residents within the dementia care unit were referring to traumatic events in their past lives. 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. This information had not been recorded and neither had it been added to the life history. Without staff can not show they have considered what they are being told.
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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 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. However, the staff need to record the actions that they were seen to be taking to reduce personality conflicts. Also information on how to work with people to make sure they are not excluded from conversations and feel confident to leave situation. Some 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. 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 have made sure the medication is stored and given out properly. The records were satisfactory. Also staff have had accredited medication training.
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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 the following standard(s): 12, 14 and 15 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: 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. Residents, on the downstairs unit again, said that the only thing that could be improved in the home was the range of activities. They said that often there was nothing to do and although the staff tried their best they often could not organise anything because they were looking after people. 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. Residents’ on the dementia care unit were making some chooses about how they spent their time. But staff need to be mindful of the need to show that people can wherever possible follow a routine that suits their needs. If because of people’s health they are unable to make informed choices this needs to be recorded in their care plans. 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): 18 The manager follows the local authorities protection of vulnerable adults procedures. EVIDENCE: Marquis Court has an appropriate protection of vulnerable adults policy and follow Sunderland Social Services Department guidance. In this guidance the Silksworth Partnership has to put in a section about what they would do if an allegation of abuse were made. Staff have had training around protecting residents. The Social Service Department has a continuous programme of training for all the staff working in care. Marquis Court Residential Home DS0000015742.V254014.R01.S.doc Version 5.1 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The 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. 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. 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. Staff have received infection control training. The laundry facilities meet the needs of residents.
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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 and 29 Staffing levels, training and records are pro-actively maintained by the manager. The lack of dedicated activities staff inhibits the service being provided. EVIDENCE: Marquis Court now has as a minimum 5/6 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. As preparation for the opening of the extension the manager is increasing to 6/7 care staff during the day and 4 night staff, including seniors were to be duty. Currently the manager is in the process of recruiting suitable staff. The home has dedicated kitchen, domestic and laundry staff. Access to activities during the day and the community is limited. The manager recognises that staffing levels either included dedicated hours for activities or an activities co-ordinator is provided to meet this need. All bar one of the twenty-four care staff hold at least an NVQ level 2, which exceeds the requirements of this standard. Some staff are currently completing NVQ level 3 qualifications in care and 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 and 35 The manager is competent and makes sure the service meets the needs of residents. 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 personal allowances were in good order. Only small amounts of money are held on behalf of residents. When money collects this is sent to the appointee or relative to put in people’s savings accounts. The manager has a system for regularly auditing these records and this is consistently used. Since the inspection took place the Silksworth Partnership have started to comply with a regulation requiring them to record on a monthly basis the outcome of visits conducted by them.
Marquis Court Residential Home DS0000015742.V254014.R01.S.doc Version 5.1 Page 15 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X X Marquis Court Residential Home DS0000015742.V254014.R01.S.doc Version 5.1 Page 16 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 (2) Requirement Staff must regularly up date the assessment and make sure changes in people’s behaviour is recorded. Staff must also record information about people presenting challenging behaviour or being vulnerable. Staff must continue to extend the care plans to include all specific actions to be carried out by staff. (Required at the last inspection - 10/02/06) Service users or their representatives must sign care plans and risk assessments. (Required at previous inspections - 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.
Marquis Court Residential Home DS0000015742.V254014.R01.S.doc Version 5.1 Page 17 Timescale for action 13/06/06 3. OP7 15(2) 12(2) Sch3(3)q 13/06/06 3. OP14 16(2) (m) 18(1) a Staff must have time allocated to 12/07/06 provide activities or a coordinator employed at Marquis Court (required at the last inspection - timescale 2.06.05) 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.V254014.R01.S.doc Version 5.1 Page 18 Commission for Social Care Inspection South of Tyne Area Office 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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