CARE HOME ADULTS 18-65
Marshlands Dennes Lane Lydd Kent TN29 9PU Lead Inspector
Lois Tozer Unannounced 31 May 2005 12:30 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 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 Stationary 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 H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Marshlands Address Dennes Lane Lydd Kent TN29 9PU 01797 320088 Telephone number Fax number Email 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 CRH 20 Category(ies) of Learning Disabilities x 20 registration, with number of places Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Residential care for two (2) persons with dates of birth of 3.12.24 and 31.7.35. Date of last inspection 23rd March 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 activly used by the residents with staff support to grow vegtables and keep chickens for egg production. Access to the town of Lydd is possible by foot, approximatly 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 and is managed on a day-to-day basis by Ms Claire Levy, who is awaiting an interview for registration. The home is registered to provide care and support to a maximum of 20 service users, however this number entails the use of double bedrooms, therefore the number of residents currently supported is 15. 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 with staff support.
Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place between 12.30pm and 5.30pm on 31st May 2005. Two inspectors, Lois Tozer and Alex Turner, conducted the visit and were pleased to be welcomed to the home by the manager and staff and introduced to all residents that were around the communal areas of the home. There were 15 residents living at the home, and the inspector had a chance to speak with 11. One resident helped the inspector, with staff support, view the communal areas and meet the resident and staff group. All residents either indicated or verbally confirmed that they liked living at Marshlands. A newer resident said that the home was lovely and they enjoyed being there. There were lots of activities taking place during the inspection, both in the gardens and activity areas and organised trips out to the beach. The atmosphere was happy and buoyant, staff and residents were getting on well with each other. During the inspection the following items were checked; residents activities and lifestyle, medication management, communal environment and one residents bedroom (with their permission, the remaining bedrooms to be seen during the announced inspection), care plan and reviews – focusing on one plan at this time, residents finance records and general health and safety matters. Some information in this report has been gathered prior to the inspection in correspondence with the manager. What the service does well: What has improved since the last inspection?
This was the first visit to the home for this inspector, and it seems that the manager has continued to work to improve the quality of life for all residents at the home. A bathroom has been decorated to make it inviting and pleasant. Residents have chosen what plants to grow, the conservatory being full of tomato and other bedding plants. Care and goal plans are reviewed each month by the key worker and daily records of events participated in by the
Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 Page 6 residents are kept. Staff have had Makaton training and are using this with residents. 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 H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 4 Assessment takes place for all prospective residents to ensure that the home can meet their needs and aspirations. Prospective residents are supported to visit the home prior to moving in. EVIDENCE: Previous correspondence has demonstrated that prospective residents have been offered a chance to have their needs fully assessed and risk assessments drawn up and understood by staff before they move in. Depending on the individual, a series of visits is organised to help the everyone get to know each other. A resident told the inspector that they were really pleased with their new home, liked the staff and the other residents and were enjoying the activities. There is a trial period for all new residents to make sure the initial assessment was correct, the placement becomes permanent after a 3 month period. Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9, 10 An individual planning system is in place and although it is full of information, it is hard to use as a practical, working and informative document. It would be beneficial if the management team periodically reviewed the key workers reviews. Goals are in place, but it is not clear if the individual has chosen these. Residents are encouraged to be involved in the running of the home. Risks are assessed to provide safe, enabling opportunities. Most information is stored well, but some improvements are required. EVIDENCE: The plan seen had lots of valuable, essential information, but was hard to use due to the size of the document and the often-repeated information. It is strongly recommended that the paperwork be reviewed and condensed to provide a more user-friendly system. Key workers are fully involved in the reviewing of individual care and support plans as well as goal plans. Goals are of a domestic nature, with no evidence that the individuals have chosen that goal themselves. This is recognised by the manager who is organising training and input in person centred planning to address this shortfall. Some of the goal reviews indicated that a certain stage had been achieved, but the plan itself had not been reviewed. This could be overcome by the management team reviewing the key worker input, for example, 3 monthly, and supporting
Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 Page 10 the key worker and resident to make the amendments to the goal support. Residents advised that they do their own laundry and ironing with staff help. Although the kitchen is generally kept locked when staff are absent, there is an area in the day service room for individuals to make hot drinks for themselves. Daily records and working care plans are in an accessible place for staff to refer to, but this area is not kept locked when not in use. This compromises confidentiality, so a requirement to lock this area is required. Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 11, 13, 14, 15, 17, Personal development is encouraged, with opportunities being provided. All residents are offered opportunities to access the wider community, but a review of the amount of group outings is recommended. Leisure activities are plentiful, with many opportunities available in the home. Family and friends are welcome to visit, subject to resident’s wishes. There is a varied and healthy range of food available each day. EVIDENCE: Residents are actively encouraged to take responsibility for their own personal washing and ironing, several residents confirmed that they enjoyed this and felt proud about being able to do this for themselves. Residents said that they get out to places like the cinema, beach, discos, and clubs regularly and enjoyed them. Records kept by the home recorded when these were attended, but did not indicate what positive alternative was offered if an activity was declined. Frequent opportunities to spend leisure time in recreational pursuits such as beach walking and walking in the local countryside takes place. There is a wide range of leisure opportunities available in the home too, with a large, detached day centre room with a table tennis table, arts and crafts facilities,
Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 Page 12 and mini kitchen. Some residents keep pets in hutches in the garden and there are gardening opportunities for those who enjoy this. Friends and relations are welcomed to the home, the individual plan holding records of visits and contact with people who are important to the individual residents. Support is offered to enable residents to maintain family links and spend time away from the home, if this is what the individual resident wishes. All residents agreed that the food at the home was tasty and good, the kitchen and larder was stocked up with fresh foods and a cook is employed 6 days a week; some residents are enabled to assist with meal preparation. Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 19, 20 Physical and emotional needs are monitored and supported appropriately. Medication management and practice is unsafe and requires improvement. EVIDENCE: Records showed that individual residents were supported to access the healthcare services they required. Documentation was clear and indicated outcomes, with written instructions obtained where this involved any changes to medication. Observation of staff administering medication to residents appeared safe, the home uses two staff members when this is carried out, one to observe the process. The location of medication storage was not satisfactory and the management of medication was found to have some serious shortfalls. Storage is currently in an under stair cupboard that is dark, dirty and contains plastic bags of dressings that are piled on the floor. Access into the cupboard requires kneeling and several non-medication items were found, as well as a full sharps container within a metal tin. Daily medication is stored in a trolley, also dirty, and is overstocked. The keys to the trolley were kept in the cupboard itself and access to the cupboard was via a number pad lock. Two dosette boxes were found containing non-descript tablets, that turned out to be medication not required during an authorised change of dose. A retuned medication book is in place, however was not being used efficiently, and was being returned to the pharmacy with the medication, the home were therefore
Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 Page 14 without their records for a substantial time period. Medication administration records were in place and were being signed according to the instructions; however, printed instructions had been altered mid-cycle. Handwritten entries had not been countersigned for accuracy (a previous requirement). Medication is being secondarily dispensed into dosette boxes by staff when it leaves the home. Requirements made are in reference to the Royal Pharmaceutical Society of Great Britain guidelines, a copy was seen at the home. Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 Page 15 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 standard(s) EVIDENCE: Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 Page 16 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 standard(s) 24, 25, 26, 27, 28, 29, 30 The home is comfortable, homely, and generally safe. Bedrooms are of adequate size. Some furnishing issues were identified as needed. There are sufficient bathing and toilet facilities. There is extensive shared space. Specialist equipment is provided as required. The home is generally clean, but some areas for improvement were identified. EVIDENCE: The communal facilities offer a wide range of choice for residents to be together, in small groups or alone. The furnishing is bright, cheerful and in good condition. Environmental safety issues identified (for standard 42) were a fire door held open with a chair and an unsuitable receptacle as an ashtray. Under stair storage areas seen were not being kept clean and were dirty and cluttered. An individuals walking aid was stored within one, which requires relocation to a place where the individual could access it if needed. One room seen was decorated to the individuals taste, but some items were absent (bedside light). The carpet was quite grubby, when asked quite generally about these issues, the resident expressed a wish to have the carpet cleaned and a lamp installed.
Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 Page 17 There are 5 toilets, 3 shower rooms and 1 bathroom for communal use. The bathroom contains an additional shower cubicle. There is an additional toilet for staff and visitors. The self contained flat has its own bathing and toilet facilities. The bathroom was very attractive with efforts made to make it an inviting place. It appeared that the toilet had been replaced, but the flooring had not been sealed, leaving a gap with the floorboards showing. For infection control purposes, such flooring must be impenetrable; action should be taken quickly before the flooring is damaged. The laundry was clean and tidy, but several resident’s toiletry bags were stored there, as were a stock of a individuals clothes. This is not an appropriate place; a requirement to make better provision has been made, for example, a locked facility within the resident’s bedroom. Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Staff are provided with appropriate training to support residents. EVIDENCE: Makaton training has recently been given to staff; staff said that this has improved the lives of the residents who use this communication. The district nurse has been supporting a resident with diabetes; the manager was pleased to say that 16 staff were to receive this specialist training the following day. Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The home is generally safe and well maintained, but an issue of concern was identified. EVIDENCE: One lounge door leading to the smoking area was held open with a chair, this must be replaced with a suitable closure device. An ashtray designed for the purpose of containing small fires from cigarette butts must also be purchased and implemented as the current use of a biscuit tin lid is unacceptable. Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 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 3 3 3 x Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 2 3 3 2
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 2 3 3 3 2 Standard No 11 12 13 14 15 16 17 2 x 2 3 3 x 3 Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Marshlands Score x 3 1 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 Page 21 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 YA20 Regulation 13 (2; 4) Requirement All handwritten entries on the MAR sheets should be signed, dated and witnessed.(Previous recommendation, now requirement). Identify more suitable placement for medication and clinical item storage. Clean and tidy the medication trolley, do not allow to become overfull. Revise the returns system and make it safe. 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. Returns medication book is the homes record and must remain on the premises. Medication keys must be kept safe on the person in charge of administration duty. Timescale for action 15/06/05 01/08/05 15/06/05 15/06/05 15/06/05 15/06/05 15/06/05 15/06/05 2. YA26 16 (2,c) Confer with all residents to 01/07/05 ensure they have the fittings and furnishings they require arrange supply of item requested - bed side light.
Version 1.30 Page 22 Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc 3. YA30 13 (3) 23 (2,d) 4. YA42 23 (4,c [i]) 17 (1,b) 4 5. 6. YA10 YA1 7. YA43 Clear out and clean the under stair storage areas. Mend the bathroom flooring around W.C. area. Arrange for named resident carpet to be cleaned - review other residents carpets regularly. Make more suitable arrangement for the storage of individuals personal toiletries and clothes. Consult with Fire Officer and fit suitable door closure on lounge door. Implement safe ashtray facility. Individual plans in day to day use to be stored securely when not in use. Add a schedule of accommodation to the Statement of Purpose, submit copy to CSCI. (Previous requirement timescale of 30.04.05 not met). Inform the Commission in writing of the correct details relating to numbers that can be accommodated and correct/relevant conditions of registration (Previous requirement timescale of 30.04.05 not met). 15/07/05 15/06/05 01/07/05 15/07/05 01/08/05 01/07/05 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 Service User and when and where it is not this should be reviewed to aid further development and keep staff focused (previous recommendation). Simplify and make individual plans more user friendly. Limitations on facilities such as access to the kitchen and
H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 Page 23 2. YA7 Marshlands laundry be reviewed to ensure the behaviours of some Service Users are not unnecessarily restricting the choices of others. The restrictions of access should then be recorded on a risk assessment so they can be reviewed regularly (previous recommendation). 3. 4. YA13 YA26 Goals to be chosen / agreed by the individual resident. Group activities be reviewed to offer a positive choice to residents who regularly decline in preference to 1:1 or smaller group activities. Where there is a shortfall of bedroom furniture against the NMS this should be discussed with the Service User and the furniture offered and/or outcomes recorded (previous recommendation). Training should be link to LDAF (previous recommendation). 5. 6. 7. YA35 Marshlands H56-H05 S23599 Marshlands V227688 310505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 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
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