CARE HOMES FOR OLDER PEOPLE
Marsh House Residential Home Ulnes Walton Lane Ulnes Walton Leyland Lancashire PR26 8LT Lead Inspector
Mrs Marie Cordingley Unannounced Inspection 28th November 2007 10:00 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 Residential Home DS0000069764.V351140.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 Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Marsh House Residential Home Address Ulnes Walton Lane Ulnes Walton Leyland Lancashire PR26 8LT 01772 600991 01772 601893 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) Marsh House Care Home Limited Miss Gail Phillips Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability (1) of places Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home only: Code PC, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP (maximum number of places: 33). Physical disability: Code PD (maximum number of places: 1). The maximum number of people who can be accommodated is: 33. Date of last inspection Brief Description of the Service: Marsh House is registered to provide residential care and accommodation for up to 33 people. The home is situated in a rural area close to the towns of Chorley and Leyland. There are 23 single rooms and 5 double, some of which have en-suite facilities. There is a large dining room and a number of communal areas available for residents use as well as well maintained grounds with seating and patio areas. These areas are accessible to people who use a wheelchair and there is also a stair-lift in place. Ample car parking space is provided. The registered manager is Mrs Gail Phillips. At the time of this visit, (28/11/07) the information given to the Commission showed that the fees for care at the home vary from £320.00 to £360.50 per week, with added expenses for newspapers, hairdressing and chiropody. Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of this home included an unannounced site visit. As the visit was unannounced the manager, staff and residents did not know it would be taking place until the inspector arrived. During this visit we spoke with residents, staff and the manager about various aspects of the service. We also looked at a variety of documents including some residents’ care plans and staff personnel files. We carried out a tour of the home viewing both communal and bedroom areas. Throughout this report there is reference to the case tracking exercise that we carried out. This involved us looking very closely at the care provided to selected residents from the point of their admission to the home. Prior to our visit, we wrote to residents, their relatives, staff and visiting professionals such as doctors and social workers, and asked them to take part in a survey about standards of care within the home. We received a number of completed surveys. We also asked the manager of the home to complete a very comprehensive self assessment form. This form covers areas such as how the home is run, qualifications of staff and also asks the manager to identify areas for improvement. What the service does well:
We received a good response to our written survey and over 20 people returned completed questionnaires to us. The majority of people who returned questionnaires to us were very satisfied with the service at Marsh House and some people made very positive comments. These included; ’In my experience this has been a consistently good care home. I have always found staff and the manager pleasant and responsive.’ ’The people here are very kind to me.’ ‘Very well run care home in a friendly environment.’ Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 6 ‘The home provides an excellent service for my mother.’ ‘A pleasant, friendly environment for both residents and staff.’ ‘I would like to say how pleasant the staff are. They deal with every situation with kindness and a smile.’ People who live at the home are provided with a varied and appealing diet. One resident wrote ‘The food is always delicious and there is always plenty to choose from.’ Another told us ‘’They will go out of their way to make sure it suits you.’’ We observed an evening meal and noticed that there were a number of choices of meals offered to residents. The meal time was a relaxed and social occasion which took part in a homely dining room with pleasant table settings. We spoke with a number of carers during our site visit and also asked them to take part in our written survey. We received very positive feedback from all the staff members we consulted. Staff showed a good understanding of their roles and told us that the manager was supportive and approachable. What has improved since the last inspection? What they could do better:
There needs to be a more person centred approach to assessing people’s needs and developing their care plans. This would involve gathering more information about people such as social histories and their personal preferences in relation to daily routines and activities. This would help staff gain a better understanding of individual residents and how best to support them. Care plans should be updated more frequently so that they contain a more current and accurate picture of people’s needs. For example, when a resident’s circumstances change, guidance to carers about the help they need should be reviewed straight away. If a resident needs support around their behaviour, this should be detailed in their care plan so that carers can approach challenging situations confidently and consistently.
Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 7 Residents’ care plans should contain details about the activities they like and their preferences in relation to daily routines such as what time they would like to go to bed. People should be given the chance to go out on trips and take part in community activities on a regular basis. We viewed the home’s general communication book and found that this contained some very personal information about residents. We advised the manager to ensure that this method of recording stop straight away and ensure that in future, personal information about residents is written in their personal files only. All areas of the home should be well maintained and a routine maintenance plan should be implemented to ensure that good standards are kept up. The manager needs to ensure that all parts of the home are kept free from offensive odours at all times. When employing new staff, a full employment history must be obtained. If there are any gaps in a candidate’s employment history, these need to be investigated. At least 50 of carers should hold National Vocational Qualifications in care at level 2 or above. Consideration should be given to holding regular meetings with residents where issues such as activities and menus can be discussed. 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
Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 9 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 Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 10 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. Standard 6 is not applicable to this home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments are routinely carried out but need to be more in depth so that staff can plan people’s care in a person centred manner. EVIDENCE: There is an admissions policy in place and the manager told us that it was routine procedure to carry out a pre-admission assessment of any prospective resident prior to their admission. There were assessments in place for all the people we case tracked and these covered areas of every day life such as mobility, personal care and nutrition. However, assessments were basic and did not contain any information about people’s preferred hobbies, or social histories for example. Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 11 This kind of information is very important as it helps carers plan people’s support in line with their individual wishes. Social histories cover areas such as previous employment and family relationships. Social histories are important as they help carers to recognise and value the uniqueness of each resident and plan their care in a person centred manner. Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ care plans don’t consistently reflect the care they need and don’t contain enough information for staff to provide person centred care. EVIDENCE: We viewed a number of residents’ care plans during our case tracking exercise. We found that the care plans we viewed didn’t always provide an accurate picture of the residents’ care needs. For example, on one occasion when a resident had experienced a change in circumstances, there was no reference to this in their care plan and there were no details about how their care needs had changed. Records of daily care provide evidence that people are supported to access health care when they need it. We also received a completed survey from a GP that regularly visits the home. He told us that he felt carers and the manager
Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 13 had a good understanding of people’s needs and were quick to identify and act on any concerns. We viewed records of accidents that had occurred within the home and found that these were completed to a satisfactory standard. We were also able to confirm that accident records are regularly monitored by the manager and that risk assessments are updated where necessary. There are procedures in place to ensure that residents’ medication is handled safely and administered correctly. All staff who handle residents’ medication have received training in this area. Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 14 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 adequate. This judgement has been made using available evidence including a visit to this service. There are activities available but residents’ hobbies and interests are not detailed in their care plans. People are provided with varied and nutritious meals. EVIDENCE: The home employs a part time staff member whose role is to organise activities for residents. People who responded to our written survey told us that there were activities held within the home on a fairly regular basis. This was also confirmed by records we viewed that listed activities including bingo, quizzes and visiting entertainers such as musicians. However, through talking to residents and staff we found that there had been no trips or outings provided for residents since the home was registered in June 2007. The manager advised us that she plans to address this as soon as possible.
Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 15 None of the residents’ care plans we viewed contained a social history or any details about their hobbies or preferred pastimes. This information is important to help ensure that people’s social needs are met and that daily routines at the home are arranged in line with people’s individual preferences. In our consultations with residents and their relatives we received some very positive comments about the food provided at the home. One resident wrote ‘The food is always delicious and there is always plenty to choose from.’ We viewed a selection of menus which confirmed there is a good variety of meals and choices available at every mealtime. In discussion, we were advised that residents who are unable to make sense of a written menu are told verbally of the meals available each day. One staff member said that she sometimes drew diagrams to help residents recognise names of food. We spoke with the manager and recommended that consideration be given to developing pictorial menus for this purpose. Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 16 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. People are enabled to raise complaints within the home. There are procedures in place to protect people who live at the home from harm. EVIDENCE: The home has written guidance which details how people should go about making a complaint and the process that will be followed if they do. A record of all complaints made, investigation and outcomes is kept in the home and monitored by the manager. We viewed this record and found that there had been two formal complaints made to the home and that these had been dealt with appropriately. There are systems in place to protect residents from abuse (safeguarding procedures). We were advised that all staff are made aware of these procedures at the start of their employment during induction. We spoke to a number of carers who showed a good understanding of safeguarding procedures and were also confident that any concerns they raised would be dealt with promptly by the management team. Marsh House Residential Home DS0000069764.V351140.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 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of accommodation is generally satisfactory but there are areas that need to be updated. EVIDENCE: During our site visit we carried out a tour of the home looking at communal and private accommodation. Marsh House is quite spacious and there are a number of communal areas for people to access including well maintained, secure gardens. Most of the areas we viewed were of a satisfactory standard, however there were some areas that were in need of general improvement. We discussed this
Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 18 with the manager who advised us that plans are in place to commence a programme of refurbishment to update all areas within the home. The home was generally clean but we did notice that some areas were malodorous. This was also commented on by one person who completed a survey for us. This was raised with the manager at the time of our visit who agreed to address the issue without delay. Marsh House Residential Home DS0000069764.V351140.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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Careful procedures are followed to ensure that only suitable people are employed to work at the home. EVIDENCE: We checked the personnel files of a number of staff members. We were able to confirm that no one had been employed without suitable checks being carried out including CRB disclosures and employment references. However, a number of files we viewed did not contain full employment histories. We advised the manager to ensure that all candidates are asked to provide a full employment history and that any gaps are investigated. A number of people who responded to our written survey commented that there had appeared to be a high turnover of staff since the home’s registration in June 2007. This was discussed with the manager who advised us that several staff members had left the home in recent months. However, new staff had been recruited and the manager said she was confident that the new team were working well. Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 20 Staff we spoke to seemed to have a good understanding of their role and said that they felt well supported. Records showed that formal one to one supervision takes place for all staff on a regular basis. Due to changes in the staff team, the number of staff who hold National Vocational Qualifications in care has dropped and the home are now falling short of the national standard of 50 . However, a number of carers are due to begin this training in the near future. Marsh House Residential Home DS0000069764.V351140.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, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home benefits from a competent manager who is committed to making improvements to the service. EVIDENCE: Throughout our inspection the registered manager was helpful, cooperative and appeared keen to implement the recommendations we made. Staff told us that they felt well supported by the manager and the majority of people who responded to our written survey said that she was approachable. Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 22 There are a number of systems in place to help the manager monitor quality at the home. These include regular satisfaction surveys for residents and their relatives. We viewed the results of the last survey the manager had carried out with residents. During this survey some residents had commented that they would like to see more craft based activities. We were able to confirm that the manager had acted upon these requests straight away. The manager has regular contact with residents at the home but does not hold regular meetings with them. We made a recommendation that consideration be given to holding residents’ meetings on a regular basis. The home has a health and safety policy in place which is supported by a number of procedures such as fire safety and infection control. Training records confirm that all staff are provided with training in the mandatory health and safety areas such as moving and handling at the start of their employment. Marsh House Residential Home DS0000069764.V351140.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 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 24 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 (1) Requirement Residents’ care plans must provide a current and accurate account of their needs so that carers know what support they require. Residents must be provided with regular opportunity to engage in local, social and community activities that are in keeping with their individual preferences. All areas of the home must be kept in a good state of repair and reasonably decorated. All parts of the home must be kept free from offensive odours. Full employment histories must be obtained for all candidates and where any gaps exist these must be investigated. Personal written information about residents must not be recorded in general communication books. Timescale for action 31/12/07 2. OP12 16 (m) 31/01/08 3. 4. 5. OP19 OP26 OP29 23 (2) (d) 16 (k) 19 (1) (a) 31/03/08 30/11/07 30/11/07 6. OP10 12(4)(a) 28/11/07 Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 25 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. 5. 6. 7. 8. 9. Refer to Standard OP7 OP7 OP3 OP12 OP15 OP19 OP28 OP33 OP38 Good Practice Recommendations Residents’ care plans should contain information about their individual preferences in relation to daily routines. Individual behaviour support plans should be developed for any resident who has needs in this area. People’s assessments should contain social histories so that staff have a greater understanding of their needs. Residents should be provided with the opportunity to go out on trips or outings. Consideration should be given to developing pictorial menus for the benefit of residents who do not read. A programme of routine maintenance and refurbishment should be developed to ensure all areas of the home are maintained to a good standard. A minimum of 50 of staff should hold National Vocational Qualifications in care at level 2 or above. Regular residents meetings should be held in the home. Risk assessments should be carried out in relation to the securing of windows and doors around the home. Marsh House Residential Home DS0000069764.V351140.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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