Care Home: Marillac

What the care home does well Overall, the Marillac presents as a well-managed service that has clear aims and objectives and systems in place to support these. Information to help people make a decision about living there is offered and they and/or their relatives are involved in planning their support needs and goals, taking into account their abilities and lifestyle preferences. People are seen as valued individuals and encouraged to maintain as much independence as possible. The manager`s AQAA tells us that an improved model of integrated seamless care is being implemented. Surveys from health/social care professionals on what the home does well told us "provide excellent care for its residents.... I feel that the facility is excellent", "a cutting-edge service that other similar organisations should aspire to" and "the Marillac always has a serene, calm and peaceful atmosphere. Whenever I visit I see excellent quality of care". There is a full staff team and effective leadership that work well together and who are committed to providing quality care to the people living in the home. All staff involved in the Marillac are valued, have clear roles and responsibilities and are encouraged to develop and attend training. A healthcare professional survey included the comment "I have been involved on the medical side in the care of residents at the Marillac since 1992 and see year on year the dedication of all the staff to provide the best individualised service for all their residents, their families and the whole community of residents, helpers and families". People living at the home told us they enjoyed the food with comments such as "The food is always cooked to a high standard and tastes like home cooked meals do". The Marillac provides a spacious and well maintained environment that is well equipped to meet the needs of the people living there. One resident when asked what the home did well replied "everything" and added "on a scale of ten, I would award nine and a half" and another said " food, TV, technology, care facilities. My condition and illness make me superstitious but I feel this place is like paradise". Another person told us "the home is a really lovely place. Everybody is kind and helpful and there is a happy and peaceful atmosphere here. I am extremely impressed with the Marillac". A relative, when asked on what the home did well, replied "good care and attention by the care staff and nursing staff, clean and tidy rooms, good food, good gardens and provide parking for cars". What has improved since the last inspection? Assessments and care planning documentation has been reviewed to ensure that there is appropriate information available about the person`s needs and a clear plan produced to show how these are to be met in everyday practice. Additional services achieved for residents include in-house speech and language therapy and pastoral counselling services. Since the last inspection there have been improvements to the premises including refurbished bathrooms with modern hydrotherapy baths and increased therapy equipment. The sensory garden has been developed and completed providing an additional facility for residents and herbs harvested from the garden are used in the kitchen. Improvements have been made to ramps and accessibility of the building and also to car parking facilities. A review of staff training has been undertaken and a training plan developed to ensure staff are provided with opportunities to develop their skills and competencies to meet the needs of the people using the service. Staff have been provided with the opportunity to participate in communication workshops and in-house training to support improved communication across the service. There are increased opportunities for residents and relatives to be involved in and influence the running of the home through the residents/family experience committee. The activity programme for residents has been extended with more opportunities to activities outside the home. Training on driving the minibuses has been offered to relatives and staff so they can make more effective use of the facility and take residents out more frequently. What the care home could do better: The management team must ensure all allegations of abuse are referred to the Safeguarding Adult Team/ Social Care in line with current guidance, protocols and good practice to ensure that residents are safeguarded. The Commission must be notified as required of all events that affect the well-being of a resident. The concerns regarding the management team`s failure to act appropriately in referring alleged abuse under safeguarding procedures have resulted in an Adequate judgement for this outcome group. This in turn has informed the home`s overall rating in line with Key Lines of Regulatory Assessment. In response to the question of what the home could do better, one resident at the home suggested that they could be taken out more and another person "nothing". Key inspection report Care homes for adults (18-65 years) Name: Address: Marillac Eagle Way Brentwood Essex CM13 3BL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Bernadette Little     Date: 2 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Marillac Eagle Way Brentwood Essex CM13 3BL 01277220276 01277221472 eleanorr@marillac.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Daughters of Charity Name of registered manager (if applicable) Wendy Chen Type of registration: Number of places registered: care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is 50 The registered person may provide the following categories of service only: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical Disability - Code PD Date of last inspection Brief description of the care home The Marillac is a care home with nursing for adults who have physical disabilities and is registered with the Care Quality Commission for the continuing care of 50 men and women with varying degrees of physical disabilities. The Home is located near Thorndon Country Park on the outskirts of Brentwood and is set in four acres of grounds. The M25, the A12 and Brentwood railway station are in close proximity. The building has been extended and adapted to provide three purpose built units, to provide a homely atmosphere for the service users and families. Trained nursing staff Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 50 Brief description of the care home and carers are available for the provision of personal and nursing care. Physiotherapists, Occupational Therapists and Therapy Assistants are also employed to provide therapies and treatments. A GP with special interest, a Consultant Physician and Consultant Neurologist attend the home routinely to provide medical care and support for residents/families. Parking is available to the front and rear of the building. The home was first registered in July 2002. The Service User Guide and Statement of Purpose are available and are updated as required. The residents and their representatives are provided with this information and also the latest Commission for Social Care Inspection reports which are available on all units. At the time of this report the manager confirmed that the fees ranged from £1045 to £1295.00 per week. Care Homes for Adults (18-65 years) Page 5 of 33 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service was undertaken on 12th December 2006. Annual Reviews of the service were undertaken in both November 2007 and September 2008 and identified that, based on all the information and evidence available to us, the home continued to provide and excellent service and there was no need to change our inspection plans. This site visit was undertaken over an eight hour period on one day as part of that key inspection. Time was spent with residents, visitors and staff and information gathered from these conversations as well as from observations of daily life and practices at the home have been taken into account in the writing of this report. The manager submitted an Annual Quality Assurance Assessment (AQAA) as required by law prior to the site visit. This provides them with an opportunity to assess how well they are meeting the needs of the people using the service, what has improved and Care Homes for Adults (18-65 years) Page 6 of 33 what they plan to do better. The AQAA contained a good level of information that was considered as part of the inspection process. Prior to the site visit, we sent the manager a variety of surveys to distribute to residents, staff and social/health professionals. Subsequent to the site visit, surveys were received from seven residents, six staff and four professionals. The information provided and comments made are included in this report. A tour of the premises was undertaken and records, policies and procedures were sampled. The manager was present during the site visit and assisted with the inspection process. The outcomes of the site visit were fed back and discussed with the manager and opportunity given for clarification where necessary. The assistance provided by all those involved in this inspection process is appreciated. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? Assessments and care planning documentation has been reviewed to ensure that there is appropriate information available about the persons needs and a clear plan produced to show how these are to be met in everyday practice. Additional services achieved for residents include in-house speech and language therapy and pastoral counselling services. Since the last inspection there have been improvements to the premises including Care Homes for Adults (18-65 years) Page 8 of 33 refurbished bathrooms with modern hydrotherapy baths and increased therapy equipment. The sensory garden has been developed and completed providing an additional facility for residents and herbs harvested from the garden are used in the kitchen. Improvements have been made to ramps and accessibility of the building and also to car parking facilities. A review of staff training has been undertaken and a training plan developed to ensure staff are provided with opportunities to develop their skills and competencies to meet the needs of the people using the service. Staff have been provided with the opportunity to participate in communication workshops and in-house training to support improved communication across the service. There are increased opportunities for residents and relatives to be involved in and influence the running of the home through the residents/family experience committee. The activity programme for residents has been extended with more opportunities to activities outside the home. Training on driving the minibuses has been offered to relatives and staff so they can make more effective use of the facility and take residents out more frequently. 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 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 Adults (18-65 years) Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Prospective residents can expect to have a full assessment of their needs to ensure that these can be met at the Marillac and will have information available to support them in making a decision as to whether the Marillac is the right place for them. Evidence: The Marillac provides a statement of purpose and service user guide that are comprehensive and supported by pictorial format. The manager advises that the statement of purpose or service user guide are not made available to people prior to admission to give them additional information on which to base their decision to live the home, but provides them with a leaflet about the Marillac and advises them to access the website. The website also provides comprehensive information including in relation to services provided, referral and assessment processes and complaints and compliments. The manager was recommended to consider making the service user guide available to prospective residents as part of the assessment process. The statement of purpose clearly identifies that the Marillac provides a range of support packages including respite, rehabilitation, intermediate and continuing care Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: and explains the facilities and services provided to meet these. Evidence at the time of the inspection demonstrates that these are effectively planned and managed. All surveys received from people living at the Marillac confirmed that they had received enough information about the home before they moved in so they could decide if it was the right place for them. Surveys received from four health/social care professionals confirmed that the Marillacs assessment arrangements ensure that accurate information is gathered and that the right service is planned for people. The managers AQAA states that there will be a thorough assessment of residents needs by appropriately skilled and experienced nurses and/or therapists, with the initial assessment being through the single assessment process in partnership with Health and Social Care. The files for two people more recently admitted to the Marillac were reviewed and confirm that a clear and comprehensive assessment is undertaken prior to admission. The residents and/or their relatives were spoken with and they confirmed that staff from the Marillac undertook an assessment of care needs prior to admission and included relevant people in this. The manager stated that they do not write to the prospective resident to confirm to them as required by regulation, that based on the assessment of their needs, the Marillac can meet these as they were unaware this was required. The manager confirmed that this would be implemented immediately and so a requirement will not be issued in relation to this. The managers AQAA states that they continue to be confident in the quality of the care they provide and no appointment is needed to visit/view the Marillac. In addition open days are offered for prospective residents/families and professional partners. Residents and visitors spoken with confirmed that they had really been able to visit the Marillac prior to admission. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. While aspects of care management documentation need attention, residents can be reassured that the care delivered will meet their needs. Evidence: The manager has introduced a new care planning system to support comprehensive and detailed identification of peoples individual needs and to specify how these are to be met by staff. Files examined on the day of the inspection contained a range of records that had been developed from peoples assessed needs. The managers AQAA states that each resident is consulted in goal setting and planning of care and therapeutic interventions, and an individualised care plan is drawn up in partnership with the residents, their representatives and the multidisciplinary team. Evidence of this was seen in care files sampled demonstrating that peoples right to be involved in the decision-making process is promoted. Care plans contained detailed information setting out what staff need to do to ensure all aspects of peoples health and personal care needs are met. This included, for more Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: recently admitted residents, information received from previous placements, to ensure continuity of care was maintained. It was noted that basic care plans such as, for example, in relation to continence management were not in place and some aspects of the care plan had been written for one person during the inspection site visit even though the person had been a resident at the home for some weeks. The manager was recommended to review this and ensure that at least a basic care plan was in place for all aspects of the residents need on admission, based on their pre-admission assessment, that could then be developed with the person and those supporting them. Care plans were supported by baseline assessments including in relation to pressure area care. A nutrition assessment on file for one person had not been completed and the manager advised that baseline assessments in relation to nutrition were not undertaken unless there were clear indicators of complex needs. Where risks were indicated, a range of detailed assessments had been developed to manage this effectively to promote the persons safety and well-being. These included moving and handling and for the use of bedrails. It was disappointing that a number of the risk assessments were not signed and dated to support effective review. The managers AQAA states that risks are managed positively to help residents achieve wider experiences and that resident capability risk assessment are regularly performed. The capability risk assessment on one of the files sampled had not been completed. Residents and relatives spoken with confirmed that they were satisfied with the care provided at the Marillac. Information from resident and relative surveys included good care and attention by the care staff and nursing staff, I am happy with all aspects of the care I receive and all my (relatives) needs are met at the Marillac. Comments received from health professionals included look after the clients in a holistic fashion, whenever I visit I see excellent quality of care, particularly recently I observed a very tender interaction with a very sick patient, the nursing and personal care is excellent and I can only wish that the nursing and personal care on the other sites where I work as an NHS consultant could provide the resident centred and comprehensive care that is delivered for all the residents at the Marillac. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported to lead an active lifestyle of their choice, to maintain relationships and to enjoy a varied and healthy diet. Evidence: The managers AQAA tells us that they have an increased programme of varied activities and entertainment including a summer fete, family fun days, plays, entertainment and concert in addition to daily group and one-to-one activities in the home. Two activity coordinators are employed equivalent to 1.2 full-time posts and there is a part-time volunteer coordinator post. Support is also provided by the League of Friends. Care plans sampled included a section specifically relating to lifestyle and the individual person. These identified the persons particular preferences and needs and the manager agreed that the way these needs were to be met could be specified more Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: clearly so that residents and staff were clear what was expected and when it could happen. They were written from a person centred approach, with the support of relatives where appropriate, including information on my story and who am I. They recorded the persons likes and dislikes, lifestyle preferences such as I like to get up at and supported dignity and skills maintenance such as I can eat... . Residents spoken with said they were happy with the range of activities available. Records are maintained of activities undertaken with residents and these included arts and crafts, roulette, bingo and games. Some residents attend college or courses such as IT lessons, art and handicrafts. The Marillac rent the hydrotherapy pool at a nearby hospital for resident use. There is twice monthly entertainment brought into the home and support from the community includes students from the local school coming in to sing in the chapel. Key workers have responsibility for arranging outings with individual residents for example going shopping, to the theatre or cinema. The Marillac have two minibuses available and have provided training on driving these which has been taken up by relatives and staff, supporting more opportunity for residents to go out. Comments from relatives included there are daily activities for residents if they would like to go to them and a bit more entertainment would be nice. A staff member commented in the survey that there could be more attention given to the needs of clients at weekends as they get so bored and while the body might be disabled, the brains still works. Another staff member commented the Marillac gives excellent care to residents, both from a personal and social aspect. A survey from a resident said a range of activities are offered to residents which are fun and interesting. The service user guide states that there is an open policy for visitors and relatives, friends and representatives are welcome to the home at any time. Residents are encouraged to make contact with important people in their lives by visiting, telephoning, e-mailing and letter writing. Accommodation is available for visitors that can be booked in advance if this is required. Residents and relatives spoken with told us that visitors are always welcome at Marillac. Residents spoken with told us they were satisfied with the food provided at the Marillac with comments such as the food is so lovely. Observation of the lunchtime meal in different areas of the home showed a choice of three main meals that appeared ample in portion and well presented. Some residents ate in the dining room while others had their meals in their room. Where residents required support, this was observed to be provided with patience and sensitivity. Staff sat with residents, interacted with them and supported mealtime as a positive social experience. A staff Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: member commented that nutrition is given a very high level of priority for residents, and the Marillac uses suppliers with good reputations in the local community. A resident spoken with said the staff are fine, they treat me as a person, the food is good with plenty of choice, I can make choices every day for example whether I go to an activity, whether I have a shower, and when I go to bed and get up. I can spend time in my room if that is what I want to do. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their personal and health care needs will be met at the Marillac, their medication safely managed and that they will be treated with respect and dignity at all times. Evidence: A survey received from a health professional said that the Marillac provides excellent care for its residents. The care of the resident is evidently tailored to meet the needs of the resident. The manager operates a named nurse and key worker system to support effective communication and management of each persons individual needs. While staff generally indicated that communication was effective in supporting good quality care, they were also aware of the need to monitor this and one person commented the home is continuously looking at ways of improving communication between services and to ensure that all staff have a forum to discuss ideas and improvements to enhance the quality of care given to residents. Systems are in place to support effective communication including fortnightly meetings with the unit managers and clinical management team. The manager advises in their AQAA that one of the improvements in the last 12 months has been to Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: establish clinical governance arrangements including a clinical effectiveness committee as a subgroup of the management board and that staff meet monthly to reflect on practice and share learning through an evidence based practice group. The homes aims, identified in both the service user guide and the statement of purpose, include providing each person with appropriate skilled nursing, therapy and personal care they need to lead a fulfilled life, empowering and respecting their dignity, privacy, choice and independence. Peoples preferences in relation to their planned support are identified within the care documentation sampled. Surveys received from residents told us that staff and managers listen and act on what they say. People spoken with told us that their dignity and privacy was respected, for example doors and curtains were always closed as appropriate during personal care. Healthcare needs are identified in the care plans. Wound assessment documentation reviewed was dated, signed, showed evidence of regular review and reference to a clear and detailed supporting plan of care. The managers AQAA advises of monthly multi-disciplinary review and care planning reviews including GP, neurologist, nurses and therapists to highlight potential progress to be built on to enable residents to be as actively independent as possible and to ensure that external services are sought where necessary. Multidisciplinary treatment to promote rehabilitation includes multidisciplinary goalsetting, regular reviews with the resident and other relevant people and include intervention by physiotherapists, occupational therapists, speech and language therapist as well as therapeutic interventions by carers and nurses. The Marillac has a comprehensive gym with equipment available and setup to maximise residents independence. A resident survey told us told us that occupational therapy, including speech therapy, is an area where the home does well. Information provided by staff indicates a positive approach to providing person centred care and interactions observed between staff and residents at the time of the site visit were both friendly and respectful. Staff comments on what the home does well include the home continues to develop a multidisciplinary approach, where the input of the various services, for example nurses, carers, therapists, housekeepers/support services are appreciated as contributing to resident care and very good resident care/ staff support. Always willing to buy necessary new equipment, products etc to enable good quality care for our residents.. excellent care of residents overall. As at the last inspection the home continues to follow appropriate procedures in relation to medication management. Each persons medication is stored in their own Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: ensuite along with their medication administration recording (MAR) sheets. Records examined confirm that the MAR are completed appropriately and contain current photographs so that people are protected from the possibility of drug errors. Controlled drugs are securely stored separately. A sample of the records of controlled drugs indicated appropriate procedures and medication reviewed against records tallied accurately. Appropriate systems and records are in place in relation to ordering of medication. The manager and staff tell us that they have good working relationships with the pharmacy providing medication to the home and this in turn was confirmed by the supplying pharmacist, who advised of a recently instigated date checking routine and review of stockholding. The management team at the Marillac undertake detailed audits in relation to medication that are analysed, producing an action plan that is monitored and reviewed. Evidence of this was readily available including in the minutes of the recent evidence based practice group meeting where an additional system was introduced to check controlled drugs at the changeover of the morning and night shifts in line with best practice standards. A survey from a health professional told us that the Marillac optimises care for the individual providing a safe and caring environment in which they as individuals can function as far as possible as they wish and be accepted as important in their own right. The nursing and personal care is excellent. A relative told us they feel that the resident is being well looked after. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. People using the service can not be reassured that they will be listened to or effectively safeguarded. Evidence: The managers AQAA states that they have an open door policy where residents and families can air their concerns and complaints and that they adopt an honest and open culture where incidents, complaints and concerns are dealt with sensitively and lessons learnt are shared. The service user guide tells people that the home has a complaints procedure, that any complaint made will be investigated, and identifies timescales and provides the providers address. It also provides the current contact details for the Commission as required. The complaints procedure and service user guide were not displayed clearly in the home. Six of the seven surveys received from people using the service told us they would know how to make a complaint, relatives and resident spoke with confirmed that they would know how to make a complaint and would feel able to do so. The Commission had recently been advised of a complaint that had been made to and investigated by the Marillac the previous year and since the last inspection. This included issues that related to a lack of support/assistance to a resident as required and poor communication, that the resident had not received some meals and that some of their laundry was lost. The complaint was investigated, the above issues were upheld, the complainant was responded to clearly, and an apology was issued with Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: information on actions to be taken to prevent further occurrences. The AQAA tells us that two complaints had been received in the past year and one of these had been upheld. A record was available of the investigation into the complaints, one of which related in part to pain relief medication being left unattended with a resident and not administered to them at the time required until the issue was raised by a family member some hours later. The manager confirmed that this complaint was upheld. The Commission had not been notified as required of this event affecting the well-being of a resident and poor medication practice. The other complaint related to a lack of staff support/assistance to a resident as required and the investigation confirms that communication and direction from the qualified staff to carers had been ineffective. The manager confirmed that this complaint was also upheld, at least in part. Appropriate action has been taken with the staff member in supervision and a record of work allocation has been implemented on each unit. Additionally, the managers AQAA states that communication workshops and in-house training have improved communication across the service. The manager had available a number of letters of thanks and compliment regarding the service and many positive comments about the service have been received in surveys sent by the Commission and reflected in this report. The manager had available a policy and procedure in relation to adult abuse and also a whistleblowing policy and procedure for staff. It was discussed that whistleblowing information could be displayed in the staff room so that it was readily available to all staff. The manager confirmed that safeguarding and whistleblowing are covered during induction including in the common induction standards unit and through the training provided to staff on safeguarding vulnerable people. The manager made available an overall record of staff training that indicates approximately 40 of the nursing and care staff have not had recent training in safeguarding. The manager had available copy of the current Southend, Essex and Thurrock guidance and protocols on safeguarding vulnerable people and confirmed that they had undertaken safeguarding training. The managers AQAA records that while no safeguarding adult referrals have been made, two safeguarding adult investigations have been undertaken. Review of the records provided by the manager demonstrated three allegations of abuse having been made, one of assault made by a resident in 2008, and two more recent whistleblowing issues where a carer alleged assault or rough handling of a Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: resident by another carer. None of these had been referred as required under safeguarding procedures to the safeguarding adult team so that a decision on who would investigate them could be made. The Commission had not been notified of any of the events as required. The manager was advised that this was a concern, and while they may have been investigated in house, this was not in line with current good practice in safeguarding vulnerable people. Care Homes for Adults (18-65 years) Page 23 of 33 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Marillac provide a clean, homely and well-equipped environment for residents that meets their needs. Evidence: The managers AQAA tells us that what they do well is to provide an attractive, clean, safe and vibrant home where residents and staff want to stay and work. The entrance is imposing and welcoming. To support a more homely ethos, the Marillac is divided into three units, St Vincent with 16 beds, St Louises with 16 beds and St Catherines unit with 18 beds. Photographs of staff and their names are clearly displayed on each unit so people can recognise more easily the staff on duty. Each unit has its own lounge and dining areas offering a choice of places to spend time, as well as a satellite kitchen where residents and visitors can make drinks and snacks. All resident bedrooms are single occupancy and are ensuite. Those bedrooms seen were well furnished and personalised to varying degrees to suit the occupants preferences. The statement of purpose confirms that in each room is provided with a personally adapted armchair, television and television point as well as an individually lockable medication storage cupboard. Residents spoken with confirmed that they were comfortable in their rooms, that they had been able to personalise them and that their rooms and the premises facilities met their needs. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: Each unit also has a range of specially adapted facilities for bathing and showering. Corridors and doorways are wide to allow appropriate access for wheelchairs and other equipment. The statement of purpose confirms equipment observed at the site visit including profiling beds, overhead electric hoists and mobile hoists. A hoist is available with weighing scales that is specially designed for wheelchair users. Each room is equipped with a Callbell system adapted to meet the needs of the service user. The system summons staff by use of a bleeper reducing noise disturbance for other residents. A portable pendant alarm also allows service users to move safely throughout the house and grounds. Other facilities available to residents at the Marillac include a gym for physio and occupational therapy, a permanent multisensory room, a chapel, hairdressing room and a cafeteria that is open to residents, visitors and staff. Computers for resident use are available on each of the units, some of which have specific sensory software and are accessible adapted. There are approximately four acres of grounds surrounding the Marillac, which are laid out for people with physical disabilities and include a wheelchair friendly woodland walk. There is also a purpose-built sensory garden, patio area, water features, seating areas and raised flower beds for the enjoyment of residents, their family and friends. The manager advised that the support for developing some aspects of the service that they have received from local businesses and the local community is very much appreciated. There is a range of offices, staff training room, staff room, a kitchen and wellequipped laundry as well as a range of other ancillary rooms. No health and safety concerns were observed at the site visit. All areas of the premises were well maintained, clean and free from offensive odours. The layout of the laundry supports effective management of cross infection and staff were aware of appropriate procedures. All surveys from residents, and discussions with residents and visitors confirmed that the home is always fresh and clean. Care Homes for Adults (18-65 years) Page 25 of 33 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent 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 be cared for by a competent and caring staff team, who were safely recruited and who are able to meet their needs. Evidence: The managers AQAA tell us that they have a highly skilled nursing, medical and therapy staff who work to deliver holistic, integrated and comprehensive care to residents, that care staff are valued and offered opportunity for promotion where appropriate and all staff are given opportunity for training and development. A resident commented the staff are very friendly and welcoming, not just to residents but to family and friends too. The manager stated that based on full occupancy and average dependency levels, minimum staffing levels on St Catherine unit are seven staff in the morning and four in the afternoon, and either six or seven staff in the morning and four staff in the afternoon on each of St Louise and St Vincent units. Minimum night staffing levels are seven staff over all three units with an additional member of staff undertaking a twilight shift until 11pm. The manager confirmed that on each shift and on each unit during the day there would be a minimum of one qualified staff and a minimum of one qualified staff overall at night. Residents, visitors and staff spoken with as well as observations during the site visit indicated that this was adequate to meet the needs Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: of the people using the service. Care and nursing staff are supported by a range of ancillary staff including activity, administrative, housekeeping, laundry, maintenance and kitchen staff. The managers AQAA states that they have recently undertaken an evaluation and updating of all nurses and carers job descriptions and competency frameworks have been established for each job role. Teambuilding and service development days have been have been used as a method of improved team effectiveness and communication. Information received from staff confirmed that generally there are enough staff to meet the individual needs of all the people who use the service and the way that information about the people they support or care for is shared tends to work well, although this was identified as an area where there could always be improvement. A comment received from healthcare professional noted the team working between different professionals is close and efficient and above all caring. The managers AQAA identifies that staff training needs have been identified and a training and development programme is available for all staff. This was evidenced within records sampled and staff training matrix. Training will include two staff undertaking Train the Trainer courses in moving and handling so that training can be provided for all staff as and when required to promote the safety and well-being of both residents and staff. The manager told us that 33 of the current care staff group have achieved NVQ level II or above and this was documented in the statistics of the most recent report by the registered providers representative. The manager advised that several staff are still going through NVQ training relevant to their roles, this includes housekeeping staff and that the Marillac is now registered on the National Minimum Dataset for social care (Skills for Care). Files were reviewed for two more recently recruited staff. This was to assess if appropriate references and checks had been undertaken to ensure that prospective staff are suitable people to care for residents of The Marillac. Both files contained evidence of required information and checks being obtained prior to employment commencing to evidence robust recruitment procedures to safeguard residents. Records of induction were available. Information received from staff confirmed their induction generally covered everything they needed to know to do the job when they started and that they are being given training that is relevant to their role and keeps them up-to-date with new ways of working, helps them understand and meet the individual needs of people, and where appropriate gives them enough knowledge about health care in medication. One person commented all staff are encouraged to participate in training and continued professional development both informally and externally (NVQs)to improve knowledge and standards of resident care. Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: The formal supervision system was not reviewed as part of this inspection. Information from staff surveys indicated that that they felt they had enough support, experience and knowledge to meet the different needs of people who live at the home and that they were given enough support by their manager who met with them regularly to discuss how they are working. Care Homes for Adults (18-65 years) Page 28 of 33 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 expect a service that overall is effectively managed to promote their safety and best interests. Evidence: The manager has been registered since the last inspection of the Marillac and is a registered nurse, health visitor and midwife and she has a general management diploma qualification. Recently attended training includes the mental capacity act, deprivation of liberty safeguards training, safeguarding vulnerable people and a registered managers development day through Essex Works to ensure practice remains current and relevant. Overall, the Marillac presents as a well-managed service with the exception of the concerns regarding the management teams handling of whistleblowing issues/allegations of abuse which has been dealt with in an earlier section of this report. A quality assurance and quality monitoring system are in place that include seeking the views of the people using the service. Evidence was provided of recent stakeholder surveys that included families, residents and professionals. These had not yet been Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: formally collated and analysed however initial viewing indicated very positive responses overall in relation to the standard of care both nursing and social, the premises, available information about the home and management and staffing. The registered persons produce an annual development plan to reflect their commitment to continuous improvement of the Marillacs services. The registered provider also produces detailed reports on the monthly visits they are required to undertake by regulation to ensure that the service is running as should. These include a review of training planned/undertaken and policies and procedures as required. The managers AQAA confirms that appropriate policies and procedures are in place and demonstrate that they have been regularly updated. Since the last inspection, the management team have established a residents/familys experience committee that meets quarterly with the manager and registered providers representative as one of the governance arrangements that reports to the management board. General meetings of residents and relatives are held twice a year on each of the units. The manager also has a range of clinical audits in place including in relation to infection control and medication and include incident reporting reviews and care benchmarking. The managers AQAA tells us of plans to redesign the user satisfaction questionnaire and to carry out an audit of the therapy services and respond accordingly. A copy of the contract agreement provided in the statement of purpose and service user guide reassures residents that the Marillac is registered under the Data Protection Act and that satisfactory systems exist to protect the confidentiality and security of patient information. The service users Charter of Rights tells residents they have the right to access their personal medical file in line with the Department of Health policy and procedure. A sample of records of routine safety checks were requested to ensure a safe environment was maintained for residents and staff. Safety inspection certificates were available relating the fire alarm, fire equipment, nurse call system and gas. A new passenger lift has recently been installed and an insurance inspection certificate was available. A current certificate of employer liability insurance was available. Monthly checks out the hot water outlets were recorded. Maintenance staff confirmed that a water risk assessment had recently been undertaken and a water management plan is currently being developed to include periodic checks of the cold water. Records of fire drills demonstrated that these have included night staff. Care Homes for Adults (18-65 years) Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 31 of 33 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 23 13 Ensure that allegations of abuse are referred to the appropriate safeguarding adult team in line with good practice and current protocols. To safeguard vulnerable people. 11/02/2010 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 6 Ensure that all care management documentation and assessments are in place in a timely manner and signed and dated. Make the complaints procedure more readily available and accessible within the home. 2 22 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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