Inspection on 20/01/06 for The Martins

This inspection was carried out on 20th January 2006.

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

The inspector 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 Martins 14/01/09

The Martins 23/01/07

The Martins 17/08/05

The Martins 24/02/05

The Martins 01/09/04

The Martins 26/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Martins The Vinefields Bury St Edmunds Suffolk IP33 1YA Lead Inspector Jo Govett Unannounced Inspection 20th January 2006 11:30 X10015.doc Version 1.40 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 Martins DS0000024443.V280079.R01.S.doc Version 5.1 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 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. Martins DS0000024443.V280079.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Martins Address The Vinefields Bury St Edmunds Suffolk IP33 1YA 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) 01284 753467 01284 725807 home.bur@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged Mrs Wendy Tomlinson Care Home 40 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (28) of places Martins DS0000024443.V280079.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th February 2005 Brief Description of the Service: The Martins was rebuilt in l998. The Martins stands in its own well kept grounds, which are frequently used by residents. The main view from the home is towards Bury St. Edmunds town centre. Many rooms look on to the historic Abbey Garden ruins, with the River Lark running between the them and the home. All community facilities are available in the town centre but only the most active of resident would make the trip regularly on foot. The purpose built home is constructed on an incline, therefore it has a lower ground floor, called Lark Close which is home for those residents who have dementia. The Home has 40 single rooms, each with en-suite WC facilities. All rooms have a front door style entrance.Communal areas in the main home comprise a large sitting room and dining room, both of which have entrances onto the veranda and a second lounge on the ground floor. There is an additional sitting room on the first floor equipped with tea making facilities. There is a purpose built hairdressing salon and a small courtyard in the middle of the Home. Lark Close is more compact, designed in a simple ‘L’ shape. It has a kitchen/diner and two lounges for communal space as well as individual bedrooms. It also benefits from a secure sensory garden containing sculptures, seating and scented plants. The home is planning to develop its facilities for dementia care, within the same overall numbers. Martins DS0000024443.V280079.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on the 20 January 2006 and was unannounced. We spoke with staff, residents, Deputy Managers and the Registered Manager, Mrs Wendy Tomlinson. We saw a variety of documentation and looked around all areas of the home. The home provides care for 40 residents; 28 frail elderly and 12 elderly with dementia. The previous inspection had highlighted that care plans, risk assessments, and daily notes require improvement, and the care staff’s ability and confidence to work with these needed to be developed. We looked at the progress of this and completed inspecting the Key Standards. It is therefore recommended that any reader of this report should also see the previous report completed on the 17 August 2005. What the service does well: What has improved since the last inspection? What they could do better: Martins DS0000024443.V280079.R01.S.doc Version 5.1 Page 6 The Registered Manager acknowledged that work needs to continue to improve care records and ensure that all relevant information is included, up to date and accurate. The home needs to review staffing levels at night. This should take account of the layout of the home and the needs of residents as well as considering staff safety. Although residents did not raise any issues about night care, some staff concerns were highlighted about lack of cover when two carers are needed to provide care, and working alone in the dementia unit. 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. Martins DS0000024443.V280079.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Martins DS0000024443.V280079.R01.S.doc Version 5.1 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 the following standard(s): 1, 4 (standard 6 is not applicable). Residents can expect the home to provide accurate information about the service it provides prior to and following their admission. EVIDENCE: Following the previous inspection a new Statement of Purpose was provided to the CSCI. Two new residents spoke about how they had decided to move into The Martins. This involved visiting in person, or a relative visiting and letting them know what the home was like. They said that the information provided by the home was “good” and they were able to speak with the Deputy Managers and Registered Manager “about anything”. One person said that they thought the most important thing was to remain as independent as possible, and the home had lived up to their expectation. Information boards around the home and a “The Martins Magazine” delivered to each resident, give information about events, resident meetings and developments within the home. Martins DS0000024443.V280079.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 7, 9, 10. Resident’s benefit from the home understanding their needs and responding to changes. Development and training needs to continue in order for the home to fully demonstrate that risks are fully assessed, reviewed and recorded appropriately. EVIDENCE: During the previous inspection the Registered Manager advised that staff require care planning training and this had been arranged to take place in September. However during this inspection they confirmed that the timescale had slipped but evidenced that all care workers at The Martins were booked to complete the Care Plan training. Staff confirmed that workshops were underway. The Registered Manager has also introduced a Key Worker system for each resident which they felt should help to keep care plans reviewed and up to date. We looked at two care plans during this visit. There is some good information on outcomes for example a “current assessment” followed by action and progress, with personal goals. However, there were gaps in review; a Waterlow chart had not been completed despite the resident being at a higher risk due to Martins DS0000024443.V280079.R01.S.doc Version 5.1 Page 10 diabetes; records were not signed, rather initialled or carers had written their first name only. The home had introduced new risk assessments for all residents and staff including a generic environmental assessment. A member of staff had attended a three-day course on Risk Assessment and is now in charge of developing and implementing this information. As detailed above, although this included good information and shows a good start, some identified risks had not been assessed. Despite this resident dependencies continue to be closely monitored, and where details were sketchy, staff demonstrated a good awareness of individual needs and how they would meet them. One resident said that carer’s “know what I need help with and I can ask them to do more if I need to”. The National Minimum Standard for Medication was not fully assessed during this visit and we did not check any Medication Administration Records (MAR). However, a previous requirement to ensure medication is stored appropriately had been met. It was noted that where the home was managing medication it was stored appropriately and staff knew why this was important. The Registered Manager confirmed that those people who self medicate have their own lockable storage (seen during the visit) and are monitored to ensure that their ability does not deteriorate. Care planning confirmed this. The Registered Manager also said that following audits of MAR charts that had highlighted two problems, they had developed and introduced the homes own competency assessments for staff, in addition to their mandatory training. We discussed issues around medication being brought into the home, either by residents or their visitors, that staff may not be aware of, and how this could be avoided. Further information on this can be read in section Management and Administration. Staff were observed speaking with and assisting residents. People appeared to be friendly and approachable. Domestic staff were also observed engaging well with residents and visitors. All staff seen were polite and helpful, knocking on doors before entering and asking residents opinions and preferences. Staff and residents commented that the atmosphere in the home was “positive”. Martins DS0000024443.V280079.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 12, 14. Residents can expect the home to empower them to make their own choices and decisions. EVIDENCE: During the visit we were able to talk with several residents one to one, and a group of residents who had been enjoying an afternoon group activity with the homes full time Activities Co-ordinaotor. They were all very happy with the activities in the home and when asked if there was anything else they would like to do agreed that they “wouldn’t have time”. Social activities and events are posted on notice boards throughout the home and also in “The Martin’s Magazine”. Some people said they liked this because they found it difficult to stand to read the notice boards. This way they could “mull over” the events in their own time and decide if they wanted to join in. Examples of events and activities included: Forget-me-nots club Coffee mornings Foot massage Quizzes Crafts Hand waxing Music Bowls Singing Skittles Worship Cooking The residents with dementia are able to join in any of these activities. The Activities Coordinator also does some more specialised activities for those with Martins DS0000024443.V280079.R01.S.doc Version 5.1 Page 12 deteriorating mental health. For example “Sonas” a multi-sensory programme using music, singing, touch, smell and taste to promote interaction and a sense of well being amongst residents. The home had also recently introduced a “Men’s Club”. They had been out to have a meal and drink at a local pub. Some of those who went said that they had enjoyed it and were looking forward to more outings and activities. Residents confirmed that they were able to go out when they wanted. Several people stated said that they regularly walked in the gardens and verandas of the home. Bedrooms are very individual and reflect the interests and lives of residents. During the visit residents walked freely about the home. Some preferred to spend time in their rooms, while others stayed in communal lounges. Staff made suggestions to them, but let them make their own decisions. Prior to a fire alarm test, staff in the dementia unit explained to a resident who was in their room what was about to happen, and asked if they wanted to come to the lounge until it was over. They chose not to, so a staff member stayed nearby for reassurance. Martins DS0000024443.V280079.R01.S.doc Version 5.1 Page 13 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 the following standard(s): These standards were not inspected during this visit. EVIDENCE: Not applicable. Martins DS0000024443.V280079.R01.S.doc Version 5.1 Page 14 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 the following standard(s): These standards were not inspected at this visit. EVIDENCE: Not applicable. Martins DS0000024443.V280079.R01.S.doc Version 5.1 Page 15 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 30. Residents and staff benefit from the homes continuing progress towards improving knowledge through qualifications and training. Some concerns regarding staffing levels at night need to be addressed to ensure that needs are met and staff and residence are not placed at risk. EVIDENCE: The Registered Manager was able to update the CSCI on the level of carers with NVQ qualifications. Five out of thirty care staff have completed an NVQ2 or above and a further twelve were working towards NVQ2 and 3 (2 of these had been completed but the certificates had not been issued). Although the Workforce Training Target is 50 of carers with NVQ2 or above by December 2005 had not been met, the home is on target to meet it this year. The Registered Manager stated that new care workers are now only taken on if they already have or agree to work towards relevant qualifications. They then complete an induction over six months, and within three months they are put forward for NVQ training. A training plan was in place, which includes programmed workshops for Care Planning, as detailed in the section, Health and Personal Care. Staff said that the home supports them with qualifications and fed back that the Registered Manager was “very encouraging”. Staff also confirmed they discuss further training needs at supervision meetings. Martins DS0000024443.V280079.R01.S.doc Version 5.1 Page 16 Some residents worried that some staff work “too hard”. Despite this they said that they felt “safe” at the home. Some staff expressed concern about staffing levels at night and lone working in the dementia unit were needs are higher. Between 21.15 and 07.15 three staff cover the three levels of the home with eight residents on the first floor, twenty on the ground floor and twelve in the dementia unit (one member of staff stays in this area at all times). At some points two carers are required to care for some residents and in addition one carer completes a drug round between 21.30 and 22.30. Residents in the main ground and first floor said that their bells were answered quickly at night and no concerns were raised. Martins DS0000024443.V280079.R01.S.doc Version 5.1 Page 17 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36, 37, 38 Staff and residents benefit from clear leadership from management. Residents can to expect the home to place high importance on the quality of its service. Continued and ongoing efforts to improve the recording and review of information should serve to further improve standards. EVIDENCE: Mrs. Tomlinson has been the manager at The Martins since February 2005. Since then her application to become the Registered Manager has been successful and she is working towards the Registered Managers Award. Residents and staff said that the home had improved since the Registered Manager had been in post. They talked about general improvements to the look of the home saying it had been “smartened up”. One staff member said that the Registered Manager is “behind the staff and people are taking pride in what they do.” Martins DS0000024443.V280079.R01.S.doc Version 5.1 Page 18 Residents said that they thought the home would “do its best” to ensure that they were well looked after. During the inspection several examples of the home changing their approach to meet the needs of residents were seen. For example a resident spoke about their changing needs and how the home had helped them to realise what they “can do”, instead of focussing on what they found difficult. The Registered Manager acknowledges that there is still some way to go to ensure that care records are accurate and complete, but evidence highlighted in sections Health and Personal Care and Staffing show that action is being taken to address the shortfall. Staff records show that supervision is taking place. Staff confirmed that they attend every “two or three months”, and discuss their job role, any training issues, concerns and general home issues. Two sets of eye drops were found stored in a communal fridge. It was discovered that they had been stored there without the knowledge of the home and had been brought in independently. The Registered Manager said that the home must ensure that residents can tell them about private appointments or changes to their health, without feeling that the home is too controlling and interfering with their independence. However, they were also concerned that any prescribed medication must be stored and administered correctly for the health and welfare of the individual it is prescribed for. Positive action was taken at the home to resolve this issue during the visit. In general there were no immediate concerns regarding health and safety, the home was clean and tidy during the inspection. It was fed back to the Registered manager that two emergency cords in bathrooms were tucked behind bins, which may make them inaccessible. Requirements have also been made to check the contents of communal fridges and monitor activity of carers on night duty. Martins DS0000024443.V280079.R01.S.doc Version 5.1 Page 19 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. 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 3 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 2 2 Martins DS0000024443.V280079.R01.S.doc Version 5.1 Page 20 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. 1 Standard OP7 Regulation 15 (2) Requirement The home must be able to evidence that care plans and related assessments are kept under review, are appropriate and accurate. Record keeping must be up to date, accurate and be fully signed and dated. The home must ensure that the contents of communal fridges are checked regularly and that they do not contain items that may be harmful. The home must monitor and record activity during night shifts to evidence that staffing levels meet residents needs and staff and/or residents are not unnecessarily placed at risk. Timescale for action 30/04/06 2 3 OP7OP37 OP38 17 13 30/04/06 30/04/06 4 OP28OP38 18 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Martins Refer to Good Practice Recommendations DS0000024443.V280079.R01.S.doc Version 5.1 Page 21 1 Standard OP38OP9 2 OP38OP28 The home should introduce agreements with residents and/or their representatives, to ensure that they disclose any medication or homely remedies brought into the home that are not to be directly managed by the home. The home should ensure that night staff have a risk assessment around lone working. This should include triggers for appropriate action should resident needs increase. 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