Care Home: Marcris House

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What the care home does well Residents are happy living at the home and speak positively about the staff and comments include ` they are kind` and `helpful`. Residents are happy with the food at the home and the group activities offered meet some of their social needs. Residents can be assured that they would be properly assessed before coming into the home to ensure that it would meet their needs and that they would have sufficient information about the home. Complaints and concerns are dealt with properly by the manager and residents are protected by the adult protection procedures and staff training that is in place in place. What has improved since the last inspection? The management team at the home have completed a significant amount of work since our last inspection although there are some items outstanding. Improvements have been made to the care planning system in the home, the administration of medication, the premises, activities, dealing with complaints, staff training recruitment and supervision, records and documentation and the general day to day management of the home. What the care home could do better: Key areas that still require work or further work are the care plans, with special emphasis on risk assessments and ensuring that all the required care plans are in place. Social care plans and the delivery of individual social care to promote, for example, residents independence and the retention of skills and interests. The routine of the day needs review in line with the early morning staffing levels to ensure the routines are resident led and person centered. Staff training still has some shortfalls that needs addressing in oder to have a competent staff team working in the home. The ongoing refurbishment of the home also needs to continue. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Marcris House Coopersale Lane Theydon Bois Essex CM16 7JH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diane Roberts     Date: 2 6 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Marcris House Coopersale Lane Theydon Bois Essex CM16 7JH 01992814276 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Chigwell Homes Limited care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 32. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Marcris house is a large detached house with a purpose built extension that provides accommodation for up to 32 older people and older people with dementia. The house is set in its own large gardens, which are partially accessible to wheelchairs. The house is located just outside Theydon Bois in Essex on the way to Abridge. The home provides 26 single rooms, 20 being en-suite, and 3 double rooms. There is a passenger Care Homes for Older People Page 4 of 30 Over 65 0 32 32 0 0 3 1 2 2 0 0 8 Brief description of the care home lift to the upper floor. There are good public transport links to the home and visitor parking. Information for prospective service users including inspection reports can be obtained via the manager of the home. The weekly fees range from £500.00 £575.00. Additional costs apply for hairdressing, newspapers and chiropody. This information was provided to the CSCI on 7th July 2008. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home over one full day and spent time with the manager, regional manager and the provider. We also met and spoke/interacted with 5 residents and 4 members of the care staff and the chef. Prior to the visit we sent out feedback surveys for residents and staff and we had quite a good response with 7 residents and 6 relatives giving us their comments. We looked at all the key standards in the home and this included the care provided, the medication, the activities and meals service, complaints management, the premises, staffing levels, staffing training, recruitment and supervision and the management of the home as a whole. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their needs will be assessed prior to admission and that they will have sufficient information on which to base a decision. Evidence: The manager has a service user guide and statement of purpose in place. These were seen to be freely available around the home, including in residents rooms. Residents also receive a welcome pack which contains a feedback questionnaire on the admission experience. The manager has yet to receive a completed form back but this is a positive development. The manager reported that a website for the home is just being set up and should be ready for use in the near future. Since our last inspection the service user guide has been updated and has a more pictorial theme but remains very wordy for most of the residents in the home. The manager undertakes the pre-admission assessment of prospective residents. Two recent assessments were reviewed and these were seen to contain sufficient Care Homes for Older People Page 9 of 30 Evidence: information on which to base a decision about the suitability of the home for the resident. Assessments contain some person centered information but were primarily needs led. The assessment was also backed up by referring information from the local authority and also, in one case, an assessment of capacity under the Mental Health Act. New residents were seen to have a generally good care plan in place following admission so that staff could be guided in relation to the care and support needed. Key information from the pre-admission assessment was seen to be used in the new care plan. Whilst residents have key workers in place, new residents were observed not have been assigned a key worker or had their name put on their door, which at the time of admission may be particularly helpful with regard to helping them settle in. New residents were observed to have settled in well and interacted with staff and other residents in the home well. Those residents and relatives, who commented, all said that they had enough information about the home prior to them making any decsions about admission. Care Homes for Older People Page 10 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to have their basic care and health needs met, but shortfalls in some areas mean that positive outcomes could be limited. Evidence: Since the last inspection, a significant amount of work has been completed on the care planning system in the home. Overall care plans were seen to be in place and were more detailed in order to guide staff as to the care and level of support that residents needed. They were also up to date and showed evidence of regular review. Whilst the care plans did contain some good person centered information, more work is needed in this area, as residents preferences were not always evident, for example, with regard to food and personal care. More emphasis is also needed in the plans, on maintaining residents independence and the retention of skills in order to promote self worth. This was evident in some care plans covering personal care but not in others, such as social aims and objectives. Staff do not identify how this aspect of their care would benefit the resident overall. Care plans were seen to be in place that detailed residents behavior and general mental state. Where appropriate these need to be linked to risk assessments, for example, the risk of wandering from the home, Care Homes for Older People Page 11 of 30 Evidence: as these were not always in place. Residents, who commented on surveys, said that thier care needs were either always or usually met and relatives who commented concurred with this. Staff complete daily notes and these primarily showed that personal care was being delivered, residents were toileted and that they had eaten. Staff used such phrases as x was washed, creamed and dressed. This does not evidence or indicate a person centered approach to the care they provide or the promotion of the residents independence. Residents were seen to be better groomed at this visit with more attention being paid to shaving gentleman and residents nails in general. From records, over more than one month however, the visiting chiropodist regularly commented in his records that residents feet needed washing and moisturising. Relatives also commented that my relative has been wearing other peoples clothes and sometimes my relative is unshaven - it would be nice if he was helped every day to shave. Records of staff communications and those within individual residents care plans, show that staff are proactive and timely when dealing with residents health care needs. District nurse referrals are appropriate and there are good records showing communication with hospitals and relatives on health matters. Staff communication records also show that they inform residents families of any notable occurrences and other records show that residents have access to external health care professionals. It was noted that, despite our visit at the end of 2008, it was over two months before the residents in the home started to be weighed regularly. It was also noted at this visit that new residents had not been weighed on admission. We understand that the home shares a set of sit on scales with another home and this, we were told by the manager, can delay weighing. This system needs to be reviewed to ensure a consistent practice in the home. It was also noted that staff were still recording that they could not weigh residents as the residents could not use the stand on scales. Where records showed that residents had been weighed recently, on a regular basis, they were seen to be putting on weight. Residents had a range of risk assessments in place and these had improved since our last visit to the home. Overall they were sufficiently detailed but in some cases, where a risk had been identified, for example, for those at risk of pressure sores or at risk nutritionally, no care plan had been put in place identifying the preventive or proactive measures for staff to take. In one case a resident had been seen by the doctor for a possible pressure sore and no care plan had been put in place. On discussion, the manager was unaware of this matter. Risk assessments were seen to be up to date and reviewed regularly. Whilst residents were seen to have care plans in place for the use of bed rails, actual risk assessments for Care Homes for Older People Page 12 of 30 Evidence: the suitability of their use with each individual resident, do need to be completed. On asking the manager, she identified one resident who can present with challenging behavior. On checking the care plan there was no risk assessment in place to guide staff and no care plan relating to the trigger for the behavior, which was pain. However, it was noted that the team were dealing with the cause of the behavior and the resident was due to see a specialist. The manager, when asked, says that she does not audit the care plans. Medication systems in the home were reviewed and generally found to be in good order. The administration records were clear and tallied with the blister packs holding the tablets. Dates of opening were recorded on liquid medications and boxes, making auditing possible. Records showed that staff check the medications into the home and use the appropriate codes when required, for example if some-one refuses their tablets. The team were not holding any controlled medications for current residents in the home. One resident was noted to be asleep in the dining room after breakfast and their medication had been left unattended in front of them. Another resident, in the same room, was also noted to have medication left with them. Staff did not return to ensure residents had taken the items but had signed to say that the residents had taken them. This is not in line with good practice. The manager said that she has just started to audit the medication systems in the home. The manager has introduced a key worker system since our last visit and residents now had the name and a picture of their key worker up in the room. Staff spoken to demonstrated a good level of knowledge of the individual residents and were aware of their key needs and past social history. On discussion staff outlined the care of some of the residents and included good detailed person centered information, which is good, but this was not detailed in the residents care plans, to ensure it is available to all staff. Care Homes for Older People Page 13 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Outcomes for residents are variable in relation to daily routines, meals and activities in the home Evidence: The routines of the day were observed and discussed with staff in the home. Staff were heard to ask residents whether they wanted to go to the toilet rather than just taking them, which is indicative of an understanding of person centered care and the day staff spoken to identified with residents choices. However, as at the last inspection, night staff records show that the majority of residents are up and washed and dressed before the day staff come on at 8 a.m. Records show that on some days all the residents (18) have been provided with personal care before this time and on one day all the residents were awake at 5 a.m. This is seen to be quite unusual even in a home primarily for people with dementia, who can have more disturbed sleep patterns. The manager has yet to complete a night shift at the home or visit the home early in the mornings. Whilst residents may be awake, it may not always be necessary to get them up and washed and dressed so early and this may disturb other residents earlier than need be. The timing of this routine compared to the number of staff available also brings into question the ability of staff to provide person centered care, promoting residents independence etc. Again, this needs review, alongside the staffing Care Homes for Older People Page 14 of 30 Evidence: levels for early morning should the residents needs dictate. Day care staff spoken to confirmed that there were not many residents left in bed when they came on duty. After breakfast residents were seen to be left in the dining room for lengthy periods of time without care staff in attendance. Residents had been there since breakfast. We arrived at 09.30 and on observation, some were still sitting there, without staff until 10.45 a.m, without any stimulation, drinks etc. Staff spoken to said that residents are left there until they can get back to them. Residents had fallen asleep and one resident was crying and suffering with a runny nose and had no tissues. Residents were further delayed as staff had to go and find missing foot-plates off wheelchairs before they could move them. Social profiles and some life histories have been completed for residents since our last visit and these were seen to be quite detailed, where possible, and gave staff a good outline of the individual. Social care plans were in place and these need more work as staff have yet to appreciate the benefit of social activities to meet residents individual needs rather than just providing entertainment to occupy time during the day. Under assessment of needs on the social care plans, staff were seen to write social aims or x is a social person with a sense of humour - giving no real assessment of need and how social care could benefit the resident. The approach to residents social needs by staff demonstrates a need for further staff training on the care of people with dementia. Care staff spoken to said that they provide the activities that are stated on the programme and that they are all group activities and it is not needs led and one to one time - there is really not a chance to do that but we can chat with them. On discussion, the manager reported that since our last visit the activities programme has improved, with staff being more comfortable providing them and external entertainers are also being brought in. A notice of forthcoming events was displayed but the format was not very user friendly for residents, as the font was small. Consideration should be given to reviewing this. Activities included movement to music, clothing parties, easter bonnets, entertainers, snakes and ladders, reminiscence, cockney show and pie and mash tea, trip to garden centre and theatre trips. The staff do have a small amount of equipment available to them and the manager appreciates the need for purchasing/developing more. It was positive to see that residents were also accessing clubs in the local community. A daily activities programme was also displayed and this was also not seen to be user friendly. These activities were seen to be primarily group orientated with only one session of one to one time. Residents social profiles, compared to their activities records showed that the activities offered were rarely linked to their individual interests, so whilst their group needs may be being met, more work is needed to ensure their individual needs are also met. Where staff do record one to one time, they should record the actual Care Homes for Older People Page 15 of 30 Evidence: activity that has taken place in order to evidence that residents needs are being met. The menus and nutritional records for the home show that choices are available with the meals in the home and this was also observed over the lunchtime period. On discussion with the chef, she was aware of individual residents needs and preferences. Residents wereobserved to be enjoying their lunch and being helped sensitively by staff where needed. Residents who commented said that they either always or usually enjoyed the meals at the home. Residents said there is plenty of food, The food is very reasonable and The food has improved a bit, it seems like there is more choice now. Care staff are now recording the quantities that residents eat but this is not completed consistently so can only give a limited picture should the need for review take place. On observation and from discussion between staff, there is still some staff who do not understand this recording and the manager needs to revisits this with the team. Since we were last at the home a pictorial menu has been completed for use with residents and these were seen displayed around the home. It was noted that a resident, with specialist dietary needs, was coming into the home on the day of the inspection, who had been assessed five days previously. The manager had not informed the chef, who was unsure what the residents condition would need and what specialist items to get in to cater for that person. Drinks were seen to be available in the lounges during the day but not in the dining room where residents had also been sitting. Care Homes for Older People Page 16 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that any concerns would be listened to and acted upon and that as far as possible they would be protected living in the home. Evidence: The manager has a complaints procedure that is included in the Statement of Purpose and Service User Guide. This document gave clear information of what steps would be taken and the timescales for action. The previous inspection identified that tis document was not in a format appropriate for residents living at the home that may be visually impaired. This remained the case at this visit. Relatives who commented said that they knew how to make a formal complaint but responses from residents were mixed with some answering that they did not know the procedure. We looked at the records of complaints held in the home, since our last visit to this service. There were 19 logged complaints. The issues ranged from not enough staff on duty to missing personal items, dirty curtains and lampshades missing. Records showed us that issues had been investigated appropriately and resolved where practicable and all appropriate actions had been taken, including correspondence with the complainant to keep them informed. There have been no complaints directly to us since the previous inspection site visit. Residents we spoke with during this inspection told us they would be confident to raise any concern or worry they may have. One person said If I have anything to say I can Care Homes for Older People Page 17 of 30 Evidence: always go and see the manager. Records showed us that 14 staff members had attended training on safeguarding vulnerable adults since the previous inspection. Only two care staff and one ancillary staff member had yet to attend. On checking recruitment records for staff who started working at the home since out last visit, this showed that the current manager operates a safe and robust recruitment procedure in order to protect the welfare of residents. Care Homes for Older People Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a generally clean, safe and in some areas, well maintained home. Evidence: We toured the home with the manager and viewed all communal areas, bathroom and a number of the bedrooms on both floors. Improvements have been made since our last visits and this included work on the bathrooms, new carpets, redecoration of bedrooms and the dining room and new flooring in the dining room. There are still bedrooms and bathrooms that require redecoration and reflooring and the proprietor assured us that these were steadily being attended to. Some of the bedroom furniture was tired and broken and required replacement, as knobs or draws etc. were broken. The proprietor informed us that new lounge and dining furniture was on order. The manager told us that they have a contract with a maintenance company who staff can call if there are any issue and this also covers maintenance of the garden. However access to the garden is limited for residents. Since out last visit more visually interactive items have been put up on the walls for residents. Overall signage in the home had improved which would help with residents independence. It was noted that the lighting in the upstairs front corridor is still dark and required review to ensure that sufficient lux is available to help prevent falls. The manager said that since our last visit she has purchased new towels and bed linen including pillows and this is ongoing at the moment. Despite to renewing of linen it was noted that pillows especially where in a poor state. Care Homes for Older People Page 19 of 30 Evidence: The manager told us that there was a rota for shampooing carpets in the home and when she tours the home daily any areas with odours identified would be dealt with. We noted several bedrooms that needed attention. Records showed that relatives had also raised odour control as a point of concern. Care Homes for Older People Page 20 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are benefiting from a stable staff team who are steadily being trained to a good level. Evidence: The staffing rota was inspected and these showed that the daytime staffing levels were three carers for daytime shifts and two care staff at night. The rota included some agency staff who were on duty. The manager told us that the staff team were settled now and that they had one new carer being interviewed and that the cook was about the leave. A family member told us the manager and all the care staff are brilliant, no complaints at all and another said the care staff are always happy and helpful. One resident who commented said they are all very helpful. Staffing levels for the early morning require review in order to ensure that if the majority of residents are getting up early then there individual care needs can be met in a person centered way. There were 17 member of staff working at the home including the manager. As at the last visit there were 9 care staff with NVQ level 2 in care and 6 of these also have NVQ level 3. There were two staff working at the home with oversees nursing qualifications and 2 staff currently working towards NVQ levels 3. An up to date training matrix was made available on the day of this visit. This showed us that various training course had been provided for the staff team including dementia, health and safety, fire safety Care Homes for Older People Page 21 of 30 Evidence: and tissue viability. Some shortfalls remained in the basic core training provided for care staff such as first aid, fire safety, infection control and health and safety. The manager said that some staff were due to start a 12 week distance learning course on caring for people with dementia. We looked at recruitment documents for one person recruited by the current manager. These records showed us that the manager operated a robust recruitment procedure to protect residents in the home. The practice could be improved by ensuring that the applicants previous employment dates are fully completed so that any gaps in employment can be discussed at the time of the interview. We also looked the the recruitment records for two established staff and found that whilst these were generally sound, one person did not have a police check (CRB) form in place. The staff member confirmed that one had been completed but it could not be found during our visit. Care Homes for Older People Page 22 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefits from a reasonably well run home that is steadily improving. Evidence: The manager as the home had been in post for 6 months at the time of our visit. She has previously been registered with the Commission and plans to register with regard to Marcris House. The manager is currently working towards NVQ level 4 in management and is an NVQ assessor. At our previous visit there was an air of confusion around the management of this service and a blurring of areas of responsibility meaning that progression in the home was slow or limited. The manager told us that it was a lot clearer now and she had more autonomy. We observed that the management organisation in the home had improved. People we spoke to during tis visit were positive about the management of the service and comments included lots of improvement since we first came here, lots of painting going on and new carpets and curtains in the lounge, the whole home is steadily being refurbished, they look after my relative well and my relative is Care Homes for Older People Page 23 of 30 Evidence: treated with kindness and the carers are friendly. Records show that the manager has met with relatives and residents to discuss the services offered in the home. The manager told us that quality assurance surveys had recently been given to residents, relatives, staff and professionals that visit the home in order to assess the quality of the service that is being provided. Most of the surveys had not been returned at the time of our visit, the manager said that she would collate the results and form an action plan to address any shortfalls. The manager has stared to audit the medication systems in the home and should give consideration to auditing other key areas such as care planning on a regular basis. There were records to show that staff are now receiving formal supervision every two months. The manager told us that she was training her senior cares to undertake supervision with care staff and had also been trying to source training on the subject for staff. Staff spoken to confirmed that they had been having supervision from senior staff. We looked at monies held by the manager on behalf of two people living at the home and on checking these balanced and agreed with the records held. We looked at records relating to the maintenance and safety of equipment and fittings in the home such as the passenger lift and fire safety. These were found to be in good order with any remedial action being taken. Accident records were reviewed and these showed that incidents of residents falling or slipping from the bed were being reported, however we noted that there was no method in place for tracking of incidents or the analysis of any patterns or trends that may indicate an underlying cause. For example, we noted that a number of falls happen in the morning when people were trying to get themselves out of bed. Care Homes for Older People Page 24 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 12 The health and welfare of 14/02/2009 residents must be addressed by the use of appropriate risk assessments, subsequent management and the use of healthcare professionals where appropriate. So that residents can be assured that their health needs are being met and their welfare is paramount. 2 12 12 Ensure that, as far as possible, the routines of the day are led by the needs of the residents. So they receive the care they need in the way that they would like 14/02/2009 3 19 23 All parts of the home used 31/01/2009 for residents must be maintained in a good decorative order and be safe. A prioritised refurbishment plan with timescales must be submitted to the Commission. So that residents live in an environment that meets their needs and does not put them at risk. 4 26 16 All parts of the home must be kept clean and free from 31/01/2009 Care Homes for Older People Page 25 of 30 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action odours. So that residents live in a pleasant and safe environment. 5 30 18 Staff must be trained and competent to undertake the duties and responsibilities that they have. Residents are cared for by an skilled and competent staff team 14/03/2009 Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Residents must have care 14/08/2009 plans in place that outline all their needs and be linked to risk assessments where appropriate. So that residents can be assured that their health needs are being met. 2 9 13 Residents must have their medication administered safely and in line with procedure To ensure residents receive the medication they need and that risk to other residents are reduced. 31/07/2009 3 12 16 Provide person centered individual activities for residents. So they can retain skills, maintain individual interest and have their independence optomised. 31/08/2009 Care Homes for Older People Page 27 of 30 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 27 18 Ensure that there are sufficient staff on duty to meet the individual needs of the residents at all times of the day. So that residents needs can be met in a person centered way. 31/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 1 8 Continue to develop the service user guide so that it is user friendly for the residents group. Review the availability of weighing scales in the home, to ensure that a consistant approach is given to the monitoring of residents weight. Ensure that information available to residents is presented in a user friendly format Ensure that kitchen staff are aware of the specialist dietary needs of residents. Ensure that staff understand how to use the nutritional record. Review the format of the complaints procedure so it is user friendly and ensure that all residents are aware of the procedure. Continue with the refurbishment of the home and give consideration to the replacement of bedroom furniture. Contunue with the ongoing replacement of bedlinen and other soft frunisings. Ensure that all the documentation required on the staff files is available for inspection. Give consideration to auditing the care plans in order to Page 28 of 30 3 4 5 6 12 15 15 16 7 8 9 10 19 19 29 33 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations help improve the care management and delivery in the home 11 38 Audit accidents and incidents regularly to see if any risks to residents can be reduced. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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