CARE HOME ADULTS 18-65
The Mariners 15 High Street Rye East Sussex TN31 6JF Lead Inspector
Jason Denny Unannounced Inspection 15th November 2005 12:50 The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Mariners Address 15 High Street Rye East Sussex TN31 6JF 01797 223480 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) Canterbury Oast Trust Mrs Frances Swain Care Home 10 Category(ies) of Learning disability (10) registration, with number of places The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The maximum number of residents to be accommodated is ten People will be over eighteen and under sixty five years of age on admission Only service users with a learning disability may be accommodated Date of last inspection 2nd June 2005 Brief Description of the Service: The Mariners provides residential and social care for up to 10 adults with learning disabilities. The home is in a Grade 2 listed building, which fronts onto the High Street in Rye. Service users accommodation is on four floors. Most of the private rooms have en suite facilities. Other rooms have bathrooms and toilets close by. The overall property includes a restaurant, which is open to the public and provides supervised work experience opportunities for the service users of this and other homes, owned by The Canterbury Oats Trust. A large lawned garden and newly fitted decking area to the rear is accessed via patio doors from the basement level kitchen/diner, or from a side exit that leads out into the shopping area of the town. Last year, extensive refurbishment and building works were carried out at the home to comply with fire safety standards. During this period a dedicated laundry room was created and a new modern lounge developed. The location of the home benefits from being a 5 minute walk to a Mainline train and bus station. The nearby high street provides an ample range of shopping facilities for residents [service users]. The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an Unannounced routine inspection [second of two planned before April 1st 2006], which took place between 12.50pm and 4.50pm. The Inspection found that of the 11 National Minimum Standards inspected, that all 11 were met, with one exceeded. The focus of the inspection was on following up on the previous more detailed inspection of June 2, 2006 of which this report should be read in conjunction with. The inspector spoke with 6 of the 10 residents [2 in detail] and looked at the care records of 2 residents. The inspector had an extended discussion with the manager. A record of complaints was inspected along with medication, routines and some other paperwork, such as the home’s guide minutes of meetings, and staff supervisions. 9 of the 10 service users completed the Commission’s comment cards prior to inspection with most responses being very positive, and some mainly so. Positive feedback was also received from social services and relatives completing the comment cards What the service does well:
One resident stated, “I like the home very much” a view which continues to be shared by other residents. The home was again found to all things well. Both existing and prospective new residents [service users] are given excellent information on the home and related services, in a very user-friendly way such as in the use of photographs. Medication arrangements are good with Health needs promptly met and carefully monitored. Staff receive effective supervision support to help them do their jobs. Regular meetings are held with staff and with residents. Residents are regularly consulted about their views with this recorded and where possible acted upon. A pleasant, warm and comfortable atmosphere was evident during the visit. All residents have clear routines based on choice and were confident about approaching staff and stating their views. All residents were found to have active and fulfilling lifestyles and freely came and went from the home throughout the inspection. New residents are only admitted to the home after all information is gathered and only after the person has visited the home several times to test things out. Other resident’s view on anyone new is sought. The group of people in the home were found to be highly compatible and are encouraged to take sensible risks to improve independence. Staff are clear about how to both identify possible abuse and report it. The home was found to smoothly manage itself based on resident involvement. Standards not assessed here such as food, management, assessment of residents, environment, and activities, were found to be either good or excellent at the last inspection.
The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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 Mariners DS0000021249.V260755.R01.S.doc Version 5.0 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 The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 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 the following standard(s): 1 The home provides both prospective and existing residents with an excellent range of information with careful attention paid to the needs of learning disabled residents. Standards 2 and 4 were fully met at the last inspection. EVIDENCE: The home has a Statement of Purpose. The home has a clear complaints procedure. All information in the home’s Resident [service user] Guide containing the Statement of Purpose was now found to be up to date. The format of the Residents Guide was in both normal print and also in large print with photographs and symbols to assist people with communication needs to follow the information. The guide contained a range of information and photographs of all key staff and managers in the organisation along with pictures of the home and activity venues. The guide also had views of some of residents with helpful photographs next to them to assist identification for prospective new residents. Emergency information such as social services emergency contact numbers was in the guide. Since the last inspection each resident has been given a copy of the guide. A copy of the guide including the most recent Inspection report was found on display in the lounge. The guide and current inspection report is sent to any new prospective new resident. The newest resident when spoken to at the last inspection confirmed this practice. The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 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 the following standard(s): 6&7 Care-Plans were found to contain good information subject to regular review with all relevant people including the resident. Care-plans showed evidence of being put into action and were found to be highly relevant to the needs of the individuals concerned. Residents are supported to make choices where it is in their best interests. Although no obvious need was identified, the benefits of independent advocacy were suggested to the home to reduce potential conflict and give residents another voice. Standard 9 fully met at the last inspection. EVIDENCE: The Inspectors sampled 3 care-plans. The key worker together with the resident carries out care planning. Residents have access to their plans and choose who is to attend their review meetings as confirmed in discussions with residents and the manager. The care plan includes an assessment of all aspects of personal and social support along with healthcare needs. The plans were found to be reviewed monthly and easy to follow. One plan looked at contained a recent annual review report including a meeting with social services. This resident confirmed to the inspector her current goals and the issues, which concern her at present. The manager and records seen also
The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 Page 10 confirmed this. The resident is currently being supported to weigh up her options about whether she wants to move to a smaller, quieter, more independent setting which lacks some of the nearby community facilities she currently enjoys. Comment cards, discussions, records and discussions with the manager and residents, indicated that a couple of residents where challenging advice being given. The advice was found to be sound and backed up by specialist support and social services. Both residents although not fully happy as shown in evidence, understood the reasons for some restrictions and were not requesting independent advocacy even though the name of an advocate is advertised in the home. The manager was advised that making such arrangements could be useful in providing residents with a person that they would perceive as neutral. The absence of independent advocacy was not found to be affecting outcomes. The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 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 the following standard(s): 15 & 16 Residents are well supported to develop relationships outside the home whilst maintaining existing ones. The homes rhythms and routines are clearly based on resident’s choice and their individual needs. Standards 11-13, and 17 fully met at the last inspection. EVIDENCE: Discussions with the manager, residents, and examining records confirmed how residents are supported to build relationships. All residents have a community-based lifestyle, which allows opportunity to develop relationships in both Rye and within the large trust, which provides work opportunities across the region. Some residents work voluntary in local charity shops, and one is a member of a local dance and performing group. Some residents travel a variety of distances on public transport sometimes to see family and friends with the home ensuring that all emergency measures are taken such as working mobile phone’s and appropriate risk assessment. The inspector observed residents coming and going throughout the inspection. Residents confirmed that waking up times is based on their own choice linked to those activities they choose such as work and college placements.
The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 20 The home was found to be meeting resident’s health needs and was fully aware of what additional support it required. The inspector judged that resident’s rights were upheld. Medication arrangements were found to be sound and well-managed involving residents as far as possible, with some self-medicating. Standard 18 was fully met at the last inspection. EVIDENCE: A range of individualised protocols is in place with clear guidance on how to support those residents with varying epilepsy conditions. A number of residents were found to receive a range of support with healthy eating through supporting appointments with weight watchers, dietician advice and well-man clinic, organising appropriate menus along with other health checks. Those residents spoken with confirmed that they were happy with the way staff support them in their health needs. Nighttime needs were found to be closely monitored with emergency procedures in place. One resident has not had seizures since moving in to the home over 2 years ago. The storage and administration of medication was looked with all records kept up to date by trained staff. A resident confirmed how she is able to selfmedicate subject to a careful risk assessment. The reason for medications was explained in records and by the manager with them being subject to regular review involving the G.P.
The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The home and organisation operate in an open inclusive manner and respond appropriately to complaints especially made by residents. Improvements have been made to the level of detail and clarity in the complaint file. This process also shows more involvement by residents with their status fully respected by the home writing to complainants. Complaints continue to be rare with issues promptly dealt with informally. Staff continue to demonstrate a sound understanding on how to prevent and report abuse and continue to benefit from adult protection training. EVIDENCE: The inspector found one entry on the complaint file since the last Inspection, which had not needed to go through a formal process. This involved a resident being confused and embarrassed about the behaviour of another resident. The home promptly dealt with this as seen in records. The manager agreed to record the complainant’s verbal comments to evidence that he was happy with the outcome. The organisation has introduced a standard letter, which goes out to any complainant including residents, which confirms how their concern will be dealt with. A recording form has also been introduced to show how the concern is being dealt with at each stage with all this now stored within an overall complaint file to make access easier. The manager has introduced a “grumbles” book where residents can log minor concerns and get a response as evidenced in the records seen. These concerns tend to concern the behaviour of residents from their peers in relation to anti-social behaviour or performance in routines such as cleaning. All concerns were found to have been resolved.
The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 Page 14 Key workers are trained to respond to service user’s wishes, suggestions, or concerns. All staff have received training in the Protection of Vulnerable Adults. There is policy guidance for staff to adhere to. Staff previously interviewed indicated a sound knowledge of all the issues involved. The home keeps accurate records of all monies, managed on behalf of Residents e.g. pocket money savings and expenditure. Staff do not handle resident’s monies, unless a resident has signed an agreement giving permission to do this. Such records were inspected at the last inspection and where found to be in order. Two staff sign any financial records as observed during this inspection. The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed. Standards 24,26 and 30 were found to be fully met at the last inspection 02/06/05. EVIDENCE: The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 36 The home ensures that at all times residents are supported by sufficient numbers of skilled staff. The home now maintains a clear rota showing the hours and capacity of staff working in the home. Staff are regularly supported and supervised to ensure that they meet needs. EVIDENCE: The duty rota shows staffing levels that reflect the needs and number of residents. The numbers remaining at the home varies according to the daily, off-site activities that Residents are engaged in. The duty rota more clearly show hours worked by each staff member along with their capacity and qualifications, and those by the manager in relation to what hours were management time and which were spent working in the home. Since the last inspection the manager has introduced a useful key section, which helps the reader to understand the written rota. Staffing ratios consist of the same two staff throughout the day, which means that routines are uninterrupted. Another flexible staff person assists during the day with driving residents to activities. Two staff work on a sleep in. These levels are subject to review and found to be suitable for an able group of residents who enjoy as much independence as possible. Written supervisory records were looked at for two staff, which showed that fully detailed supervisions were occurring at least six times yearly.
The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed. Standards 37,38,39 and 42 were found to be fully met at the last inspection 02/06/05. EVIDENCE: The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 Page 18 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 4 X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X 3 X X 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Mariners Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000021249.V260755.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 YA7 Good Practice Recommendations That the home makes arrangements for independent advocacy. The Mariners DS0000021249.V260755.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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