Inspection on 25/06/08 for Marshlands

This inspection was carried out on 25th June 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Marshlands 30/05/06

Marshlands 19/12/05

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 28/09/2008.

CARE HOME ADULTS 18-65 Marshlands Dennes Lane Lydd Kent TN29 9PU Lead Inspector Kim Rogers Unannounced Inspection 25 and 26th June 2008 09:45 th Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 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.V365677.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 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.V365677.R01.S.doc Version 5.2 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) marshlands@craegmoor.co.uk Craegmore.co.uk Park Care Homes (No 2) Ltd Ms Claire Stephanie Levy Care Home 20 Category(ies) of Learning disability (20) registration, with number of places Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th May 2006 Brief Description of the Service: Marshlands is a 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. 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. Service users 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 personal care and support to a maximum of 20 service users, however this number entails the use of double bedrooms, therefore the number of service users currently supported is 19; the Registered Manager stated this is the maximum number of service users 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 8 toilets for communal use. Communal space includes a large lounge, a separate smaller lounge, 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. The fees range from £800.00 to £1500.00 per week. For more information about the fees and services please contact the Provider. Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit formed part of the Key Inspection and was carried out over two days, a total of about 9.75 hours. We spoke to the manager, area manager, staff and service users, individually and as a group. Observations were made including medication administration, the lunchtime meal being served and how staff interact with each other and service users. Records were sampled including care/support plans, medication administration records, staff files, incident reports and some polices/procedures. We had a look around the home and one service user showed us their bedroom. The manager completed the Annual Quality Assurance Assessment (AQAA) that all homes are required to complete every year. This asks for information about the home and services as well as how they have improved and how they intend to improve. The quality rating for this service is 1 star. This means people who use the service experience adequate outcomes. What the service does well: What has improved since the last inspection? The AQAA asks for what has improved in the last 12 months. The AQAA says there are new care plans, there are more people going to college, people now have a health action plan, the complaints policy has been reviewed, four bedrooms have been decorated and more staff have enrolled on National Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 6 Vocational Qualification courses at level 3. The manager has completed the Registered Managers Award. 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. Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 7 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.V365677.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good outcomes. People’s needs would be assessed before they move in so the home knows if they can meet those needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said she would assess a person’s needs before they moved into the home to make sure that the home could meet those needs. The manager said that trial stays could be arranged so people get to know what it is like to live at Marshlands. No new people have moved in since the last inspection. There is some written information about the home including a Statement of Purpose and Service User Guide. This information gives details of the facilities and services on offer. Some information is produced in Makaton (symbols) format with words. The AQAA says they could be better at having information in picture format and they plan to do this. Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 People who use the service experience adequate outcomes. People cannot be sure their needs and personal goals will be recorded and supported by staff. People may be restricted from taking risks as part of an independent life so opportunities may be limited. Communication could be better supported giving people more choice and control over their lives and a bigger say. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person has a service user plan or care plan in an individual file in the staff office. Three service user plans were sampled. All are produced in the same written format; one had been signed by the service user. We found that people’s needs are recorded, however, there is not always a plan detailing what staff should do to support the need. For example one plan said ‘when I get angry I rip my clothes and break things’- ‘Specific care plan Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 10 needed NO’. Another said ‘I get anxious when left on my own’- ‘Specific care plan needed NO’ Staff told us about some people’s needs that were not recorded in the service user plan. This means that there is no written agreed record of what staff should do to support a person’s needs so the person may get inconsistent support. Staff may not know what support is right for the person if not recorded and regularly evaluated with the person. Some personal goals are recorded for example ‘I like gardening and I want to go to the farm again’ ‘Specific care plan needed No, Risk assessment needed NO’ Service users told us about their personal goals for the future, but some are not recorded. Again with no plan in place people may not achieve their goals. We found some risk assessments in service user plans. Some people are open to potential risks that have not been recorded and assessed. For example someone with a specific health need likes to take a bath, which has risks attached. The care plan said in relation to bathing ‘No risk assessment needed’ and there was none in place. Due to the potential risks to health and safety a requirement was made to address this. Risk assessments need more focus on enabling people rather than restricting them through a solid risk assessment framework as this could limit opportunities. For example an assessment to see if people can take any control of their medication requires that service users ‘are aware of potential side effects of medication, are able to indicate the route of medication and are able to state times specific medication should be taken’ This criteria is not achievable for most people who live at the home which means they may never have the right support to take some control of their medication. Staff and the manager spoke about everyday things being ‘too dangerous’ for people, as reasons why some ordinary life, developmental activities had not been assessed and planned for. This could limit developmental opportunities. We found that the manager or deputy sign and date a review sheet in service users plans on a monthly basis. We found little evidence that service users are involved in this review process which means that may not have a say about their support and changing needs and goals. Some people have special communication needs. One service user plan dated 26/10/07 said ‘I can say a few words and use a communication board with pictures’. The communication board was in the staff office. The Deputy manager said staff do not use the communication board but use the pictures. We found that communication could be better supported giving people more choices and control over their lives. For example, the environment does not support communication as well as it could, so people do not know who’ll be on Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 11 duty, what activities are on offer, what’s for dinner and what the meal choices are so they cannot make choices in advance. Staff said service users are told verbally when they ask. We found little evidence that service users are supported with decision-making processes to make informed choices. Some limitations and restrictions on facilities and services have been made without assessment and consultation with people. For example two service users said they are not allowed in the kitchen but there was no assessments to support this decision. The development of person centred plans will give people more of a say and help to demonstrate who would like to do what. It will then be clear if individuals would like to become more involved in running the home and how staff are to support this to the maximum level. Both the manager and area manager said they recognise that plans could be improved. The AQAA says they have improved by introducing new care plans, what could be better is blank with plans to improve says ‘audit review and evaluate’ Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 People who use the service experience adequate outcomes. People have opportunities to take part in a range of activities. Opportunities for personal development are limited. Service users could be more involved in planning and preparing meals and in the day to day running of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found that service users have opportunities to attend a range of activities at a nearby day service. People said they like to go to Bingo there and enjoy the discos when a service user is the DJ. Some people said they go to the local shops and to church. There is a vegetable patch in the garden that service user have been involved in planting up. Some people have a weekly activity planner and some do not. Staff said for the people who do not have a planner they offer activities, but they are not planned in advance. This means some people do not get the chance to choose from a variety of activities in advance. Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 13 We found that opportunities for personal development are limited. For example one plan said that the person’s ‘understanding of money is poor’ but there is no plan in place to increase the person’s understanding and skills. The manager said that one person needs support to cook as they cannot read cooking directions. The manager said they have not presented the directions in a way the person can understand to increase their independence and skills. No other plans were seen in service user plans sampled to increase skills, engagement or participation. Details of service users’ friends and family are recorded in care plans. We found that service users are supported to keep in touch with their friends and families. Plans to increase relationships, friends and acquaintances are not in place. The home employs a cook who works from 1pm till 6pm. Support workers make lunch and breakfast. Meals are prepared and served from a central kitchen. The manager said that food is ordered and delivered to the home via the internet so service users do not get to experience going to the supermarket regularly for the weekly food shopping. Lunchtime was observed and we saw people being given the time and support they need. There is a four-week written menu displayed on a notice board in the dining room. A written sign says that alternatives can be made if you ask staff. The format for the menu and signs is not user friendly. The manager had told us that some people cannot read, so they may not know in advance what is for dinner etc so won’t know about alternatives and options. A service user was in the kitchen helping the cook during the inspection, another service user was observed washing up the breakfast dishes. We found that some service users are prevented from entering the kitchen; this means that they do not have the opportunity to make their own snacks and drinks. There is a water dispenser but there were no cups available. This means that service users have to ask staff for drinks and snacks. One person said they were hungry between breakfast and lunch. Staff said ‘we usually stick to mealtimes’ and no snack was offered. The manager said she would love to have fruit around the home but could not due to one person’s needs. There is a building in the grounds that has kitchen facilities but this was not open during the inspection. The AQAA says that they could be better at getting more work placements and more varied college placements for people. The plan to improve for the next 12 months is blank. Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People who use the service experience adequate outcomes. Personal care needs are recorded but lack of detail means people may not be supported in the way they prefer. Health needs are generally met but some need risk assessing. There is potential for some people to take more control of their medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found that personal care needs are recorded basically in service user plans. For example one said ‘get me a towel and my toiletries and prompt me’ and ‘help me get in and out of the bath’. Staff told us a lot more detail about a person’s personal care needs but this was not recorded. This means that people may get inconsistent support. One person has a significant health need and likes to take a bath, which poses risks. This could be potentially very serious but has not been risk assessed. There are no en suite bedrooms so people share bathrooms and toilets. Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 15 The manager said that each person has a health action plan. These are kept in the manager’s office and not with service user plans. Health appointments are recorded in service user plans. Each person is registered with a doctor. In the past the home has made referrals for specialist health and psychological support. We found that some people may be in need of this support but no referral has been made. Some health needs are recorded but others are not. For example a person’s sleeping habits present a direct support need but have not been recorded as such and there is no plan to support this need. Although plans showed review by the manager and deputy manager no real change had been made. For example, one person is on a course of antibiotics for an infection but there is no mention of this in the service user plan. This means that staff may not have the information they need to support people’s needs and changing needs effectively. Everyone’s medication is stored in the staff office and staff have the keys. We found that there are no plans to increase service user’s skills and control over their medication. Assessments are carried out to see if people can self medicate but this requires people to be able to read, count, know about side effects, know about routes of administration and know about specific timings of medication. This means that it is unlikely anyone will ever take any sort of control of their medication. There is potential for some people, with the right support, to take some control of their medication following appropriate consultation and assessments. When we discussed the possibility of people taking more control of their medication with staff and the manager they said things like ‘it is too dangerous’ X can’t count and would take too many tablets’ ‘if they had their medication in their rooms we would have to have 15 separate keys.’ Staff gave reasons why people should not have control rather than thinking how people can have more control. Medication administration was observed on the first day of the visit. Service users queued outside the staff office while the door was kept shut. Two staff checked the administration record and one dispensed the medication to a pot, opened the door and administered the medication to the service user in the corridor. Staff then signed the administration record and moved onto the next person. We found that medication administration is not dignified and not done in private. The AQAA says what could be better is blank and they intend to improve in the above areas over the next 12 months by ‘audit, review and evaluate’ Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People who use the service experience adequate outcomes. The complaints procedure comes in text and a symbol and text format. Service users need support to use this. Staff know how to report suspected abuse. Service users are at risk from current behaviour management strategies. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are two types of complaints procedure kept in the hallway, one in text and one supported with Makaton symbols. The way this is presented is not clear or plain, and would be difficult for a person who uses symbols and for those who do not to understand. This means that people may not have the support they need to make complaints and raise issues. There is a Safeguarding Adults policy and procedure. Staff spoken to were aware of who they should report suspected abuse to. Staff attend regular training on safeguarding vulnerable adults. The AQAA says they have improved by reviewing the complaints policy. The ‘What could be better?’ section and the plan to improve over the next 12 months section are blank. We found that some people are subject to restrictive physical intervention. ‘Time out’ and punishment is also used to manage problem behaviour. For example one person has their personal belongings taken away and put in the Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 17 office until the problem behaviour ceases and one person is taken to another room for time out until problem behaviour ceases. Some people said they are ‘banned’ from the kitchen following incidents of problem behaviour. Incident reports and care plans showed this and staff confirmed this practice. Due to the nature of this support and to protect service users human rights and health and safety strict guidelines are laid down in the National Minimum Standards. We found shortfalls to the Standards in that there are no clear agreed guidelines in place for the use of restrictive physical interventions. There is no agreement or consent by service users nor detailed risk assessments to protect service users and staff. Incidents have been reported in writing by staff but not monitored by the manager who said she took full responsibility for not monitoring the incidents. Staff have recorded that they ‘restrained’ service users, ‘assisted a person to another room where they were restrained’ and ‘sat a person in a chair with his arms held’ there is no ‘action taken to prevent further occurrence ‘ recorded. By the second day of the visit the manager wrote some draft guidelines to manage one person’s behaviours. The area manager said in discussions that he felt it was a recording issue. Without proper monitoring and debriefing it is not clear but because of the potential risk to service users we have made a safeguarding vulnerable adults alert was made to adult protection at social services who said they will investigate. Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 People who use the service experience adequate outcomes. The home is generally clean and comfortable but some improvements are needed to enhance people’s lives.. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home was made with the manager. We found that the home is generally clean and well maintained. Some parts need attention for example Venetian blinds to a first floor bedroom window are bent and buckled and may let the light in as they do not close as they should. Staff and the service user said there were no curtains in the room. The manager said that there are no curtains because she disagrees with the pattern the service user has chosen for the curtains. There was an odour to a ground floor corridor on the first day of the inspection. This was addressed by the second day of the visit. Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 19 One bedroom poses a risk to a service user in that there is some broken furniture, an electrical wire near the door pulled from the wall creating a scorch mark and lots of items on the floor posing a trip hazard. The service user had a large scratch on his arm saying they scratched it on a part of upturned furniture in their room. Staff said the service user does this to their room; however staff must ensure people’s health and safety is maintained by giving the right level of planned support. All bedrooms are now for single occupancy, no rooms have en suite facilities so people have to share bathrooms and toilets. Bedrooms are personalised with peoples own things like pictures and posters making it feel like home. The manager said that everyone has a key to their room but no one has a key to the home’s front door. The manager said this was too risky and people would loose them although this is not based on any trial or assessment. Some restrictions are imposed like access to the kitchen without the necessary agreement, assessment and review to see if restrictions are the least restrictive option and are still necessary. There is a large garden to the back of the house that service users can freely access. There is a vegetable plot that service users tend. The AQAA says that the have improved y decorating 4 bedrooms, ‘what could be better?’ is blank and they plan to improve the environment in the next 12 months by ‘review, audit and evaluate’ Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 People who use the service experience adequate outcomes. Staff are trained for the job they do but some work long shifts affecting them and service users. Recruitment checks are thorough protecting service users, however service uses should be involved in recruiting staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff work in 3 teams and work 6 days on then 3 days off. There is currently one full time support worker vacancy; the manager said existing staff are covering this shortfall. One staff said they felt tired, as they had worked extra hours. Three weeks of staff hours were sampled; we found that some staff work 14.5 hour days and some staff have worked 17 hour days. We found that one staff worked 73 hours in a week another worked 60 hours in 5 days. This means that staff may be tired leading to poor support for service users. The manager said she advertises and interviews staff. She said that one service user has helped interview prospective staff in the past. Other service users have not been involved which means that not everyone has a say in who may potentially support them. Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 21 Two staff files were sampled. Both were well organised and to hand and had all of the required information and checks. Training is organised by a training manager who keeps records of staff attendance at training. Mandatory training is organised and staff automatically requested to attend when their updates are due. Some training is organised relating to service users needs including communication and behaviour management. Although staff attend behaviour management training incident reports show that they may not be following the recommended techniques and practices and that their practice is not monitored We observed staff working and we found that most staff support service users respectfully and appropriately. Induction for new staff was sampled and we found that this is in line with the Minimum Standard. Staff said they are allocated to service users and to tasks at the start of their shift, which may mean support and routines are task based rather than person lead. We found that staff have more control than service users, for example staff have control of keys to the front door and kitchen, medication and service user monies. This means that there is a lack of equality between staff and service users. Records showed supervision took place regularly, but staff are not observed as part of the supervision process so their practice is not monitored. The manager said that staff meetings are not held ‘as often as they should be’. The AQAA says that they could be better at getting more staff to complete a National Vocational Qualification. They plan to improve over the next 12 months by ‘review, audit and evaluate. Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42,43 People who use the service experience adequate outcomes. The home is adequately managed. Health and safety could be better protected in the way problem behaviours are managed. A lack of monitoring of practice could place service users at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been no change in management since the last inspection. The manager said she has the qualification required by the Minimum Standard but has no qualification relating to service users specific needs- i.e. learning disabilities. The manager completed the AQAA and some parts asking what could be better at the home were blank. Other parts asking how the home intends to improve Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 23 over the next 12 months said ‘audit, review and evaluate’ and gave no intentions of improvement. This means that the service may not improve for service users. We found that the manager is not open to the idea of giving service users more control for example, she said things like it was too dangerous for some people to do everyday things, ‘that would not work here’ and that some people could not control their medication even though no assessment suitable to service users needs or consultation has been carried out. Without innovative and creative thinking, planning and constant meaningful dialogue with people who use the service, service users may not have the support they need to lead the lives they want. Service users views are sought at monthly service user meeting, some changes have been made based on service user views but these are limited to menu choices, holiday destinations and colour schemes for the home. So support and opportunities for people to affect real change are limited. One service user from the home attends ‘Your Voice ‘ meetings chaired by the area manager. Changes have been made to some homes as a result of these meetings. The company carry out audits of the service. Part of this is monthly audits by the area manager. These visits would be more meaningful and effective with more focus on outcomes for service users. For example incident reports have not been monitored so service users may be at risk of inappropriate restraint. Without effective robust monitoring the manager cannot be sure that the best support is being used. Incident reports showed no action recorded to prevent further occurrence of incidents. There is no record of any debrief and no record of any injury to staff or service users or that medical advice was sought following an incident of restraint. As mentioned staff must comply with the requirements of the Minimum Standard if they use restrictive physical interventions. We gave good practice guidance by the Department of Health ‘Guidance on the use of Restrictive Physical Interventions’ and other guidance to the area manager. The AQAA shows that required health and safety checks of facilities and appliances are carried out. Service users said that staff check the fire alarm and water temperatures regularly. Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 24 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 Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 X 3 X X 2 2 Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 25 No 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 Standard YA6 Regulation 15 Requirement Care plans need to include all peoples’ needs and aspirations. Plans must have a plan for staff to follow that is regularly reviewed with the person to ensure needs and personal goals are supported. To keep people safe all potential risks must be identified and recorded with strategies to reduce these risk recorded. To keep people safe from harm any use of restrictive physical intervention, punishment and time out must be clearly documented with agreement from the service user as detailed in the Minimum Standard. All incidents must be monitored to ensure the right support is being used. Timescale for action 30/09/08 2 YA9 13 31/07/08 3 YA23 12,13 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 26 No. 1. 2 Refer to Standard YA24 Good Practice Recommendations Ensure that people have what they need in their rooms like curtains of their choice. To give people more say consult service users and carry out appropriate assessments. This includes things like medication, money and everyone being involved in recruiting staff. Make sure people have the support they need to access and make their own drinks and snacks. YA7 3 YA17 Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Marshlands DS0000023599.V365677.R01.S.doc Version 5.2 Page 28 - 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. 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