Inspection on 11/04/05 for The Marguerite Centre

This inspection was carried out on 11th April 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Marguerite Centre 12/03/08

The Marguerite Centre 27/09/06

The Marguerite Centre 15/02/06

The Marguerite Centre 20/12/04

The Marguerite Centre 05/04/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE The Marguerite Centre The Royal Bucks Hospital Buckingham Road Aylesbury Buckinghamshire HP19 9AB Lead Inspector Christine Sidwell Unannounced 11th April 2005 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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Marguerite Centre Version 1.10 Page 3 SERVICE INFORMATION Name of service The Marguerite Centre Address The Royal Bucks Hospital, Buckingham Road, Aylesbury, Buckinghamshire, HP19 9AB 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) 01296 436938 01296 399875 Dr J. Clarke Janet Sillitoe Care Home 25 Category(ies) of Old age not falling within any other catgory(OP) registration, with number 20. Physical Disability (PD) 5 of places The Marguerite Centre Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: The home may provide care for physically disabled people over 45 years of age. The home provides respite care. The home provides intermediate care. Date of last inspection 20th December 2005 Brief Description of the Service: The Marguerite Centre is care home with nursing, situated within the Royal Buckinghamshire Hospital. The hospital is close to Aylesbury town centre offering level access to restaurants, a library, a shopping centre, cinema and other local amenities.The Marguerite Centre offers long-term nursing and respite care to people over the age of forty-five, including married couples. There has been a recent change in registration to allow the home to offer intermediate care for up to eight people. The home is on the first floor of the Royal Buckinghamshire Hospital and is on one level, making it wheelchair accessible. Access to the home is via a service lift. There is always a registered nurse on duty supported by healthcare assistants. The Marguerite Centre Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of the home, which took place over a day. A part of the day was spent talking to the manager and staff team and examining records, policies and procedures. The rest of the day was spent talking to residents and observing their care. What the service does well: What has improved since the last inspection? There was only one requirement made at the last inspection, which was that the proprietor sends a monthly quality assurance report to the Commission for Social Care Inspection. This is now in place. The Marguerite Centre Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Marguerite Centre Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Marguerite Centre Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 The arrangements for admission of residents to the home work well providing potential residents with sufficient information and opportunities to see the home before they decide to move. The home has the capability to establish intermediate care services for older peolple who may need short-term rehabilitation following an illness or surgery. There is an effective respite care service enabling older people and their carers to book a respite break. EVIDENCE: New residents are admitted to the home following a full assessment of their needs. Residents who are admitted for respite care also have a full assessment of their needs, which is updated at each admission. Those residents who are supported by the Buckinghamshire Social Services have a care management assessment. A plan of care is agreed with the residents and is updated regularly. The registered nursing input required by each service user is assessed by a registered nurse from the local Primary Care Trust, (PCT). There is a planned respite care programme, which enables respite service users and their carers to plan their breaks. The Marguerite Centre Version 1.10 Page 9 The home has recently been registered to provide eight places for intermediate care and is currently in discussion with the local social care and primary care services as to the funding arrangements for these services. The intention is to provide eight short-term intensive rehabilitation places, using the specialised facilities available in The Royal Buckinghamshire Hospital. The Marguerite Centre Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 8,9and 10 Resident’s healthcare needs are anticipated and met, maximising their health and abilities. The systems for administration of medication are good, with clear and comprehensive arrangements in place to ensure resident’s medication needs are met. Attention is paid to protecting resident’s privacy and dignity. EVIDENCE: Residents were well groomed and attention had been paid to their personal hygiene. An assessment of their risk of developing pressure damage has been undertaken. There were no residents with pressure damage at the time of the inspection and the necessary equipment for the prevention of pressure damage is available. The manager has recently attended a training programme run by the NHS Tissue Viability Nurse and is participating in a programme to introduce common protocols for the prevention and treatment of pressure damage. Individual continence assessments are undertaken and residents have their own prescription for any aids, which they may require. Residents have nutritional assessments on admission and the home is working closely with the gastro-enterology unit of the Stoke Mandeville Hospital to ensure that the needs of residents requiring specialist intervention are met at the home, as far as is possible. Residents may remain registered with their own General The Marguerite Centre Version 1.10 Page 11 Practitioner (GP) if they wish, although most are registered with the local General Practitioner’s surgery. A General Practitioner visits the home on a weekly basis. Residents have access to the full range of NHS services following referral by the General Practitioner. There is a medication policy in place. No residents are self-medicating at present, although there is a policy and risk assessment to cover this if residents wish to maintain their independence and manage their own medication. Medication is not administered covertly. The medication records are completed in line with the guidance of the Royal Pharmaceutical Society. Controlled drugs are stored and checked in line with above guidance. At the time of the inspection a local pharmacist was visiting the home to assess medication practice and to review residents’ medication. Two staff members have undertaken syringe driver workshops in the last two years. Other medication updates for qualified nursing staff have not been undertaken. Residents have their own rooms and are treated with courtesy. Residents were wearing their own clothes, which were in good repair. Not all residents had stockings and some were wearing socks with skirts, which is not appropriate. The residents said that they saw their doctor in their rooms and that all personal and nursing care was given in their rooms. There are no shared rooms. The Marguerite Centre Version 1.10 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,14 and 15 The atmosphere in the home is open and welcoming and residents are helped to maintain their own interests and to maintain contact with their family and friends. Whilst the standard of the food is generally good, the menus would benefit from review by the residents, care team and a dietician to ensure that they meet resident’s nutritional needs and provide variety and interest. EVIDENCE: Residents are able to receive visitors in their own rooms or in the small lounges. The resident’s guide says that visitors are welcome at any time. One resident said that he enjoyed his respite care times at the Marguerite Centre and that he was able to bring his computer to stay in contact with his friends and that his ‘Bridge friends came once a week for their regular Bridge game’. There is an activities organiser who was in the home at the time of the inspection. Residents said that they enjoyed the diversion. The activities organiser works with groups and individuals. She also runs gentle exercise classes. There is a four-week menu plan, although some of the dishes are repeated on a weekly basis. Not all daily menus contained five portions of fruit and vegetables. One general assisstant/hostess has regular contact with the catering staff and is responsible for ensuring that residents receive appropriate meals. A number of staff said that they would like to discuss new menus with The Marguerite Centre Version 1.10 Page 13 the chef and that they would like the pureed foods to be presented in a more attractive manner. A dietician has not reviewed the menus. The manager said that this was in hand. Residents were enjoying their lunch in the dining room. The catering team are able to meet the needs of residents who have special cultural or religious dietary needs. The Marguerite Centre Version 1.10 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home has a satisfactory complaints process and a process for reviewing complaints, which indicates that service users are listened to and their comments are acted upon. There is a Protection of Vulnerable Adults policy in place although not all staff have received training in this, which may put service users at risk. EVIDENCE: There is a complaints policy and records are kept of informal complaints. The manager said that informal complaints were responded to promptly and that the home has not received any formal complaints during the last year. The Social Care Commission has not received any complaints. The clinical governance committee of The Royal Buckinghamshire Hospital would review complaints. There is a Protection of Vulnerable Adults policy in place and the manager has attended training run by Buckinghamshire County Council Social Services. Most, but not all, staff have undertaken abuse awareness training. Criminal Records Bureau and P.O.V.A checks are undertaken for all staff. The home does not manage residents’ own finances on their behalf. This is usually undertaken by the resident themselves or their families. Families may leave a small amount of personal allowance with the home, for safe-keeping, for residents. This is managed on an individual basis and receipts are kept for all expenditure. The home’s policies preclude staff assisting or benefiting from resident’s wills. The Marguerite Centre Version 1.10 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The home comprises a floor of an Victorian hospital building and as such, by virtue of its original design, does not provide a ‘homely’ environment for service users. The management and staff team have done their best to compensate for this and the home is well decorated and maintained, creating a pleasant environment for residents to live in. EVIDENCE: The home is located on the edge of the town centre of Aylesbury. It is on the first floor of the Royal Buckinghamshire Hospital. There is a patio garden at the front and back of the home and residents may sit on the balcony, from which there is a good view of Aylesbury and the surrounding countryside. There is a programme of routine maintenance. The fire service has just inspected the building and found all matters to be satisfactory. There is a CCTV camera, which monitors the outside and the entrance to the home. The home is clean and tidy with no offensive odours. There is a separate laundry, which provides a service for all the facilities within the hospital. There are infection control policies and some staff, but not all, have attended The Marguerite Centre Version 1.10 Page 16 infection control courses and updates. There is a clinical waste disposal policy and clinical waste is disposed of correctly. The Marguerite Centre Version 1.10 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 There are sufficient staff with the necessary knowledge, skills and experience to meet resident’s needs. EVIDENCE: In addition to the manager and the deputy manager there are six registered general nurses on day duty and two on night duty. The manager aims for a shift pattern of two registered nurses and five healthcare assistants during the morning, two qualified nurses and three healthcare assistants in the afternoon and evening and one qualified nurse and healthcare assistant at night. Staff providing personal care are not under 18 and nobody under the age of 21 is left in charge of the home. Residents spoken to say that the staff were kind and caring and that their needs were attended to promptly. There is an active training programme and the study days that staff had attended in the previous year were relevant to the needs of the residents. Staff said that they had had an induction programme and had had mandatory annual training updates. The Marguerite Centre Version 1.10 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Overall the home has an effective Health and Safety system in place, which protects service users. An increase in the number of staff trained in first aid would improve the safety of residents and visitors. EVIDENCE: There is a health and safety policy in place. There are fire safety policies in place and the staff spoken to understand the fire zoning procedures and the evacuation procedures. Buckinghamshire Fire Safety inspected the home in April 2004 and found all matters to be satisfactory. There is a first aid box. There are two qualified first aiders employed on the staff of the hospital. There is a registered doctor on call at all times. Although the doctor and qualified nursing staff may attend if first aid is required there is not a qualified first aider on duty at all times. Annual maintenance records were complete. The radiators were covered. The water temperature at four water outlets was measured and found to be at the recommended temperature. There is an accident book and accidents are recorded. The staff spoken to understood the The Marguerite Centre Version 1.10 Page 19 requirements of the RIDDOR reporting regulations. The kitchen was clean and tidy. Staff have had food handling training. The temperature of food at the point of serving is recorded. Refrigerator temperatures are recorded regularly, although one was found not to be operating at the required temperature. The Marguerite Centre Version 1.10 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 x 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 2 The Marguerite Centre Version 1.10 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 38 Regulation 13(4) Requirement Timescale for action 30.09.05 2. 38 13 Sufficient staff must hold an up to date first aid certificate to ensure that there is a qualified first aider on duty at all times The kitchen refrigerator must run 31.05.05 at the recommended temperatures. 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 10 Good Practice Recommendations Residents should not wear socks with skirts unless they choose to do so. Stockings or overknee stockings should be available. The Marguerite Centre Version 1.10 Page 22 Commission for Social Care Inspection 8 Bell Business Park Smeaton Close Aylesbury Buckinghamshire HP19 8JR 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 The Marguerite Centre Version 1.10 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. 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