Random inspection report
Care homes for older people
Name: Address: Marsh House Residential Home Ulnes Walton Lane Ulnes Walton Leyland Lancashire PR26 8LT one star adequate service 15/12/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Marie Cordingley Date: 3 0 0 4 2 0 0 9 Information about the care home
Name of care home: Address: Marsh House Residential Home Ulnes Walton Lane Ulnes Walton Leyland Lancashire PR26 8LT 01772600991 01772601893 marshhouseres@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Marsh House Care Home Limited care home 33 Number of places (if applicable): Under 65 Over 65 33 old age, not falling within any other category Conditions of registration: 0 The registered person may provide the following category of service only: Care home only - Code PC to service users 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 The maximum number of service users who can be accommodated is: 33 Date of last inspection Brief description of the care home 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
Care Homes for Older People Page 2 of 11 1 5 1 2 2 0 0 8 Brief description of the care home place. Ample car parking space is provided. The registered manager is Mrs Gail Phillips. At the time of this visit, the information given to the Commission showed that the fees for care at the home vary from 346 - 397 pounds per week, with added expenses for newspapers, hairdressing and chiropody. Care Homes for Older People Page 3 of 11 What we found:
The visit was carried out to assess the homes progress in meeting requirements we made following the last key inspection in December, 2008. In addition, we wanted to look into allegations made in an anonymous letter that the home were in breach of a number of care homes regulations. Choice of Home We viewed the homes Service User Guide and found that this had been updated to contain up to date and accurate information. We also noted that the manager had made arrangements to make the guide available in a number of different formats so that more people have access to the information. Health and Personal Care The CQC pharmacist inspector visited on 24th April 2009 to look at the arrangements for handling medication and to see how concerns identified at the previous inspection were being addressed. The visit lasted approximately five hours and involved discussing the handling of medication with senior care staff, examination of medicine records and storage arrangements. At the end of the inspection feedback was given to the manager. Overall, we found that action was being taken to address concerns raised at the previous inspection but there were some weaknesses in the homes arrangements for handling medication that need to be addressed, to help ensure peoples health and wellbeing is best protected. Part of the morning medicines round was observed. We saw that staff left pots of medication with two people to take in their own time. This respects peoples choice and independence. But, it is recommended that this preference is recorded and written consideration is given to potential risks. We saw that administration records were signed when the medicines were prepared and not after they had been taken. This means that if medicines are then not taken, records have to be amended reducing their clarity. We looked at how people were supported when they looked after their own medicines. People were able to take their own medication when they wished to and were able; this promotes their independence. Peoples choice to self-administer medicines was recorded but there could be more written guidance for staff about any support people may need to manage their medicines safely. The home has arrangements in place so that nonprescribed medicines for the treatment of minor ailments can be given. This benefits people at the service as they can receive treatment for conditions such as minor pain without delay and without the need to see the doctor. The manager said staff had completed formal medicines training courses but this did not include night staff. Arrangements need to be made to ensure medicines can be safely administered throughout the night, if requested. Making sure that staff are trained and competent helps to protect people from medication errors. Records showing the administration of medication were generally up-to-date but there
Care Homes for Older People Page 4 of 11 were some areas that could be improved to ensure the completeness and clarity of these records: Most administration records were pre-printed by the pharmacist but where handwritten entries were made these did not always include the full dosage instructions. The entries were not always signed and countersigned. This is recommended to help reduce the risk of errors. When asked, staff were knowledgeable about the use of peoples prescribed creams and medicines given when required. But, there was little written information about this. Having written information about these medicines will help make sure all staff know when and for creams, where they may be needed. It was of concern that arrangements were not made to ensure special medicines instructions such as before food were followed. These instructions need to be followed to help ensure medicines work properly. Records for the receipt and disposal of medication were generally clear and accurate. Records for communication with health care professionals such as doctors were generally clearly made, so changes to peoples medicines could mostly be tracked. But, these were not always followed-up by care staff if later prescriptions still showed the original dose. This needs to be done to confirm changes have been carried out properly. We found that medicines including controlled drugs were stored securely. This helps to ensure that they are not misused or mishandled. But, we saw that one persons medicines were in a dosette box that was not labeled to show what medicines were in it. The persons care plan did not include a list of currently prescribed medication. When staff administer medicines it is important that they know what they are giving, and can check the dose instructions. All medicines should be safely administered from the original pharmacy labeled container. The manager carries out regular medicines stock checks but wider in-house audits (written checks) of medication handling were not completed; this is recommended to help ensure medicines are safely handled and that should any weaknesses arise, they will be identified and quickly addressed. We viewed a selection of care plans and found that they contained a better level of information and increased guidance for carers about individual residents needs. This is a good improvement which helps ensure that people receive their care in line with their personal preferences. We spoke with a number of residents and in general, found that they were satisfied with the way their care was provided. One resident said They are very kind, they do anything I need. When asked about daily routines, all the residents we spoke with said they were able to rise and retire at times of their own choosing and that help was available at whatever time they needed it. We spoke with a number of staff who demonstrated a good understanding of individual residents needs and preferred daily routines. Complaints and Protection All the residents we spoke with knew how to make a complaint and in general, felt that any complaints they did make would be dealt with appropriately. We noted that the homes complaints procedure had been updated since the last
Care Homes for Older People Page 5 of 11 inspection to provide contact details for the manager and registered provider. We spoke with a number of staff members about the homes whistle blowing procedures. People showed a good understanding of the procedures and said that they would not hesitate in reporting any poor practice. In addition, carers told us that they felt they would be supported by management in the event that they did report any concerns. One staff member said Gail (the manager) is very approachable, I know she would deal with anything like that straight away Environment We carried out a tour of the home and found all areas to be warm and comfortable. In general, most areas were clean. However, we did note that one of the lounge areas was quite malodorous. We pointed this out to the manager and have made a requirement in relation to the matter. Staffing During our visit we noted that there appeared to be ample numbers of staff on duty to meet residents needs. Staff went about their duties in a relaxed and unhurried manner and were able to spend time with residents. Staff spoken with felt that staffing levels were adequate at all times. When viewing rotas we were concerned to note that seniors were not always rostered for duty after 8pm in the evening. In discussion, the manager told us that seniors usually stayed on duty after this time but that the rotas didnt reflect this. We made a requirement that rotas provide an accurate record of all shifts worked within the home. The manager confirmed that she would immediately alter seniors shifts to finish at 10pm each night. Management Following our last inspection we made a requirement that monthly visits be carried out by or on behalf of the registered provider. We were able to confirm during this visit that arrangements had been put in place for these to be completed by the newly appointed area manager. We viewed records of mandatory training and found that 8 out of 11 carers had attained certificates in moving and handling. We were also able to confirm that the remaining three carers were due to complete the training. We also noted that 10 carers now hold nationally recognised qualifications in care at level two or above which is a good achievement. In line with a requirement made following the last inspection, we were able to confirm that the homes fire risk assessment was in place and available for all residents, staff and visitors to view. Care Homes for Older People Page 6 of 11 What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 9 13 Medicines must be checked and confirmed on admission to the home to ensure they can be safely administered. 23/06/2009 2 9 13 Arrangements must be made 23/06/2009 to ensure medicines can be safely administered throughout the night to ensure people can always be safely given any medicines they may need. 3 26 23 All parts of the home must be kept clean and free from offensive odour. This is to help ensure that residents are provided with comfortable accommodation 30/06/2009 4 37 17 An accurate record of the duty rota and shifts worked must be maintained in the home. This is so that the manager can effectively monitor 30/06/2009 Care Homes for Older People Page 9 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action staffing levels. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 2 9 9 Handwritten entries should be signed and countersigned to reduce the risk of errors. There should be more written information about how safe self-administration is supported to help ensure people always receive any help they may need. Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - 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!
