Care Home: Marlborough House

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What the care home does well One person has been involved in taking photographs of different meals. These will be displayed to show people what choices are on offer. One person has had support to use public transport. They have learned to go out and use public transport independently. This was broken into steps and produced in a meaningful way to help the person learn effectively. People can find out things for themselves including what is for dinner, who is duty and what activities are on offer. This information is displayed around the home and produced in a user friendly way. People said that they have the support they need to keep in touch with their family and friends. People are involved in keeping the home clean and doing their laundry and cooking. This means people have the opportunity to take part and increase their skills. People have the opportunity to take part in a range of activities in house and in the community. All of the current staff have a National Vocational Qualification. What has improved since the last inspection? The manager has nearly completed a National Vocational Qualification in management at level 5. They have introduced a new care planning tool based on Essential Lifestyle Planning. There is a new person centred assessment tool. They have introduced Health Action Plans. There is new Registered Provider that is a large organisation with other similar services around the country. The manager said he has had good support and supervision in the last 6 months from his new line manager. What the care home could do better: In places the carpets on the stairs is frayed and worn and should be replaced as it could be a trip hazard. The issue about how many hours staff are paid for supporting people on holiday should be sorted out so people can book and enjoy their holidays. There is potential for some people to have more control of their medication with the right support. Key inspection report Care homes for adults (18-65 years) Name: Address: Marlborough House 78-80 Coolinge Road Folkestone Kent CT201EP     The quality rating for this care home is:   two star good 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: Kim Rogers     Date: 2 2 0 5 2 0 0 9 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 27 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) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Marlborough House 78-80 Coolinge Road Folkestone Kent CT201EP 01303239160 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): james@futurelifehomes.com European Lifestyles (FL) Ltd Name of registered manager (if applicable) Mr James Moore Hall Type of registration: Number of places registered: care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 9 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category ; Learning disability (LD) Date of last inspection Brief description of the care home Marlborough House is registered to provide personal care and support to up to 9 adults who have a learning disability. The home is two houses knocked into one dwelling in a residential road in Folkestone. There is parking to the front and a small paved garden to the rear. Each bedroom is single and has a wash hand basin. There is a lounge, dining room, kitchen and an activity room. The home is close to the town, the sea and public transport. Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 9 Brief description of the care home The same manager is in post as at the last inspection and he is registered with us. There is a new provider since the last inspection. The new provider organiation has other simialr services throught the country. The current fee starts at about 870 pounds per week. For more information about the fees and services please contact the Provider. Care Homes for Adults (18-65 years) Page 5 of 27 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: two star good 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: This was an unannounced Key inspection of the service. This means that we assessed the Key Minimum Standards. The last Key inspection of this service was 13/06/07. We carried out an Annual Service review on 14/05/08. Copies of these reports are available from the Provider or can be viewed on our website. We spoke to people who use the service. Three people showed us their rooms and one person showed us around the home. We spoke to staff and the manager and sampled various records. We made observations. We looked at the Annual Quality Assurance Assessment or AQAA. The manager completed this and it gives information about how the home has improved and how they intend to improve further. We looked at any notifications from the home about accidents and incidents. We sent Care Homes for Adults (18-65 years) Page 6 of 27 surveys to people who use the service and other stakeholders. People told us what they think about Marlborough House. We received 4 surveys from service users, 2 from relatives or friends and 5 from staff. All made positive comments about the service including This is the best place my relative has been I have always found staff courteous and helpful Marlborough house is one of the best places we have used and the staff are great Service users said that the food is good and that staff enable them to do things they enjoy. One service user said that they have freedom and like going out independently. Care Homes for Adults (18-65 years) Page 7 of 27 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 Care Homes for Adults (18-65 years) Page 8 of 27 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 27 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 27 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. People have some information and trial stays to help them decide about moving in. Assessments are carried out to make sure the home can meet the persons needs. Evidence: We found that there is information about the home and the service provided. This has some pictures and symbols to make it more user friendly. We received four surveys from service users. Three out of four said they had enough information about the home to help them make a decision about moving in. The AQAA says they have a new person centred assessment tool and that trial stays and visits are offered before a person moves in. This means that people can get a feel of what it is like to live at Marlborough House. One person said that they visited the home before they moved in. No one has moved in since the last inspection. The manager said that compatibility with current service users is considered for anyone who wants to move in. Care Homes for Adults (18-65 years) Page 11 of 27 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. The planned improvements to the care planning system should improve outcomes for people who use the service. Risks are assessed and managed and people have support to make choices. Evidence: We found that each person has two files containing information about them. We found that the home are in the process of introducing a new care planning tool based on Essential Lifestyle Planning. This is in the early stages of introduction and has been introduced by the new Provider. The manager hopes that this will improve outcomes for people who use the service by identifying and recording personal goals and aspirations. He hopes to develop support plans with individual service users so staff know how to support peoples goals and aspirations. People told us about their personal goals for the future including wanting to live more independently, seeing a show in London, going on holiday and going to college. The AQAA says they plan to make sure support plans are individualised so they mean Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: something to each person. We found that potential risks to people are identified and assessed. This means that people are supported to take risks and therefore are not restricted. For example a risk assessment was developed to support and teach a person the skills needed to travel on public transport independently. The person was involved in this process and the assessment was presented in a way that is meaningful to the person. The person said that they are happy that they can now go out on their own and use public transport independently. The manager said that risk assessments are reviewed regularly to make sure that people continue to have the right support. We found that people have support with communication. The environment supports communication in that there is information on display about what staff are on duty, the activities on offer and the meal choices of the day. This information is presented in a way that is meaningful to the people who use the service. This means that people can go and find out things for themselves rather than having to rely on staff telling them and people can make more informed choices. Staff have made referrals for support with communication to the speech and language service for people in the past. Care Homes for Adults (18-65 years) Page 13 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to take part in a range of activities including community based activities. Relationships are supported and people are involved in planning and preparing meals. Without support plans people may not increase their skills and learn new ones. Evidence: We found that people have the opportunity to take part in a range of activities in the community and at home. There is an activity room which has jigsaws, board games and art activities for people to use freely. Each person has an activity planner so they know what they are doing from day to day. Some people enjoy college and community activities. One person said they would like to go back to college. We found that hobbies are supported. We received surveys back from four service users. All four said they can choose what to do during the day and evening. Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: The AQAA says that they plan to help people find work placements. We found that people have support to keep in touch with family and friends. Visitors are welcome at the home and there is a pay phone that people can use. We found that people are involved in planning and preparing meals. One person said they like to go to the shops and can have a say about the food. The menu is displayed in the kitchen and dining room. The menu is produced in text and pictures so people can see what the choices are without having to ask staff. A service user has been involved in taking photographs of meals so they can be displayed to show what is on offer. The written menu in the kitchen has a staff member named for each day. In other words staff take turns to cook the meal. The manager said that service users can and do help when they want to. This is done on an ad hoc basis as it is not planned. This means that some people could be helping more than others and some people may miss out on the opportunity to be involved and increase their skills. We found that some people want to learn new skills and improve their existing skills. We found a lack of current plans to support skill development like budgeting and cooking. The manager hopes that the new care planning tool will address this. The manager said that they are in the process of planning holidays but none have been booked yet. Staff said there has been some confusion about staff salaries during service user holidays which has caused delays in booking holidays. One person said they want to go to Clacton. This delay has affected outcomes for the people who use the service. Care Homes for Adults (18-65 years) Page 15 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their health and personal care needs will be supported. Medication practice is safe. Evidence: We found that people have the support they need with their personal care needs. There are bathrooms, shower rooms and toilets on every floor of the home. Each person has a health action plan that shows peoples health needs and the support they need to remain well and healthy. Staff have made referrals to health professionals for support when necessary. We found that medication storage is safe and records of administration and receipt are in order. We found that staff control medication in that service users come to the office for their medication. One person said they would like to take their medication in their bedroom but staff say they have to come to the office for their medication. This means current medication support is not person centred. The manager said some service users would like to take more control of their Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: medication with the right support. Individual medication cabinets have been purchased so that people can store medication safely in their rooms. The manager plans to talk to service users and carry out assessments to see if people want to have their medication in their rooms. This means that staff will administer medication to people individually in their rooms giving more privacy and control to service users. Care Homes for Adults (18-65 years) Page 17 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their complaints will be listened to and acted on. People are safeguarded from harm and abuse. Evidence: We found that there is a complaints procedure which is produced in large print and has pictures. This makes it meaningful so more people can use it. Neither the home nor the Commission have had any complaints about the service since the last inspection. Two service users told us that if they had a complaint they would speak to the manager and he would sort things out for them. We received surveys back from four service users and all of them said that they know who to talk to if they are not happy about something. There are policies in place to safeguard people from potential harm and abuse. Staff have training so they know how to recognise and respond to abuse. Staff and the manager told us the proper procedure to follow when we asked them. Service users said they feel safe at Marlborough House. Care Homes for Adults (18-65 years) Page 18 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and generally well maintained. Evidence: A service user showed us around and three service users showed us their rooms. We found that the home is clean and generally well maintained. There is a maintenance man who comes in a couple of times a week to carry out minor repairs. Service users said they are involved in the cleaning and laundry with support from staff. We received surveys back from four service users and all four confirmed that the home is usually clean and smells fresh. People said they are happy with their bedrooms. Bedrooms are all single and have a wash hand basin. None have en suite facilities. Toilets and bathrooms are on every floor and are near to bedrooms. There are pictures and photographs around the home. There is a lounge, separate dining room and an activities or hobby room. There is a kitchen that everyone has free access to. This means that there are separate communal spaces for people to relax in. People have keys to their rooms but no one has a key to the front door. There is a number pad entry system fitted and some people know the code so can let themselves Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: in. Others have to rely on staff to let them in because they do not know the code or cannot operate the system. The manager said he will review the system to enable people to have more control and let themselves in to the home. There is a small garden which is paved. Staff said they plan to grow some plants and maybe vegetables in pots. We found that the carpet on some of the stairs and landings is worn and frayed. Because of the potential trip hazard we made a requirement that this be replaced. Care Homes for Adults (18-65 years) Page 20 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough trained staff to meet peoples needs. Recruitment checks are robust protecting service users. Evidence: We found that there is usually three staff on duty including a team leader. There are two staff on duty at night. The manager said that he is on call for advice and support. Three staff have left recently so three new staff have been recruited. The manager said they are waiting for checks to come back before the new staff can start work at the home. In the meantime current staff have been working longer shifts and extra hours to cover the shortfalls. We sampled a staff file and found that recruitment checks are carried out before a person starts work at the home. We found that staff have terms and conditions of employment and have job descriptions. In surveys we received from staff four out of five said they had a Criminal Records Bureau check before they started work at the home. All five said their induction was thorough. We found that all current staff have a National Vocational Qualification. The manager said that all staff are up to date with mandatory training and about half of the staff Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: have had training in person centred planning. In staff surveys we received four out of five said that they have the training they need to meet peoples needs. Three out of five said they have the training they need relating to health and medication. Staff have the opportunity to attend regular staff meetings. We observed staff encouraging people to do things for themselves. For example one staff asked a service user to go and get a drink of water so they could take their medication. In surveys we received from service users three out of four said staff always treat them well. Care Homes for Adults (18-65 years) Page 22 of 27 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. The home is well managed and is managed in service users best interests. People know that their health and safety is protected. Evidence: The manager has worked at the home for several years. He has the qualifications required by the Minimum Standard and has almost completed a National Vocational Qualification in management at level 5. Although the manager has attended some one day courses in areas related to peoples needs like Person Centred Planning he does not have an accredited qualification in Learning Disabilities. The manager said he has an open door policy and likes the home to feel relaxed. We found that the manager does have his door open and service users and staff came in and out of the office in a relaxed manner throughout the visit. In five surveys received from staff all said that they have enough support from the manager. There is a new Registered Provider since the last inspection. This is a large organisation that has other services throughout the country. The manager said there Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: have been some changes which he is managing. He said he feels empowered and supported by his line manager and the new organisation. The manager said he attends managers meetings and has regular one to one meetings for support and mentoring. Service users said the manager is good. The manager completed the Annual Quality Assurance Assessment or AQAA. Homes must complete this every year and it has information about what the service does well, where it needs to improve and how they intend to improve. The AQAA was well completed and gives us the information we need. The AQAA shows that the manager knows where the service needs to improve and he has plans to do this. The AQAA shows an understanding of issues related to equality and diversity and says how they promote equality and diversity. We found that there are systems in pace to check the quality of the service. An area manager makes regular visits to the home and carries out an audit and monitoring exercise. Views are sought from the people who use the service. We found that regular meetings are held when service users have the opportunity to talk about the service provided. The manager said that everyone is involved in these meetings and everyone gets to have a say. We saw the fire log book and found that checks are carried out of the fire equipment and regular drills are held. This means that staff know what to do in the event of a fire. The AQAA shows that checks are carried out of the premises and equipment. The manager said he carries out monthly health and safety checks and sends the results to his line manager. The manager has given individual staff members allocated responsibility for certain things including areas related to health and safety. Staff have training in areas related to health and safety including first aid and fire awareness. This protects service users. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 24 23 The frayed and worn carpet on the stairs must be replaced. To ensure that people do not trip on it. 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 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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. 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