Inspection on 11/07/05 for Marsden House

This inspection was carried out on 11th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Marsden House 03/10/07

Marsden House 23/08/06

Marsden House 09/12/05

Marsden House 12/01/05

Marsden House 24/08/04

Marsden House 27/03/04

Marsden House 03/12/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Marsden House Whitchurch Symonds Yat Herefordshire HR9 6DJ Lead Inspector Wendy Barrett DRAFT Announced 11 July 2005 9:30 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. Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Marsden House Address Whitchurch Symonds Yat Herefordshire HE9 6DJ 01600 890869 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) Mr G W and Mrs LE Fillery Mr P S Young Care Home 23 Category(ies) of Dementia over 65 23 registration, with number Mental Disorder over 65 23 of places Physical disability over 65 23 Old Age Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11 January 2005 Brief Description of the Service: Marsden House is a well-established Care Home situated in the centre of the village of Whitchurch between Ross-on-Wye and Monmouth. It is within easy access of the main A40 road. Village facilities e.g. post office and general store, are within easy walking distance. The Providers have been registered since October 2003. There is a separate registered Care Manager who has not been at work in the home since August 2004. One of the Providers is undertaking the management of everyday care until this situation is resolved. The service accommodates 23 people over the age of 65 who have needs arising from the normal ageing process or because they have additional needs associated with physical disability, dementia illnesses or other mental health difficulties. The home is situated in large grounds. There are two lounges, a conservatory and a separate dining room on the ground floor. It is the policy of the home to offer all residents single bedroom accommodation. However, there is the facility for couples to share a double sized room if that is requested. Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Although Mr. And Mrs. Fillery are jointly registered as the Providers at Marsden House, Mr. Fillery is undertaking care management responsibility during the absence of the registered Care Manager. Where this report states ‘the Provider’ this refers to Mr. Fillery who was present at the inspection. This was an announced inspection that was undertaken between the hours of 09.30am and 17.15pm. The main focus of the inspection was to look at the work undertaken by the Providers since their registration to improve the quality of the overall service. This included action taken to comply with any outstanding requirements arising from previous inspections and also action taken at the initiative of the Provider. Information was gathered from a variety of sources. These included the Commission’s records of contact with the home since the last inspection, records and documentation maintained at the home, interviews with 4 residents and interviews with 2 staff. The Provider led a tour of the premises and there were opportunities to observe and meet other residents and staff as they went about their daily routines. Feedback questionnaires were sent to the home in early June and the Provider was requested to distribute these to residents, their relatives and all staff. The Commission received 13 resident responses, 6 relative responses and 7 staff responses. Comments within these responses have been taken into account in the writing of this report. What the service does well: The residents are offered a very attractive, spacious building that is furnished and maintained to a high standard. There is considerable confidence in the Provider and he is described as approachable and helpful. This means that problems and concerns are more likely to be identified and dealt with promptly, and this will ensure the overall safety and comfort of the residents. The staff are well supported and supervised and they are given the training they need to do their job well. The residents are recognised as individuals and their needs and wishes are taken into account. The business is professionally managed with the interests of the residents central to this work. The Provider understands the law he has to comply with. There are good recording systems at the home. Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 Page 6 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. Marsden House E52 - E02 S54060 Marsden House V237842 110705 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 Marsden House E52 - E02 S54060 Marsden House V237842 110705 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) 1,2 and 4. Prospective residents have the information they need to help them decide if the home would suit them. New residents are given written details of conditions of residence. EVIDENCE: There is a Statement of Purpose and Service User Guide that contain all the required information. The information well describes the capacity of the home e.g. ‘we are able to care for residents with mild dementia, where the resident is able to fit into, and benefit from, the life of the home. If the progress of the illness leads to disruptive behaviour, or causes problems for other residents, we would not be able to cope’. There is a statement of conditions of residence and a form of agreement that is signed by residents and the Provider at the point of admission. Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 Page 9 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, 9 and 10. There are individual plans of care that address health, personal and social care needs. Medication is managed in a way that protects residents. Residents feel they are treated with respect and their right to privacy is upheld. EVIDENCE: The Provider has developed and implemented individual plans of care. This is a significant piece of work that was ongoing at the time of the last inspection. The plans are based on a comprehensive assessment and are evaluated monthly. There has been additional training since the last inspection to equip staff with relevant knowledge in their care planning and assessment work e.g. the Provider and two staff have completed a one day course on Nutrition in the Elderly. Assessment processes have recently been broadened to include attention to skin care, nutrition and manual handling. A recently recruited care assistant described how he would help a resident take a bath. His response reflected an individualised approach to the task e.g. seeking resident’s approval for a bath, own toiletries, and choice of bathroom/equipment. Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 Page 10 A resident remembered a care assistant sitting with her to fill in an activity programme. Another resident described how staff were attending an area of sore skin. One resident said her G.P. saw her immediately when she developed a sore area on her oedematous lower leg. A District Nurse had just been in to take blood from her for testing. A feedback response from a relative referred to improvements in the everyday care since the new Providers arrived – ‘much better assistance with her personal hygiene’, ‘incontinence better managed’. Another response stated – ‘staff show perception of my mother’s emotional needs and give comfort and encouragement when down’. Relatives on behalf of residents had completed many of the feedback questionnaires. The feedback confirmed that relatives are being consulted about the care of the resident and that residents feel they are treated with respect and dignity. The Commission’s Pharmacy Inspector visited the home on 5th November 2004 at the request of the Provider. Some requirements and recommendations were made. The Provider wrote to the Commission on 24th February 2005 and confirmed that a number of requirements had already been complied with. Records inspected during the current inspection provided evidence of compliance e.g. MAR (Medication Administration Records) being kept as detailed in the Pharmacist Inspector’s report, and a medicine cupboard and trolley securely fixed to a wall. A revised policy and procedure has also been submitted to the Commission following the pharmacy inspection. The Provider’s Quality Assurance Review dated May 2005 referred to a Provider and nine staff having successfully completed a ‘Safe Handling of Medicines’ training course’. This information was also seen in staff records during the current inspection. Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 Page 11 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) 2, 13 and 14 The Provider is readily available and is responsive to residents and relatives interests. Residents are able to continue with their preferred lifestyle and the involvement of their relatives is encouraged when appropriate. This opportunity may be made more accessible for some residents with the help of an independent advocate. EVIDENCE: Feedback responses from residents and relatives reflected a much improved service in respect of attention to individual expectations and preferences – ‘there is an increase in activities since Mr. Fillery took over – my 92 year old mother has enjoyed these’, ‘the needs of dementia patients shows signs of improving amongst some staff’. Relatives responses confirm that their continuing involvement is encouraged – ‘the Manager is very patient and understanding’. There is a programmed meeting time each month for residents to discuss any issues with the Provider. It may be helpful if an independent advocate were sought to support residents who have no family representation in making use of this opportunity. The availability of this type of service is advertised in the home but it may be that the residents most likely to benefit would need help in accessing this service. The cook enthusiastically described the success of themed lunches. This was confirmed by residents. A ‘What’s On’ poster for the month of July listed Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 Page 12 opportunities for Holy Communion, movie afternoons, in-house shop, music and movement and bingo. A staff member described how the Provider goes to see residents as soon as he hears they have a problem that they wish to discuss. Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 Page 13 Complaints and Protection 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 Complaints and suggestions from residents and relatives are listened to, taken seriously and acted upon. There are good systems in place to protect resident from abuse. EVIDENCE: The Provider’s report of a Quality Review May 2005 referred to one justified complaint with direct action taken to address this within four days of the complaint being received. Other complaints had been investigated and found to be unsubstantiated. A register is maintained of related information. The report also refers to a positive response to a resident’s suggestion to introduce Resident Surgeries with the Provider. The Commission has not received any complaints about the service. All but one of the resident feedback responses confirmed they knew who to talk to if there were concerns about care. All relatives who responded to the consultation exercise confirmed their awareness of the home’s complaints procedure. A care assistant described a clear understanding of the potential sensitivities arising from the employment of two close relatives, one employed at a senior level, at the same home. This situation could compromise other staff in feeling able to ‘whistleblow’. Strategies for dealing with this had obviously been recognised and addressed by the Provider. There is an example of the Provider’s appropriate referral to local multi-agency protocols for the protection of vulnerable adults. A pack of information issued to new staff included a copy of the home’s policy and procedures relating to adult protection. Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 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 standard(s) 19, 20, 24, and 25. The residents live in a well maintained, safe and comfortable environment that provides residents with the space and facilities they need. EVIDENCE: The home is very well presented with good quality fittings and furnishings throughout. The accommodation also meets the National Minimum Standards in terms of space and facilities. A resident explained how personal items of furniture had been accepted into the home. The Provider has complied with environmental requirements arising from the last inspection e.g. automatic control of hot water temperatures to bath and washbasin outlets, risk assessment regarding legionella. It is recommended that bath thermometers be provided to back up the automatic system of water temperature control. Staff did confirm that they already test the temperature manually before immersing a resident. The remaining bedroom door without an approved lock Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 Page 15 has had this facility fitted. Heated radiator covers have been fitted where risk assessment has indicated this is necessary. There are also examples of additional work undertaken by the Provider to improve the quality and safety of the accommodation e.g. decorating of 6 bedrooms. A Quality Review report written in May 2005 includes a commitment to decorate other bedrooms as vacancies arise. The home’s fire risk assessment is being kept under review. Safety has been improved with a new emergency bar on a fire door. A new hoist has been purchased. The entrance hall and stairway, quiet lounge and dining room have been fitted with new carpet. Staff feel that the Provider promptly attends to repairs and replacements of equipment. One staff feedback questionnaire suggested that specialist feeding aids may be helpful. This idea could perhaps be discussed at a future staff meeting. A corridor recess was being used to store miscellaneous items at the time of the inspection. The practice should be subject to further risk assessment and alternative areas of storage may need to be identified depending on the outcome of this exercise. Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 Page 16 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) 27,28,29 and 30 Staffing levels are satisfactory for the number and dependency levels of residents. Staff are carefully selected to ensure they are suitable to work with vulnerable adults and they are given support and opportunities to develop relevant knowledge and skills. EVIDENCE: The Provider has undertaken a staffing level analysis over the months of April, May and June of this year. This identified approximately 35 more staff employed than the recommended level indicated by applying a nationally recognised formula. Staff consider staffing levels adequate. Most relatives feedback questionnaires also supported this view. Three relatives felt that there were not enough staff. This perception may be worth exploring at any future meetings with relatives. One relative suggested that staff may be at work but not easily visible. This may be the case given the size of the building. There was considerable evidence of thorough attention to training of staff to equip them with appropriate skills e.g. N.V.Q., health and safety, professional practice. This was reflected in staff responses and records at the home. A recently employed staff member described a thorough recruitment and induction process that addressed all the required elements e.g. references, Criminal Records Bureau checks, information packs including core policies and procedures, induction programmes in line with national specifications. Records seen in staff files confirmed good practice in selecting suitable employees. Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 Page 17 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, 33, 36, 37 and 38 Residents, relatives and staff all express confidence in the Provider. There is conscientious attention to the welfare of residents and staff are well supervised and supported. EVIDENCE: The Provider intends to obtain a Registered Manager’s Award so that he has the appropriate qualification to manage everyday care at the home. There are quality-monitoring systems in place to assess the effectiveness of the service. A quality Assurance Review report produced in May 2005 referred to staff meetings, use of staff disciplinary procedures, and the introduction of a substantial training programme. There was also reference to improved staff morale since the arrival of the new Provider. Staff feel very well supported by the Provider because he is readily available and responsive to their issues and any issues raised with them by individual residents. A staff member felt the Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 Page 18 regular presence and accessibility of the Provider was a more effective way of supervising staff than one to one sessions. Feedback responses from relatives also included supportive comments about the Provider’s work with them e.g. ‘very patient and understanding’. There is reference in this report to robust attention to health and safety issues e.g. environmental aspects, staff training. Staff feedbacks confirmed their awareness of the home’s Health and Safety policy and the relevance of associated procedures. The Provider is due to attend a Fire Safety Management Training course in September 2005 to update his knowledge. Staff have received fire safety training this year and there has been a fire drill exercise. A few staff indicated that they had not participated in a recent fire drill although evacuation procedures have been reviewed with written guidance displayed in the home. Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 Page 19 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 3 x 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 3 x x x 3 3 x STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 4 x 4 3 3 3 x x 3 x 3 Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 Page 20 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 19 Regulation Requirement Timescale for action 31st August 2005 23(2)l and The fire risk assessment must (4) a include evidence of attention to potential risks of using corridor areas for storage purposes. 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 14 Good Practice Recommendations To review the situation of any residents unable to represent their own interests and without relatives or friends to do so. These residents may need active support from staff in accessing any advocacy service that may be available. To review whether any residents may benefit from specialist feeding aids re: comment from staff feedback. To review the programme of fire drill exercises to ensure that each staff member is participating in at least one drill each year. 2. 3. 15 38 Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Hereford Area Office 178 Widemarsh Street Hereford HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Marsden House E52 - E02 S54060 Marsden House V237842 110705 Stage 4.doc Version 1.40 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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