Inspection on 24/04/07 for Marsh House

This inspection was carried out on 24th April 2007.

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

Marsh House 24/01/06

Marsh House 18/08/05

Marsh House 28/02/05

Marsh House 24/08/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Marsh House Victoria Road Ulverston Cumbria LA12 0ER Lead Inspector Ray Mowat Unannounced Inspection 24th April 2007 08:00 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 Marsh House DS0000035535.V331631.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. Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marsh House Address Victoria Road Ulverston Cumbria LA12 0ER 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) 01229 894114 01229 894113 david.tyson@cumbriacc.gov.uk www.cumbriacare.org.uk Cumbria Care Mr David Tyson Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 30 service users to include: up to 30 service users in the category of OP (Old age not falling within any other category) The staffing levels in the home must meet the Residential Forum Care Staffing Formula for Older Adults. When single rooms of less than 12 sqm usable floor space become available they must not be used to accommodate wheelchair users, and where existing wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a larger room when one becomes available. Two service users may share a bedroom of at least 16 sqm usable floor space only if they have made a positive choice to do so, and when one of the shared spaces becomes vacant the remaining service user has the opportunity to choose not to share, by moving to a different room if necessary. 24th January 2006 5. Date of last inspection Brief Description of the Service: Marsh House is a care home registered to provide residential accommodation for 30 people over 65 years of age. It is situated in a residential area of the town of Ulverston, Cumbria, within walking distance of the amenities of the town centre. The home is on two floors, the top floor being accessed by one of two passenger lifts or staircases. The ground floor is divided into three distinct living areas: Richmond, Springfield and Victoria that each comprises a lounge and kitchen/dining area. Residents move freely between the three living areas. There are also a number of resident’s bedrooms on the ground floor. The remainder of the bedrooms are on the first floor in addition to communal bathing and toilet facilities. The home has a well kept garden and off road parking facilities to the front and a private, enclosed garden and patio area to the rear. Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 5 The current scale of charges range from £363 to £385 per week (20/03/07), with additional charges for personal sundry expenses such as hairdressing and toiletries. Information about the home is provided in an informative service user guide, which includes the terms and conditions of residence. This information and the previous inspection report are displayed in the entrance hall. Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection visit took place at 8am to enable me to see the morning routines of the home. Before the visit I received a pre-inspection questionnaire from the manager, which provided me with information about the people living in the home, staff working their and the general running of the home. I received six surveys from people living in the home and eight surveys from relatives/advocates, which were sent out before the inspection. I also got feedback from other professionals who work closely with the home. During the visit I spent time talking to residents and looked at the records held by the home that help them to provide a suitable service. I also met individually with three care staff and the manager. What the service does well: What has improved since the last inspection? Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 7 The home is developing more detailed pen pictures of residents, which helps staff to provide a personalised service and gives them a better understanding about the person and what is important to them. A more detailed nutritional assessment is also being introduced, which will be more effective in monitoring and identifying issues relating to diet and nutrition. 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. Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 8 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 Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sound systems in place to ensure people’s needs are assessed and can be met by the home. They are given suitable information before moving in to enable them to make an informed choice. EVIDENCE: The service user guide and statement of purpose were recently reviewed and updated to ensure they reflected changes in the service. These are made available to people considering moving into the home as well as people already living there. The organisation and the home produce an informative brochure, (including the service user guide) which is also being made available on the website. Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 10 I examined three people’s personal files held by the home. These contained a detailed contract of terms and conditions, which was signed by the person or their representative and a senior member of staff. They contained suitable information relating to the persons rights and obligations while staying in the home and the overall care and services covered by the fees. In addition Social Work contracts were also held on file. Before admission to the home a member of the senior team will complete a needs assessment to ensure the home is able to meet the individual needs of the person. This is in addition to a Social Work assessment in most cases. Staff will also liaise with other professionals at this point to ensure they have all the necessary information to make an informed decision. I asked one resident about their experience of moving into the home. They said they were not well enough to visit but a relative had visited the home on their behalf. They went onto say “I knew the home as I lived locally. I have not been here long but everyone has made me really welcome, the staff are so kind to me”. Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 11 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, 10, 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures individual personal and healthcare needs are recorded. Staff have a good knowledge of people’s needs and provide appropriate support in a consistent manner. EVIDENCE: All the people living in the home have a detailed care plan in place, which records all aspects of their health, social and personal care needs. Staff are in the process of developing a personal profile or pen picture for each person. This records a person’s social history, family and relatives, significant events in their lives and things that are important to the person. This information is invaluable to staff in providing a personalised service and gives them a better understanding about the whole person. They are also introducing a more detailed nutritional assessment for everyone in the home to ensure they are well nourished and maintain a healthy diet. Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 12 Care plans are reviewed on a monthly basis and any changes recorded. The manager keeps a matrix to monitor that reviews are taking place within this timescale. They are signed and agreed by the person or their representative and the named carer from the staff team, which is good practice. I looked at four people’s care plan files in detail including one person on respite care. They were all up to date and reflected individual needs. Daily care notes are recorded at the end of each shift by staff to ensure a smooth handover and a continuity of care. Referrals to other agencies were well documented with guidance or strategies to guide staff and ensure a consistent approach recorded. The home’s medication policies and practice are in line with good practice guidance. I sampled medication records and checked these against stocks held, including controlled drugs. These were all up to date and accurately recorded. Medication administration records (MAR) were all signed and up to date. Records of people receiving respite care were held separately. Based on my discussions with a visiting District Nurse and from reading some thank you cards, the home had worked closely with families and other agencies to ensure people were treat with sensitivity and respect at the time of their illness and death. The following quote confirms this “Marsh House is a wonderful home, you enabled mum to maintain her dignity and her integrity to the end”. Marsh House DS0000035535.V331631.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, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The routines of the home encourage and support people to lead a fulfilling and independent lifestyle. People were enjoying a good quality of life. EVIDENCE: An activities coordinator has recently been appointed for three days each week. They are taking a lead role in planning and facilitating activities and events each week. This includes both individual and group activities and entertainment, such as bingo, nail care, reminiscence quiz, relaxation and massage, or for the more energetic bowls, chairobics exercises, Tai Chi and skittles. There are also less formal activities such as a video film afternoon with a glass of sherry, music and a sing-along. People are also encouraged to maintain their own hobbies and interests. One person I spoke to said, “We like to have a chat or a game of cards or bingo”. Over the festive period and also over the Easter holidays professional entertainment had been provided by a pantomime company and a music group, which people had enjoyed. Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 14 At a recent residents’ meeting ideas for trips out had been discussed with staff, who were now trying to arrange some of these for the summer months. Based on my discussions with residents they were enjoying a safe and fulfilling lifestyle in the home. Information about advocacy services and how to make a complaint were displayed on the notice board, which is accessible to residents and visitors. Religious services for different denominations were also advertised on the notice board, which reflected the cultural needs of the people living in the home. When I arrived breakfast was being served to people either in their own rooms or in one of the lounge/dining rooms. There was a relaxed atmosphere and people were doing things at their own pace. A variety of breakfasts were available to meet individual tastes. A notice board in the hallway displayed the menu for the day and the staff on duty. Despite the kitchen being out of commission for two days due to repairs taking place the home had managed to provide suitable meals and alternatives. Marsh House DS0000035535.V331631.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, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home encourages consultation with people and responds positively to any concerns or issues. People feel safe and secure in the home. EVIDENCE: There have been no recorded complaints since the last inspection, however there were several thank you cards that I examined, which confirmed a high level of satisfaction with the service provided. As one person put it, “ Its not just care, its care with love and dignity”. The complaints policy explaining to people how to complain is displayed in the home and is included in information supplied to residents and relatives. There were a number of people in the residents survey completed by the home said they did not know how to complain, however this has been addressed with those people. People who I spoke to said they felt able to raise any concerns and felt they would be dealt with. The home had the new Adult Social Care Mistreatment and Abuse procedures, which had been shared with staff. Training has been provided through induction and NVQ. Based on discussions with staff they had a good awareness of what constitutes abuse and how to react. Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 16 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, 20, 22, 23, 24, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Marsh House provides a safe and comfortable living environment that is accessible and meets the needs of the people living there. EVIDENCE: The home has an annual survey that identifies planned repairs and renewals that will maintain a safe and comfortable environment. The carpet in the Springfield lounge is worn in places and although is not a trip hazard is ready for renewal. This has been noted by the manager and is to be replaced in this financial year. The bathing and toilet facilities are accessible and are fitted with suitable aids and adaptations. Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 17 When specific needs are identified referrals are made to other specialist services for assessment to ensure the environment is safe and accessible and independence is promoted. All areas of the home were found to be clean and hygienic, with the lounge/dining rooms providing suitable space where people can relax or enjoy an activity Individual rooms were decorated to people’s taste with many having their own pieces of furniture and belongings around them giving the room a homely feel. Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 18 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, 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home benefits from having a well trained and knowledgeable staff team who are well motivated and receive good support and guidance. Care staff and domestic staff levels have improved. EVIDENCE: The numbers of care staff and kitchen and domestic staff hours have increased since the last inspection. There are five care staff and a supervisor on shift all day and four staff and a supervisor in the evenings. There is also an additional member of staff on a Wednesday to support people to access the hairdresser, which makes it a pleasant social occasion. During this visit there was a relaxed atmosphere with staff providing personal care and attention to people in an unobtrusive manner. Staff have a good knowledge of individual needs and were courteous and respectful as they provided support. This is appreciated by residents as the following comment confirmed, “It’s a lovely place the staff are so kind”. I also spoke to visiting health professionals who said “The staff are very proactive and work closely with us, the standards of care are excellent”. Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 19 I interviewed three staff individually and examined their personnel file and training and development records. These confirmed that the home has good systems in place to ensure staff are appropriately recruited and people living in the home are protected. All staff currently employed in the home had appropriate CRB (Criminal Record Bureau) checks in place. Staff are well trained with the manager actively encouraging and supporting staff with personal development and training. Over 80 of the staff have achieved their NVQ qualifications and there are regular core and specialist training sessions taking place as needs are identified. The manager has an overview of all training provided and the needs of the staff team, which ensures they receive suitable training as required. In addition each staff member also has an individual continuous professional development portfolio to record all aspects of training and personal development. On the day of this visit the local District nursing team were providing a training session for staff in relation to administering eye drops, eardrops and dealing with skin tears. Further training was planned for staff in dealing with palliative care and bereavement and loss, which is good practice. Staff meetings are held at least every two months, which provides staff and management with a good opportunity to share pertinent information, policies and procedures and good practice. The manager also holds regular supervisor meetings to ensure information is shared and a consistent approach maintained. Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 20 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, 33, 35, 36, 37, 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well managed and has good records and systems in place to safeguard people and promote their best interests. EVIDENCE: The home has sound systems in place to support the effective and efficient management of the home. There are clear lines of accountability between the manager and staff, with the manager working closely with the supervisory team to provide support and guidance for them. The home completes an annual “customer satisfaction survey” with residents, relatives and advocates. Based on the feedback from the surveys an action plan is developed to make sure issues are responded to and resolved. As a result of feedback from the last survey an activities coordinator has been appointed and the number of domestic hours has increased. People living in the home felt staff listen to them and are “very kind and helpful”. Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 21 The manager completes a quarterly report for senior management, which is a quality monitoring system that relates to the organisations business plan and enables the manager to measure the home’s progress against key targets. Residents meetings are also held on a regular basis, which provides another opportunity for them to discuss any issues or concerns. Recent subjects discussed included discussions regarding day trips, menu suggestions and activities. The manager supervises the senior team who then supervise the care staff and domestic staff including relief staff on a six to eight week basis. The manager maintains a matrix record of all supervisions to make sure they are taking place in the recommended timescale. Staff spoken to also confirmed they receive regular supervision and that they could raise “issues or concerns at any time I don’t have to wait for supervision”. The policies, procedures and records ensure people are safeguarded and their rights are respected at all times. There were examples of general risk assessments and specific risk assessments that support and encourage independence, whilst keeping people safe. The servicing records for utilities and equipment were all examined and found to be up to date and in order. An internal health and safety audit is also completed on an annual basis in which the manager and staff were commended for the high quality of their records and systems. Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 22 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 3 3 3 4 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 4 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 3 X 3 3 3 3 3 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 4 3 4 Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 23 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. Refer to Standard Good Practice Recommendations Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Marsh House DS0000035535.V331631.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!