CARE HOMES FOR OLDER PEOPLE
Marsden House Marsden House Whitchurch Symonds Yat Herefordshire HR9 6DJ Lead Inspector
Wendy Barrett Unannounced Inspection 9th December 2005 11:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Marsden House DS0000054060.V272533.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Marsden House DS0000054060.V272533.R01.S.doc Version 5.1 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 Mr Paul Simon Young 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.V272533.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th July 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 DS0000054060.V272533.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 11.15am and 3.30pm. The Provider was present for part of this time. The main focus was on core National Minimum Standards that were not covered during the last inspection. In order to gain an overall picture of the service both reports should be referenced as scores have only been entered for the specific Standards covered this time. Three residents were interviewed in the privacy of their bedroom. Some time was spent in discussion with the Provider (Mr. Graham Fillery) and Senior Care Assistant and staff were observed in their handover meeting between shifts. Some areas of the residents’ accommodation were visited and a sample of records relating to care practice and the catering service was inspected. There was reference made to correspondence between the Provider and the Commission since the last inspection. What the service does well:
The Provider (Mr. Graham Fillery) has successfully developed the quality of the care service despite the long-term absence of the registered Care Manager. He has undertaken various training courses to supplement his knowledge and has been prepared to work towards the achievement of a Registered Manager’s Award as part of this commitment. This pro-active approach means that the care offered at the home is based on up to date good practice and with good awareness of the various legislation that must be complied with. Mr. Fillery also recognises the expertise of experienced senior staff at the home and they are encouraged to contribute to the management of the care service. The Commission are kept informed and consulted appropriately. This suggests the type of open approach that is necessary to ensure the overall protection of the residents. The accommodation is spacious and is maintained to a high standard. The quality of this will be further enhanced when the current building work is completed. Residents feel they are treated well and are able to continue living in the way they prefer. When they need help they are confident the staff will be there to support them. They enjoy the meals and staff have received training to help them prepare balanced, healthy choices to suit individual requirements and preferences. Marsden House DS0000054060.V272533.R01.S.doc Version 5.1 Page 6 Any money residents leave in safekeeping with the Provider is safely handled with good records to account for its’ receipt and disposal. There is careful consideration before agreeing to admit new residents. This gives everyone involved a good opportunity to decide whether the home will suit the resident and will be able to meet their care needs. 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 DS0000054060.V272533.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Marsden House DS0000054060.V272533.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 New residents are only accepted into the home once there has been a through assessment of their care needs and their expectations of the service. Admissions are only accepted if the staff feel they will be able to meet the needs and wishes identified in this assessment. EVIDENCE: The Provider has produced the necessary information literature and documentation to describe the service e.g. Statement of Purpose, Service User Guide, Contract of Residence. Arrangements for assessing the needs of prospective residents were inspected this time. There are examples of pre-admission visits to Marsden House, and of staff meeting prospective residents in their own home or in hospital before admission is arranged. Information about care needs and personal preferences is sought from relatives or others who have been caring for the individual e.g. hospital staff. Records are kept of all the above work and examples were seen at the home to illustrate the procedure. The Statement of Purpose clearly describes the home’s capacity and limitations regarding the care needs it can meet.
Marsden House DS0000054060.V272533.R01.S.doc Version 5.1 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 the following standard(s): 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: All the core National Minimum Standards in this section were met at the last inspection. There were up to date examples to illustrate a continuing satisfactory situation. A resident was aware of an appointment with an eye specialist in the near future. Two residents expressed appreciation for the transport provided from the home to get them to hospital appointments. All staff who handle medication have completed a comprehensive course on medication management. A bottle of eye drops had been properly dated to show when it was first opened and ensure it was not used after the expiry date. A sample of care records contained references to recent attention from health care professionals e.g. district nurses, community psychiatric nurse, G.P. Comments from residents indicated their satisfaction with the attitude of staff e.g. ‘ Graham always comes if you need him’, ‘yes, I can choose how I spend my day’, ‘the staff are very kind’.
Marsden House DS0000054060.V272533.R01.S.doc Version 5.1 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 the following standard(s): 15 There is attention to the particular dietary needs and preferences of older people so that the meals are healthy and interesting. Food produce is stored and prepared in clean and hygienic surroundings. The residents and their relatives are satisfied with the quality of the catering service. EVIDENCE: The home continues to produce written programmes of future activities for the residents’ information. A resident spoke about these and said she didn’t get bored and could go out whenever she wished. 19 feedback questionnaires were received from residents and relatives as a result of a consultation exercise before the last inspection. These responses confirmed overall satisfaction with the quality of the meals service at the home. Key staff are provided with basic food hygiene training. The Provider and two staff had also attended a training day on ‘Nutrition in Care Homes’ that was organised by the Primary Care Trust this year. Staff demonstrated awareness of special dietary needs or preferences of individual residents e.g. when being interviewed, a resident spoke about her intolerance to dairy products. Later on in the inspection a staff member showed awareness of this, its cause, and how it was being managed.
Marsden House DS0000054060.V272533.R01.S.doc Version 5.1 Page 11 Menus are produced with records kept of alternative dishes that are served to suit individuals. Residents commented on ‘excellent meals’, ‘I like everything’. One resident appreciated the more imaginative meals prepared by the Provider when the cook was not at work. During the last inspection the cook described success with ‘themed lunches’ – partly as a social activity and also as an opportunity for residents to taste unusual dishes to see if they would like them as part of the main menu. The kitchen was clean and tidy when inspected. Fresh and dry goods were stored carefully. Records of fridge/freezer temperature checks were seen and there are cleaning rotas in place. A new extension currently being built will provide a new dry store area for the cook. Marsden House DS0000054060.V272533.R01.S.doc Version 5.1 Page 12 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): EVIDENCE: The Commission has not received any complaints about the service since the last inspection. Marsden House DS0000054060.V272533.R01.S.doc Version 5.1 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 the following standard(s): 26 The home is kept clean and hygienic by staff who have up to date knowledge in infection control measures. EVIDENCE: At the time of this inspection building work was underway to improve the residents’ accommodation. This work will result in four new bedrooms and an additional communal lounge with ramped access to garden facilities. The new bedrooms will replace existing accommodation so that the registered number of places will remain unchanged. Four staff (including the Provider) completed a comprehensive training course on infection control procedures in May 2005. There are examples of thorough attention to cleanliness and hygiene e.g. the residents’ accommodation is clean and pleasant, the Provider has undertaken a risk assessment for legionella, cleaning schedules are implemented. Staff are supplied with disposable protective clothing to reduce the risk of cross infection. Residents were being protected from the effects of the current building work e.g. dust curtains at affected doorways.
Marsden House DS0000054060.V272533.R01.S.doc Version 5.1 Page 14 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): EVIDENCE: The above National Minimum Standards were either met or exceeded when the home was last inspected. There were enough staff on duty at the time of this inspection to respond to residents’ needs and an experienced Senior Care Assistant was in charge during the period when the Provider was out of the home. Marsden House DS0000054060.V272533.R01.S.doc Version 5.1 Page 15 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): 35 Residents’ financial interests are safeguarded through clear policies and procedures for staff to follow and detailed records of money held for safekeeping. EVIDENCE: The Provider has been undertaking care management responsibility during the long-term absence of the registered Care Manager since August 2004 and he has almost completed work towards a Registered Manager’s Award. An experienced Deputy Manager and Senior care staff support the Provider. There is a financial policy implemented at the home. Staff are supplied with a second policy and a policy instructing them how to respond to residents wishing to give them money or other gifts. The Provider does not act as agent for any resident although he and his Deputy Manager collect pension money for one resident. Records of these transactions were seen and were being satisfactorily maintained. A sample of
Marsden House DS0000054060.V272533.R01.S.doc Version 5.1 Page 16 records of personal money in safekeeping for residents was checked. Actual money balances were accurate when checked against those shown on the records. Residents, when able, are encouraged to confirm receipt of money by signing records. Examples were seen. This method of recording should also be used when valuables are held e.g. jewellery, and staff should be given clear advice how to describe these items e.g. ‘yellow metal’ or ‘red stone’ is preferable to ‘gold’ or ‘ruby’. This practice avoids the risk of suggesting an item is more valuable than it actually is. There was an example of the Provider’s attention to advising residents so that they received any benefits to which they are entitled. The Provider completed a 2-day course on Fire Risk Assessment in September 2005. This has familiarised him with new fire safety regulations that are soon to be introduced. There is an existing fire risk assessment for the home. The Provider was aware that this will need to be reviewed when the new regulations come into force. Marsden House DS0000054060.V272533.R01.S.doc Version 5.1 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 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 x 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x 3 x x x Marsden House DS0000054060.V272533.R01.S.doc Version 5.1 Page 18 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. 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 35 Good Practice Recommendations Although it may be a rare occurrence when personal valuables are taken into safekeeping there should be a similar system of recording receipt and disposal as already adopted for money deposits. Staff should receive guidance about the most appropriate way to describe items such as jewellery (see main body of report). Marsden House DS0000054060.V272533.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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