Inspection on 23/08/06 for Marsden House

This inspection was carried out on 23rd August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 09/12/05

Marsden House 11/07/05

Marsden House 12/01/05

Marsden House 24/08/04

Marsden House 27/03/04

Marsden House 03/12/03

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Inspirations

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

CARE HOMES FOR OLDER PEOPLE Marsden House Marsden House Whitchurch Symonds Yat Herefordshire HR9 6DJ Lead Inspector Wendy Barrett Unannounced Inspection 23rd August 2006 15:00p 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 Marsden House DS0000054060.V306483.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. Marsden House DS0000054060.V306483.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marsden House Address Marsden House Whitchurch Symonds Yat Herefordshire HR9 6DJ 01600 890869 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) Mr Graham Winston Fillery Mrs Louise Elizabeth Fillery Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (23), Old age, not falling within any other category (23), Physical disability over 65 years of age (23) Marsden House DS0000054060.V306483.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th December 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 Provider is also registered as the Care Manager. 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 and the Provider has recently improved the accommodation by building four new bedrooms to replace existing accommodation. There is also an additional lounge/hairdressing room with ramped access to the gardens. The fees ranged from £350 to £425 in September 2006. There are additional charges for hairdressing, chiropody, toiletries and newspapers. Marsden House DS0000054060.V306483.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report was based on information gathered during two inspection visits to the service. The first visit was unannounced and the second was pre-arranged so the Provider could arrange to be present and assist with the work. Additional information was gathered from records of the service held by the Commission and through a sample of survey forms distributed to residents, relatives and visiting professionals. What the service does well: What has improved since the last inspection? The residents’ accommodation has been improved by replacing four bedrooms and building an extra lounge that will offer easy access to the garden. Night staffing levels have been increased because the Provider has recognised residents are becoming more frail and tend to need more support through the night period. Marsden House DS0000054060.V306483.R01.S.doc Version 5.2 Page 6 The Provider recognises the value of developing the cohesion of the staff team because it is important for residents to enjoy a consistent approach to their care. He does, therefore, intend to strengthen the way he manages this aspect of the service and will soon be introducing new systems to help the staff achieve this end. 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 DS0000054060.V306483.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 Marsden House DS0000054060.V306483.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): 2,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are able to make an informed decision about the suitability of the home. The Provider carefully assesses care needs before and after admission to be sure that the service can cope with these. EVIDENCE: Pre-admission work was satisfactory at the time of the last inspection. During this inspection visit a resident described her gradual introduction into the home. She had been able to assess the suitability of the home during a respite stay and a trial period of residence prior to making up her mind if she wished to move in permanently- ‘(The Provider) was very attentive through my admission. He helped me to go home to try twice again’. A copy of an initial assessment record and a signed and dated contract of residence were seen to confirm continuing good practice. The Provider carefully monitors changing care needs of residents so that he can ensure the home operates within its capacity and the quality of life is not Marsden House DS0000054060.V306483.R01.S.doc Version 5.2 Page 9 adversely affected. He consults and informs the Commission as part of this work when necessary. Marsden House DS0000054060.V306483.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): 7,8,9,10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident has a plan of care and residents and relatives are satisfied with the care received. The written records are not being fully completed to show how the care is being monitored and discussed with the resident or their family. EVIDENCE: Each resident has a written plan of care to guide staff in responding to individual needs and wishes. The plans are based on comprehensive assessment work. There were a few examples where identified needs had not been followed through with risk assessment or care planning e.g. a self medicating risk assessment had not been completed for a resident described as ‘self medicating’, reference to a history of falls was not sufficiently well addressed in the resulting care plan ‘mobility – uses a walking stick’. The inclusion of a night care plan was indicative of good practice but a sampled plan had not been signed or dated and the section for the resident to confirm whether they wished to be checked through the night was not completed. Marsden House DS0000054060.V306483.R01.S.doc Version 5.2 Page 11 The plans contained evidence of attention to routine medical checks, weight monitoring, manual handling and skin care. However, some were seen that appeared not to have been recently completed e.g. last chiropody visit dated 3/3/06 with comment ‘due again in 6-8weeks’. Residents met during the inspection visit expressed satisfaction with the way staff were caring for them – ‘there are people to ask if I need anything. Everyone is friendly’. Observations made during the inspection visit were positive e.g. fresh supplies of cold drinks seen in all occupied bedrooms’. Staff are supplied with a written procedure for handling medication. This addresses potential risk areas well. Records reflected up to date good practice e.g. completion of allergy boxes, double-checking of transcribed entries. Two interviewed senior staff referred to the provision of in-house and external training in medication management to ensure their competence to handle medication safely. There is written guidance to guide staff in caring for residents nearing the end of their lives. A relative had written a letter of thanks for the care received by a resident who was cared for at the home up to his death. This was very complimentary – ‘thank you to the night staff – night times were often Dad’s more active hours’, ‘greatly appreciate your agreeing to keep Dad…. Death in his own room, surrounded by your caring staff, is a memory we will all hold’. Marsden House DS0000054060.V306483.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 judgement has been made using available evidence including a visit to this service. There is a flexible approach so that residents can spend their days in the way they prefer. Staff offer support in pursuing leisure interest and relatives are encouraged to contribute when if they are able to do so. Residents are satisfied with the meals and these are planned to ensure a wholesome and varied diet. EVIDENCE: Residents are able to choose how they wish to spend their day e.g. what time they get up in the morning and go to bed, whether they prefer to spend the day in their own bedroom or communal areas. A pre-inspection questionnaire lists a variety of leisure opportunities e.g. musical entertainers, bridge and comic club, film afternoons and minibus trips (although no residents currently wish to take advantage of this opportunity). A local vicar visits the home. There are examples of staff support in pursuing individual leisure interests e.g. visits from PAT dog, escorted walks around the garden. A resident was observed enjoying a discussion with a staff member about football and current affairs. The production of specific care plans for Marsden House DS0000054060.V306483.R01.S.doc Version 5.2 Page 13 social care would ensure that all residents receive the support they need with this aspect of their lives. The Provider’s contact with the Commission in between inspection visits confirms that relatives are consulted about issues affecting residents’ life style choices e.g. risks associated with mixing alcohol and prescribed medication. The meals service was satisfactory at the last inspection. A new cook had very recently started work at the home. The lunch being prepared included fresh produce and looked and smelt very appealing. Recommendations arising from an inspection by an Environmental Health Officer in August 2006 were already being actioned by the Provider e.g. consistent use of meat temperature probe, deep cleaning of kitchen. Records of menus and food provided were being properly maintained. Marsden House DS0000054060.V306483.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Concerns about the service are managed well and there is good attention to ensure the protection of the residents from abuse. EVIDENCE: There is a written complaints procedure advertised at the home. The Provider maintains a record of all concerns raised at the home and how they have been dealt with. Two contacts have been made with the Commission since the last inspection. These were primarily to do with staffing issues and did not identify shortfalls in the service provided to residents. There is evidence of the Provider’s robust approach to issues of adult protection. The Commission was kept informed of this work. This open approach strengthens the safety of residents at the home. Staff are supplied with guidance about abuse awareness and how they should report any relevant concerns. Marsden House DS0000054060.V306483.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. The environment is well maintained with ongoing work to continue improving its quality and safety. EVIDENCE: The Provider has been investing in improving the quality of the accommodation and has plans to continue with this work. Four new bedrooms have been built to replace existing rooms. Two of these are particularly spacious. A conservatory lounge has also been added and garden landscaping is underway. Two existing en-suite bedrooms have been enlarged. New laundry equipment and a new oven have been purchased. Future plans include the installation of an improved fire alarm system and a programme of redecoration where necessary. The home was clean and tidy at the time of the inspection visits. When the potential hazards were pointed out to staff, the Provider cleared the new Marsden House DS0000054060.V306483.R01.S.doc Version 5.2 Page 16 conservatory lounge of stored furniture and equipment and building tools between the two inspection visits. Tins of paint, ant powder and paraffin had also been secured in a locked storage area. This attention to resident safety and comfort should continue to be sure that the accommodation will be safe and accessible at all times. The kitchen had been deep cleaned in response to a recent inspection by the Environmental Health Officer. It was clean and tidy at the time of the inspection visit. Marsden House DS0000054060.V306483.R01.S.doc Version 5.2 Page 17 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 judgement has been made using available evidence including a visit to this service. There are enough staff employed to meet the needs of the residents. They are selected and trained to be sure they work safely and effectively. EVIDENCE: There are a satisfactory number of staff employed to meet the care needs of residents and the Provider adjusts this level if necessary e.g. an additional waking night care assistant has been employed since May 06. There has been some turnover of staff in recent months. Replacement staff have been appointed although there is still some dependence on agency staff. An agency worker described how she was well supported by permanent staff when she first worked at Marsden House. She now works regular shifts at the home and has been able to get to know the residents well. Staff are introduced to work at the home through an induction programme that meets national specifications. A satisfactory number of care assistants had achieved a National Vocational Qualification when the home was inspected during 2005. The current number was not obtained on this occasion although interviewed staff referred to their involvement in achieving this award. Records were seen of manual handling instruction provided last year. A staff member was aware that the Provider was arranging external training in Marsden House DS0000054060.V306483.R01.S.doc Version 5.2 Page 18 medication management in the near future and another staff member mentioned a training session on motor neurone disorder. This had been arranged to help staff care for a particular resident. A sample of recruitment records was inspected. The documentation confirmed a thorough procedure for assessing the suitability of applicants e.g. written references, Criminal Records Bureau /Protection of Vulnerable Adults register checks prior to starting work at the home. There have also been examples of the Provider’s good use of disciplinary procedures to maintain the suitability of the staff group. Marsden House DS0000054060.V306483.R01.S.doc Version 5.2 Page 19 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 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): 31,32,35,36,37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is managed in a responsible and competent manner and in the best interests of the residents. EVIDENCE: The Provider is also registered as the Care Manager and has the qualification and experience to undertake this role. He also participates in further training opportunities to make sure he is up to date with emerging legislation e.g. fire safety regulations. There are proposals to introduce a new quality assurance system during the next year. This work should include a programme of reviewing policies and procedures at the home. The Provider already implements various auditing Marsden House DS0000054060.V306483.R01.S.doc Version 5.2 Page 20 processes as part of his business management. There will need to be a report produced of any quality assurance exercise that can be made available to the Commission within one month of the request being made. There will be further guidance for Providers regarding self-assessment reports in the near future. Residents’ personal money is not held at the home. Relatives are asked to provide any necessary support with this task. Staff referred to regular team meetings although one to one supervision sessions had lapsed due to the particular staffing changes during recent months. The Provider described clear proposals to develop and strengthen the staffing arrangements in the future. The re-introduction of one to one supervisions sessions would be part of this work. Records are being well maintained in a secure manner. Some computerised records are used to support the overall administrative work. The Commission is being notified of events occurring at the home as required under Regulation 37 of The Care Homes Regulations 2001. Staff are receiving statutory health and safety training and work practices at the home follow good practice guidance. There may need to be more attention to ensuring potentially hazardous materials are not stored in areas accessible to residents (see Environment section). Marsden House DS0000054060.V306483.R01.S.doc Version 5.2 Page 21 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 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x x 3 2 3 3 Marsden House DS0000054060.V306483.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? no 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 OP7 Regulation 15 Requirement All sections of the written care plans must be fully completed and information kept up to date. Timescale for action 31/10/06 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 2 Refer to Standard OP33 OP38 Good Practice Recommendations The Provider should ensure that the proposed quality assurance system will satisfy the revised Care Homes regulation 24. The Provider should ensure that storage arrangements at the home are adequate to comply with health and safety legislative requirements regarding hazardous materials. 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