Inspection on 19/12/05 for Marshlands

This inspection was carried out on 19th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Marshlands 25/06/08

Marshlands 30/05/06

Marshlands 31/05/05

Marshlands 23/03/05

Marshlands 12/07/04

Marshlands 22/01/04

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

CARE HOME ADULTS 18-65 Marshlands Dennes Lane Lydd Kent TN29 9PU Lead Inspector Lois Tozer Announced Inspection 19th December 2005 09:40 Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 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 Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 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 Adults 18-65. 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. Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Marshlands Address Dennes Lane Lydd Kent TN29 9PU 01797 320088 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) Park Care Homes (No 2) Ltd Care Home 20 Category(ies) of Learning disability (20) registration, with number of places Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th June 2005 Brief Description of the Service: Marshlands is a spacious, detached, Edwardian property set in a rural location on the outskirts of Lydd, on Romney Marsh. The home overlooks farmland and has views across the Marsh. The house is set in its own extensive grounds, which are actively used by the residents with staff support to grow vegetables and keep chickens for egg production. Access to the town of Lydd is possible by foot, approximately a 15 minute walk or very short car journey. Public bus transport is available from the main route through Lydd, however the home has access to several vehicles. The home is owned and operated by Park Care Homes (No2), Ltd (a Craegmoor Healthcare company), and is managed on a day-to-day basis by Ms Claire Levy. The home is registered to provide care and support to a maximum of 20 residents, however this number entails the use of double bedrooms, therefore the number of residents currently supported is 15; the homes statement of purpose states this is the maximum number residents that will be accommodated at any one time. Bedrooms are located on two floors (ground and first) and one resident has a self contained flat. The home has one bathroom, three shower rooms, and 5 toilets for communal use. Communal space includes a large lounge, a separate smaller lounge, a small computer room, and a conservatory, which can be used for smoking, a kitchen, and laundry. Additional recreational space on site is available by way of a detached day service room that has a table tennis table, art and craft facilities and a small kitchen where residents are able to make hot and cold drinks and do their ironing with staff support. Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory announced inspection took place on 19th December 2005 between 09.40am and 5.50pm. Two inspectors visited the home, to enable as much observation of actual practice as possible. The majority of one inspectors time was spent talking to and observing residents enjoying life at the home, while the other inspector looked at the management of documentation. There are currently fifteen people living at the home, and several residents were able to give feedback during the inspection, at lunchtime and throughout the inspection, and when residents were being supported in activities. Observations of staff with the individual in the home indicated that they all got on very well. Residents commented, or indicated (paraphrased) ‘I like it here, the staff are nice’. ‘I have a key worker X, and she is my friend’. ‘We go out shopping, I go to clubs’. ‘I enjoy working in the garden with X’. ‘I get on well with everyone here’. ‘I really like my room, yes, I chose how it looks’. ‘I go out a lot – we all go to pubs and clubs if we want’. ‘Craft is good’. ‘We have a Christmas party coming up’. Much observation of residents with staff indicated that they were happily at ease and found staff easy to approach. Five comment cards were returned, all indicated that they were happy with the overall care provided and some comments received (paraphrased) included; ‘I find the home very good, the staff are always very helpful and supportive’. Marshlands is managed extremely well by Claire Levy. X seems very happy here’. ‘I am sure that if I wanted to make a complaints, or see the inspection report, I would be able to do this without any problems’. ‘X is very happy and relaxed, which must reflect the standard of care’. Paperwork seen included medication and administration documents, training and recruitment records, quality assurance, care, support, goal plans and risk assessments, a person centred plan, induction packages, resident finances and the adult protection policy. A tour of the communal parts of the home and several bedrooms took place. Both inspectors sat in on a shift ‘hand-over’. Staff were happy in their role and said they felt well supported. The home has an easy-going, happy, atmosphere. Residents are free to come and go as they please within the home and grounds, and staffing is sufficient to enable those who need support when outside of the home. Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? The physical environment of the home has improved under the current ownership and continues to develop. Environmental requirements from the last inspection have been met. The individual plans of support and cares have been revised, and several now have ‘person-centred’ plans, that have been developed with the residents full input. The manager aims to have every resident and staff familiar with person-centred plans by the end of 2006. These plans have highlighted individual’s aspirations and wishes in life. The medication storage area has been changed, and is now in a much more suitable, clean area, that is easier for staff to work in. The keys to this area are kept with the shift leader at all times. The statement of purpose clearly states that Marshlands would not offer placements to more than 15 persons. Storage of information has improved, and is in a much more orderly place condition. The induction package now reflects the Sector Skills Council and Learning Disability Award Framework focused learning outcomes. Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 7 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. Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were inspected. EVIDENCE: Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 Some resident plans have improved and the remainder are set for improvement, using the person-centred plan (PCP) approach, by late 2006. Better staff organisation would increase residents decision-making and participation opportunities. Risks are well assessed and responsibly managed. Storage of information has improved, and accuracy is increasing with the PCP review. EVIDENCE: Several residents have benefited from a person-centred plan, that involves the individual and acknowledges their aspirations and personal wishes. The manager aims to have all staff conversant with this system and all residents benefiting from it by the end of 2006. Some recently created records were not dated, which is important for accurate reviewing. Decision-making and participation is reasonably well supported, but is not sufficiently structured to enable residents to have regular opportunity to accept or decline daily living skill activities. During the inspection, staff were not observed offering residents the chance to do chores, before doing the task themselves. Staff were clear that residents had the choice to decline, and said ‘its residents choice’, but systems are not in place that give a convincing picture that consistent opportunity is offered for real choice to be made. Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 11 Residents do have input into the home via 1:1 time with their key workers each month, and some group discussion. Risks have been carefully assessed, and these have action points to help staff give the right support to decrease risk. Many of these have been reviewed recently and have proven effective. The storage of records has improved, and staff are able to easily access individual plans without compromising their security. Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Personal development has come along way, but it and daily routines could be supported better with a more organised and planned shift structure. Education and planned activities are very well supported, as are links to the community. Residents say they have fun and do things they want to do in their leisure time. Menus show a good choice of quality food, often home cooked, but meal times would benefit from a more structured approach. EVIDENCE: Without doubt, residents have benefited from the increased opportunities for personal development and better staffing levels in recent years, making personal routines easier to carry out. However, there is still room for improvement, as in above standards for ‘Individual needs and choices’, residents would benefit from the shift leader planning out time when named residents could be offered involvement in certain tasks on a rotational basis. In discussion, planning was seen as regimenting the home, but this is not the aim. With 15 residents, planning would enable all to have a really active role in running the home. There are many sources of help for creating shift planning and actively supporting people, and its recommended that these be sought and considered. Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 13 Residents were keen to say how much they enjoyed their leisure time, both in and outside of the home. Lots of opportunities to do things individuals enjoy are available and attendance is recorded on individual charts. Staff support residents to see their family and friends both in and outside of the home. Menus and food purchased is of a good quality and is varied. A cook is employed 5 days per week, and all enjoy freshly prepared food. Specialist diets are catered for, and professional input from dieticians is followed. The lunchtime during the visit was rather chaotic, so returning to shift planning, a staff member would benefit from being delegated to sit in the dining room and chat while supporting by observation, and the manner in which lunchtimes are conducted, and food supplied to residents, would benefit from reviewing and improving. Staff being present is required to aid the very real possibility of choking. Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 20 Personal support is well documented, and is given in the way the individual requires it. Medication management has improved, but some requirements were not conveyed to staff, and some practice makes the system unsafe for service users. EVIDENCE: Each individual resident has their personal support requirements assessed and documented, enabling staff to meet their needs. Records indicated that staff actively supports residents to do as much for themselves as possible. The improvements in medication storage are really good, a dedicated cupboard in a safe place has been identified, and the trolley is no longer in general use (although discussion took place on the safe transportation of medication around the home). This area was clean and tidy – a well thought out improvement. The home has a robust policy on medication management, but senior staff were not familiar with this. Some directions on the medication label had been altered, but not authorised by the GP – although this did not change the dose to the resident, it was misleading. The manager must ensure that the training the staff have received is sufficiently in depth for the work carried out and all staff understand the policy and procedures. Recommendations to put in place a homely remedy protocol for each individual and update the initials list with signatures was also made. A medication error took place prior to the inspector Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 15 arriving, and it was really encouraging to see how fast this was reported and action taken to make the situation safe. It is reassuring that a culture of openness and learning is in place and staff feel confident to highlight their errors. Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Residents know how to complain and staff support individuals who have communication difficulties to be heard. Adult protection processes are well understood in the home, staff are aware how to report abusive practice. EVIDENCE: The home has had two complaints in the last 12 months, and has investigated appropriately, demonstrating openness and clarity. Residents are supported to express how they feel, and situations within the home are resolved usually using the key worker system. Care managers are kept informed of any concerns that the home cannot resolve on behalf of a resident. Clear records are maintained. Staff are aware of the adult protection procedure, several staff have received formal training, and the new induction package covers the adult protection module in depth, so future staff will have this knowledge very soon in their career at Marshlands. One adult protection alert has been raised in the last 12 months, concerning the theft of service users money. A full review of the financial procedure has taken place, and a very robust system has now been implemented that should limit the possibility of such occurrence in the future. Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30, 31 The home is comfortable, homely, and generally safe. Bedrooms are of adequate size. There are sufficient bathing and toilet facilities. There is extensive shared space. Specialist equipment is provided as required. The home is clean and hygienic, but homely. EVIDENCE: The communal facilities offer a wide range of choice for residents to be together, in small groups or alone. The furnishing are bright, cheerful and in good condition. Individuals rooms are to their liking, and although the bedside light identified by a resident as needed at the last inspection was not in place, it was on its way. Bathrooms were in good order, and the areas needing improvement had been addressed. Although it is a very large home, it is in good condition and is attractive, with pictures of residents doing activities on walls and lots of puzzles and games available for people to use as they wish. The activities room in the grounds is well used and enjoyed, and provides a level of independence and freedom (drink making) currently unavailable in the house. Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 Residents are protected by the company recruitment policy and procedure, but telephone verification of references would be beneficial and full employment history is essential. The induction package is in depth and supports staff to meet residents needs with a strong understanding of learning disability support requirements. EVIDENCE: The process for recruitment is robust and follows good practice, but some files seen did not contain staff full employment history. The manager advised that gaps are explored at interview, but not documented. Staff references were on file, but these are not followed up to verify if they are genuine, which is recommended. The induction package is in line with the sector skills council and LDAF learning outcomes, and is accredited going towards an NVQ qualification. It has not been used with many staff so far, being a recent introduction, but the one seen was well completed and was said to have been of great help to the staff member. Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 42 A quality assurance process to seek views of family and representatives of residents is in place, but the one aimed at the residents would benefit from review. EVIDENCE: The organisation have a quality assurance process, and this seeks the views of family and representatives. The home have developed a QA questionnaire for service users, but this is, for some, quite complex. A discussion surrounding the use of the person-centred plan took place, as this is a good in-road for people who have communication difficulties in expressing how they feel. Using this clearer system would benefit the process, and aim to get the home ready for ‘Inspecting for Better Lives’, where the onus of inspection will be on the home gathering the service users views and incorporating it into the home’s development plan. Environmental concerns from the previous inspection have been addressed and the pre-inspection questionnaire submitted confirmed that all systems checks and certificates were up to date. Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 2 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score X X X 2 3 X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Marshlands Score 3 X 2 X Standard No 37 38 39 40 41 42 43 Score X X 2 X X 3 X DS0000023599.V261801.R01.S.doc Version 5.0 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA6 YA17 Regulation 17 13 16 13 Requirement Documentation to be dated to enable accurate reviewing. Mealtime support to be safe and respectful and the manner in which food is presented at the table be reviewed and improved. (Previous requirements, timescale 15/6/05 unmet) All handwritten entries on the MAR sheets should be signed, dated and witnessed. (Previous recommendation, now requirement). Cease the practice of secondary dispensing medication. Directions to medication must be safe and robust and not altered mid month on the part completed administration record. Review the medication management training given to staff to ensure that is sufficient to meet the service needs. Implement a process of all staff who have medication administration responsibility to be totally conversant with the policy and procedure. Cease altering medication administration directions – DS0000023599.V261801.R01.S.doc Timescale for action 01/02/06 01/02/06 3 YA20 01/01/06 4 YA20 13 18 01/02/06 Marshlands Version 5.0 Page 22 5 YA34 19 unless the GP has authorised such change. All residents who have ‘as required’ prescription medication have a protocol in place. Obtain staff full work history and keep on file. Follow up any previous employment in the care industry. 01/02/06 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 YA6 Good Practice Recommendations Care plans should contain goals, which are a development opportunity for the Resident (previous recommendation – work is in progress). Simplify and make individual plans more userfriendly (work in progress). Staff shifts to be more organised, to enable all residents to have opportunities for participation in household and domestic tasks. Staff list of initials – would also benefit from signatures, as these are being used. Each resident to have a homely remedy protocol. Photo of each resident on MAR sheet to be in colour and up to date. Review the induction process by September 2006 to reflect the common induction standards www.skillsforcare.org.uk www.arcuk.org.uk www.ldaf.org.uk Verify written references as genuine by telephone, record the outcome. Review quality assurance system aimed at service users to prepare for ‘Inspecting for Better Lives’. 2 3 YA7 YA8 YA11 YA16 YA20 4 YA35 5 6 YA34 YA39 Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 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 Marshlands DS0000023599.V261801.R01.S.doc Version 5.0 Page 24 - 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. 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