Inspection on 03/10/07 for Marsden House

This inspection was carried out on 3rd October 2007.

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 23/08/06

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

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 Marsden House Whitchurch Symonds Yat Herefordshire HR9 6DJ Lead Inspector Wendy Barrett Unannounced Inspection 3rd October 2007 09:30 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.V342173.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.V342173.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 vacant post 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.V342173.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd August 2006 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.V342173.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report was written with reference to information obtained from a quality assurance assessment report submitted by the Provider, results of a sample survey of resident and relative views about the service, an unannounced inspection visit to the service and information about the service and held by the Commission. What the service does well: What has improved since the last inspection? The Provider has continued to invest in improvements to the premises. The staff have received additional guidance to be sure all areas of the home are regularly cleaned as part of infection control measures. A period of managed staff changes now seems to have settled down. This will mean residents have a more stable team of carers and staff have a more settled working environment. More staff have obtained a national vocational qualification. Marsden House DS0000054060.V342173.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Marsden House DS0000054060.V342173.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.V342173.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are only agreed once enough information has been gathered to decide if the home will be able to meet the potential resident’s needs and expectations. Potential residents are able to visit the home to help them to decide if the home will suit them. This work helps new residents feel comfortable with their admission into the home. EVIDENCE: Prospective residents have the opportunity to visit the home to help them decide if it will suit them. The Provider also goes out to meet them and find out what they need from the home and what sort of service they would like to receive. There are written records of this work so the staff can use it while they are getting to know a new resident. Reports from other care Marsden House DS0000054060.V342173.R01.S.doc Version 5.2 Page 9 professionals are sometimes obtained to help with this pre-admission assessment e.g. one record included a mental health care assessment report. A resident described how she had been admitted in an emergency and hadn’t been able to visit the home first. Once resident at the home she decided that her bedroom did not suit her. This had been sorted out and she was now in a different room where she felt very comfortable. Marsden House DS0000054060.V342173.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are very happy with the personal care they receive, but the way this is achieved is very dependent on verbal communication between staff. The use of written records of care needs more development to be sure each plan of care gives staff up to date guidance on all the resident’s care needs and what actions to take in order to meet them. Staff have good procedures and training to be sure medication is handled safely, but there are some examples of discrepancies that indicate a need for more regular and robust audit of stock and records. EVIDENCE: Marsden House DS0000054060.V342173.R01.S.doc Version 5.2 Page 11 The residents are generally happy with the way the staff provide their care – ‘they always come and walk with me-I’m nervous’. One resident referred to the time he fell over and how the staff came to help him ‘very quickly’. Survey form responses were mostly positive-two residents said they ‘sometimes’ get the medical attention they need. Given that these survey forms were not signed it is not possible to check if these comments reflected on the home’s staff or on the overall provision of medical support from G.P’s etc. Every resident has a written plan of care that is intended to tell the staff what care each resident needs and how this should be provided. The plans aren’t always addressing important aspects of the care e.g. there was no care plan instructing staff how to support a resident with an in-dwelling catheter. It is also important that these records are kept up to date so that they reflect any changes in residents’ needs. A sample of care plans had not been reviewed for some time – one plan had not been reviewed since March 2007. The care staff were regularly completing day to day reports of significant events but sometimes there were entries that indicated a need for further attention from senior staff e.g. there were several references in the same week about a resident’s restlessness –‘getting residents agitated’. There was no record of any response to these reports i.e. guidance offered by senior staff in managing this behaviour, or referral to health care professionals for further advice. The staff are completing risk assessments to help them identify when residents may be at some risk and may need additional support e.g. eating and drinking, mobility. This is good but the results of risk assessments need to be given more attention. There were examples of assessments identifying a resident at risk e.g. a Risk of falls assessment confirmed ‘high risk’. When this happens the staff should have a plan of care to tell them what action they should take to reduce the risk of the resident experiencing falls. Staff receive training in handling medication safely. The provider was due to come back into the home 3 evenings of the inspection week so that he could instruct night staff. A care assistant confirmed she had received this in-house training and had also attended a Boots pharmacy training session. There were examples of medication being managed well at the home e.g. staff have recently received additional written guidance that explains the reason why each type of medication has been prescribed for a resident. A resident’s tranquillising medication has been significantly reduced in response to his improved condition. The records of administration are generally well recorded e.g. allergy information completed, two staff signing to confirm hand written entries have been double checked for accuracy. However, a sample of stock checks identified small discrepancies in actual stock balance and the amount that should have been in stock if calculated using the written records. A resident had been without a medication for a few days because the home was out of stock. This should not happen and needs to be addressed more robustly in future. Marsden House DS0000054060.V342173.R01.S.doc Version 5.2 Page 12 Marsden House DS0000054060.V342173.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are offered a variety of social opportunities to help them enjoy their days, and they are able to make choices so that their preferences are taken into account. A few residents are not entirely happy with this aspect of their care and care plans should better address individual needs and preferences. Residents are satisfied with the meals and these are planned to ensure a wholesome and varied diet. The way that nutritional needs are assessed should better address the risk of malnutrition through the use of a more robust assessment tool. 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. Marsden House DS0000054060.V342173.R01.S.doc Version 5.2 Page 14 There are a variety of leisure opportunities e.g. live music, minibus trips out every 3 to 4 weeks, manicures, escorted walks out to the local Post Office, hairdressing days. A local vicar visits the home. During the inspection visit the communal sitting areas weren’t being used much-most residents preferring to sit in their bedroom. Staff said this was not always the case and it could sometimes be very lively around the home. Residents who completed survey forms offered differing responses about the quality of their social opportunities. Some were completely satisfied, others less so. One resident wanted more people to talk to. This indicates a need to develop attention to social care within the care planning process for each resident. Records of menus and food provided are being maintained. The home uses fresh produce and works hard to serve meals that will be attractive, healthy and served at a time that suits the residents. Residents are happy with the meals –‘food’s marvellous’. Staff keep an eye on residents’ weights so they can quickly pick up any fluctuation that needs further investigation. Nutritional needs are assessed using a nutrition screening tool obtained from Herefordhsire Social Services, but there are now more robust tools such as the MUST tool which would strengthen the home’s approach to nutrition assessment. Marsden House DS0000054060.V342173.R01.S.doc Version 5.2 Page 15 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. 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 although sometimes residents find it difficult to talk to junior staff about their concerns. 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. Some survey responses indicate that residents don’t always feel the staff listen to them – ‘some do, some don’t’, ‘staff listen, but this often takes time’. One resident referred to ‘staff variations’ making it difficult to know who to speak to at times. The Commission has received one complaint about the service since the last inspection. This was not substantiated. In fact, the complaint arose following the provider’s actions taken to protect a resident from abuse. There is other evidence of the Provider’s robust approach to issues of adult protection e.g. the Commission is being notified when there is any staff disciplinary work Marsden House DS0000054060.V342173.R01.S.doc Version 5.2 Page 16 being done to ensure the safety of residents. This open approach strengthens the overall protection of residents. When new staff start work at the home they receive copies of the home’s complaints and adult protection policies. Marsden House DS0000054060.V342173.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents benefit from high quality accommodation. The premises are well maintained to ensure a safe and comfortable environment for the residents, and hygienic working practices by staff. EVIDENCE: The home and gardens were very tidy and attractively presented when the inspection visit took place. All areas of the residents’ accommodation were clean and odour free. Furnishings and décor are high quality and residents were happy with their bedrooms. Marsden House DS0000054060.V342173.R01.S.doc Version 5.2 Page 18 There is ongoing investment to maintain a safe setting e.g. a new fire door alarm system has been fitted since the last inspection. Potential environmental hazards e.g. garden pond, unrestricted windows on first floor of home, were noticed during a brief tour of the premises. Although the provider was satisfied there was no further action required to ensure residents’ safety it is important that there is a record of the way this type of decision has been reached. There is good attention to infection control e.g. all staff have received training and the home has related policy and procedures. A new cleaning rota has recently been introduced to cover the type of cleaning tasks undertaken by care assistants e.g. wheelchairs, laundry room etc. Marsden House DS0000054060.V342173.R01.S.doc Version 5.2 Page 19 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. 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 were a satisfactory number of staff on duty when the inspection visit took place. A senior care assistant, two care assistants, a cook, two cleaners and the provider were at work. Residents agreed their needs were being met‘staff always come and walk with me-I’m nervous’, ‘they know me well’. One resident described an occasion when he had fallen –‘staff picked me up very quickly’. The way that new staff are selected was satisfactory when the home was last inspected. There are thorough checks to make sure potential employees will be safe to work with vulnerable adults. Sometimes the Provider has informed the Commission of his concerns regarding staff performance and describes appropriate disciplinary action he has taken to maintain the safety of the residents. Staff are introduced to work at the home through an induction programme that Marsden House DS0000054060.V342173.R01.S.doc Version 5.2 Page 20 meets national specifications. An agency worker described how the senior gave her details of each resident’s care needs before sending her to work with them during her shift. She felt well informed and supported. Staff are being supported in obtaining a National Vocational Qualification- 71 of care assistants have either obtained this award or are working towards it. Some staff are working on a higher level award now. Some additional training is arranged when necessary-a Senior Care Assistant mentioned a training session that had been arranged to help staff understand the needs of a resident with Motor Neurone disorder. Documentation relating to purchased training packages were seen at the home. They included a dementia care course consisting of a workbook and test. Marsden House DS0000054060.V342173.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,35,36 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. The management of staff would be strengthened with the introduction of a structured supervision and appraisal programme. EVIDENCE: The Provider is also registered as the Care Manager and has the qualification and experience to undertake this role. He has an open relationship with the Commission and keeps us informed of significant events at the home. Marsden House DS0000054060.V342173.R01.S.doc Version 5.2 Page 22 The provider closely monitors the service because he is regularly present at the home e.g. he was coming back into the home on three evenings of the inspection week so that he could meet with night staff and check their understanding of medication procedures. Residents have confidence in him‘always good at doing anything. Always feel able to trust him’. Relatives are asked to provide any necessary support in financial matters. A resident mentioned how his sister helped him with his banking. Staff referred to regular team meetings although one to one supervision sessions have not been re-introduced after a period of staff changes. This should now be addressed because it strengthens support and accountability for each member of staff. However, a staff member felt well supported through senior meetings, a new staff team and the recent appointment of two new senior staff. 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 e.g. two cleaning staff confirmed they had received guidance about the care of hazardous cleaning materials. They also had protective clothing and goggles. The Provider is consulting other professionals for additional guidance- a Fire Safety officer had been consulted in June 2007 when a new alarm system was being installed. Marsden House DS0000054060.V342173.R01.S.doc Version 5.2 Page 23 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 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 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 x 3 Marsden House DS0000054060.V342173.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15 Requirement All sections of the written care plans must be fully completed and information kept up to date. (previous timescale of 31/10/06 not met. Timescale extended) Timescale for action 31/12/07 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. 3. 4. Refer to Standard OP9 OP7 OP12 OP16 Good Practice Recommendations There should be regular audits of medication stock and records so that shortfalls and discrepancies are quickly identified and dealt with. Assessment of residents’ nutritional needs and associated risks would be strengthened with the adoption of the MUST tool. Care planning work should incorporate more attention to residents’ social interests and lifestyle preferences so that staff know what support will suit each individual. Staff should receive additional guidance to be sure they recognise the importance of their role in helping residents DS0000054060.V342173.R01.S.doc Version 5.2 Page 25 Marsden House 5. OP36 have their concerns listened to and acted upon. There should be a more structured system of staff supervision and appraisal. 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