CARE HOMES FOR OLDER PEOPLE
Marray House 12-14 Essa Road Saltash Cornwall PL25 4ED Lead Inspector
Mike Stokes Announced 16 June 2005 10:00 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. Marray House D52-D04 S9195 Marray House V226655 160605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Marray House Address 12-14 Essa Road Saltash Cornwall PL12 4ED 01752 844888 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) Mrs Enid Robertson Crofts CRH 23 Category(ies) of OP, 23 registration, with number of places Marray House D52-D04 S9195 Marray House V226655 160605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 24 November 2004 Brief Description of the Service: Marray House is registered to provide personal care and accommodation for up to 23 older persons. It is a detached house situated near the centre of Saltash, close to the shops, public transport and community facilities. Service users bedroom accommodation is provided on the ground and first floors. A stair lift is provided to assist service users. Communal lounge, dining room, kitchen and laundry areas are provided on the ground floor. Mrs Crofts has been registered as a care provider for 27 years. Marray House D52-D04 S9195 Marray House V226655 160605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection of care standards at Marray House. I arrived at 10.00 am and the inspection finished at 2.30 pm. During the inspection I was able to discuss what it is like to live at the home with service users. Mrs Crofts, a senior carer and staff assisted me in reviewing records kept to monitor care at the home and discussing issues regarding the welfare of service users. A tour of the home occurred to monitor environmental standards. Comment cards were received from 6 service users and 7 relatives that all expressed approval of services received at the home. Mrs Crofts also completed a detailed pre inspection questionnaire to assist in the inspection process. What the service does well: 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.
Marray House D52-D04 S9195 Marray House V226655 160605 Stage 4.doc Version 1.30 Page 6 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 Marray House D52-D04 S9195 Marray House V226655 160605 Stage 4.doc Version 1.30 Page 7 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) 1, 3 and 5. The registered person has provided a statement of purpose and service users guide that details the facilities and services available within the home. The registered provider will assess all prospective service users prior to admission to ensure that the home can meet their care needs. EVIDENCE: A statement of purpose is available within the home and a service users guide has been issued to each service user. These documents explain the services and facilities available within the home as part of the contract and that hairdressing, chiropody and newspapers can be provided at the home and are at the service users expense. The registered provider or a senior carer will visit the prospective service users at their own home or in hospital prior to admission to complete an assessment process. These records include information received from other agencies to assist in appropriate admissions to the home. Marray House D52-D04 S9195 Marray House V226655 160605 Stage 4.doc Version 1.30 Page 8 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, 8 and 10. The health needs of service users are met with evidence of multi disciplinary work occurring to provide for service users welfare. EVIDENCE: The existing care plans and weekly summary sheets for service users were reviewed with the senior carer on duty. The home should develop the system to expand on the needs of service users regarding health, social and personal care. The management should provide details of the action staff should take to meet these needs and demonstrate a monthly review of these plans with the involvement of service users. A range of dependency levels were inspected and appropriate references to the risk of falling, personal care and attention required were recorded. The homes accident book and procedures to report incidents in reference to regulation 37 are appropriately maintained. A range of pressure relieving equipment is provided and appropriate liaison occurs with the community nursing service to provide for the welfare of service users. Service users are registered with local GP’s in Port View Surgery and Saltash Health Centre. Service users stated that, “staff were kind and answered the call bell when I needed help” and “ I have got used to the same staff helping me with personal care”. Marray House D52-D04 S9195 Marray House V226655 160605 Stage 4.doc Version 1.30 Page 9 Marray House D52-D04 S9195 Marray House V226655 160605 Stage 4.doc Version 1.30 Page 10 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 standard(s) 12, 13 and 15. Service users exercise their choice to enjoy the privacy of their own rooms or join other service users in communal areas for company or meals. Service users maintain contact with visiting relatives and friends at the home. Service users are predominantly dependent on these contacts to access community facilities and the registered provider will organise visiting entertainers and group activities at the home. The meals provided in the home are good with special diets catered for. EVIDENCE: Service users were met in communal areas or their own rooms. Service users bring items of furniture and possessions such as televisions, radios and CD players. Service users expressed approval that regular visits are received from their relatives. The opportunity to meet visiting relatives did not occur but records of visits are maintained. A relatives comment card stated,” I feel the home is well run, clean and the staff have a pleasant manner”. A discussion occurred with service users and the cook on duty to review the catering arrangements and the main midday meal was observed. The main meal is at lunchtime and a choice is provided for the evening meal, with snacks and beverages also provided during the day. The menu was inspected and a range of nutritious meals is provided, including special diets. Service users expressed their approval of the traditional catering arrangements at the home and that, “we enjoy 3 roast meals during the week”.
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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 and 18. The registered provider uses the policy and procedures at the home to assist in the protection of service users. EVIDENCE: The complaints procedure containing the Commissions contact number and address was displayed in the home and is detailed in the service users guide. The registered manager maintains a record of complaints received and how these have been dealt with appropriately at the home. The senior carer stated that day-to-day control and regular contact with service users provided the opportunity to monitor standards. The registered person has provided appropriate ‘Protection’ policy and procedures. A recommendation is made that staff attend the ‘Protection of Vulnerable Adults’ training provided by social services. There is a policy regarding staff accepting gifts from service users and precluding staff involvement in the making or benefiting from service users wills. The homes insurance provides for service users to make claims on personal items and for public liability. The home provides appropriate records regarding finances and items held on behalf of service users. Marray House D52-D04 S9195 Marray House V226655 160605 Stage 4.doc Version 1.30 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, 20, 22, 24, 25 and 26. The registered provider is providing a reasonable standard of décor and maintenance to ensure service users live in a safe and comfortable environment. EVIDENCE: The home is close to community facilities and offers service users a safe and well maintained environment. I met service users in both of the large lounge areas, these separate rooms provide a choice of lounge space for service users and they are also used as dining rooms. Service users can choose to use the communal areas of the home or enjoy the privacy of their bedroom accommodation. Service users have sufficient and suitable bathroom, shower and toilet facilities. The home provides a call bell system throughout the home. The 4 stair lifts and bath hoist are appropriately maintained. A mobile hoist, grab rails and various pressure relieving equipment is available within the home to assist service users. The heating is provided through radiators in each room that have individual controls. A programme of providing radiator covers has been completed in 9 rooms and this work should be completed for the remaining areas. Appropriate lighting and ventilation in bedrooms is
Marray House D52-D04 S9195 Marray House V226655 160605 Stage 4.doc Version 1.30 Page 14 provided, the windows have restrictive opening devices. The baths at the home have mixing valves to control the supply of hot water and the registered person is currently providing safety valves to sinks to prevent the risk of scalding to service users. The home presented as clean, pleasant and hygienic. Appropriate instruction is provided to staff and soap for hand washing, disposable gloves and aprons are readily available. The laundry facilities and procedures are well maintained and domestic staff are employed to clean the house. Marray House D52-D04 S9195 Marray House V226655 160605 Stage 4.doc Version 1.30 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 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 29. A stable staff team that is receiving appropriate support and training opportunities is providing service users with a consistent approach to care. EVIDENCE: On the day of this announced inspection there were appropriate numbers of senior staff, carers and ancillary staff to present an organised home, providing for the welfare of service users. There is a minimum of 2 carers at all times with 4 carers at peak times of activity. A waker and sleeping night carer are provided for service users that require attention at night. The recent recruitment process for staff was inspected and noted to receive appropriate information. Staff files were inspected and references from the previous employer had been received and the required checks taken. Induction and foundation training are developed concerning ‘principles of care’ and staff training records show that First Aid, Basic Food and Hygiene, Fire Precautions and Manual Handling are provided. The 2 senior carers who are NVQ Assessors continue to develop and oversee these responsibilities and have developed the individual staff files to record training completed. Staff were observed to exhibit appropriate skills and attitudes during their interactions with service users. Marray House D52-D04 S9195 Marray House V226655 160605 Stage 4.doc Version 1.30 Page 16 Management and Administration
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) 31,32, 36 and 38. The registered person is providing clear and effective leadership and management to maintain a safe and comfortable home for service users. EVIDENCE: The registered person is appropriately experienced and was able to refer to appropriate policy and procedure and discussion occurred regarding various topics. The schedules 3 and 4 listing all records to be kept were reviewed and appropriate records are maintained at the home. The registered manager is completing risk assessments and the appropriate maintenance of health and safety precautions, training and equipment is occurring. The health, safety and welfare of service users and staff are promoted and protected. Staff induction and training are provided. The provider is advised to continue to review standard 38 to ensure as far as is reasonably practicable the health, safety and welfare of service users and staff is maintained. A recommendation to provide staff supervision has been complied with.
Marray House D52-D04 S9195 Marray House V226655 160605 Stage 4.doc Version 1.30 Page 17 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 3 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 x 3 x 3 2 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 x x x 3 x 3 Marray House D52-D04 S9195 Marray House V226655 160605 Stage 4.doc Version 1.30 Page 18 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. 1. 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 7 Good Practice Recommendations The registered person should develop the care plans to expand on the needs of service users regarding health, social and personal care. The management should provide details of the action staff should take to meet these needs and demonstrate a monthly review of these plans with the involvement of service users. The registered person should ensure that staff attend the ‘Protection of Vulnerable Adults’ training provided by social services. The registered person should complete a programme of providing radiator covers for the remaining areas in the home. 2. 3. 18 25 Marray House D52-D04 S9195 Marray House V226655 160605 Stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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