Care Home: Marlfield House

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What the care home does well The home provides care in an excellent pleasant and welcoming environment by a well managed supported, motivated, well trained and qualified staff team who work in a manner that recognises residents need for personal privacy and dignity. What has improved since the last inspection? There were no areas of concern and no requirements made following the last inspection. Two services on the same site have been combined under one registration with one manager. What the care home could do better: Following this inspection no requirements were made and there were no areas of concern, however attention should be paid to the following: To ensure that all residents are able to understand the daily menu this should be produced in a format or formats that all residents can understand. A satisfaction survey involving residents,residents representatives, staff and visiting health care professionals should be undertaken as a matter of urgency. Key inspection report Care homes for older people Name: Address: Marlfield House Gilbert White Way Wooteys Alton Hampshire GU34 2LF     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: Peter McNeillie     Date: 0 3 0 8 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 Older People Page 2 of 25 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 Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Older People Page 3 of 25 Information about the care home Name of care home: Address: Marlfield House Gilbert White Way Wooteys Alton Hampshire GU34 2LF 0142083973 01420542362 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hampshire County Council Name of registered manager (if applicable) Type of registration: Number of places registered: care home 74 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 74 The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Marlfield House is a care home owned and managed by Hampshire County Council which is registered to provide accomodation, care (including nursing care) and support for up to seventy four older persons some of whom may have dementia. Care Homes for Older People Page 4 of 25 Over 65 0 74 74 0 Brief description of the care home The service is sited in landscape grounds on the outskirts of the North Hampshire town of Alton and provides accomodation in single rooms on two floors of a large purpose built building of two wings. Residents have access to all parts of the building and safe garden including a central paved courtyard which has a water feature and sensory feature. Ample on site parking is available. Care Homes for Older People Page 5 of 25 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report was written after taking into consideration a number of sources of evidence and information, including a site visits to the premises and sampling residents and staff training/ recruitment records. We also talked with residents, staff on duty management, The Manager by phone and received a response by the manager to a pre inspection Annual Quality Assurance Assessment. (AQAA). Responses were also received from staff, residents, and visiting health care professionals to to a CQC pre inspection satisfaction survey. During this inspection which took place on 03/08/09 between the hours of 9.15 am and 1.45 all of the key standards for older persons were inspected. The results and findings contained in this report will determine the frequency and type of future inspections. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a system of assessing and identifying residents needs which ensures residents safety and that their assessed needs can be met. Intermediate care is not provided so this standard does not apply. Evidence: The manager informed us in the homes Annual Quality Assurance Assessment (AQAA) that residents were only admitted in accordance with corporate pre admission policy that requires a detailed written assessment of need and risk being carried out by a member of the homes management team in consultation with the prospective resident. A Sample of four residents pre admission assessments chosen at random were viewed. Care Homes for Older People Page 9 of 25 Evidence: These were produced in accordance with the policy and procedure previously mentioned and took into consideration residents care, nutritional and communication needs, wishes, choices, aspirations as well as any present or potential risks and confirmed that potential residents are consulted about and were involved in the assessment process. As part of the admission process management also liaise with external health and social care professionals regarding any care needs, risks, equipment and aids, that need to be considered and included when developing a plan of care. Records also confirmed ongoing assessments of need and risk for all residents are carried out on a regular basis and care plans (Section 7-11 of this report refers) updated to reflect any changes. Care Homes for Older People Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a well-developed system of planning and reviewing care, which reflects residents, wishes, and aspirations and ensures residents needs are met within a risk management policy involves residents and residents representatives or relatives in decisions that affect them. Clear policies and procedures are in place for the handling of residents medication. Evidence: To ensure the standards were being complied with we viewed four residents records aand care plan chosen at random including the most recent admission. All of the detailed care plans which included confirmation that residents were involved in producing, were reviewed at least monthly were based on pre admission assessments to identify what help and support individuals needed and any attendant risks and any other issued that could affect their welfare as described in the previous section of this report. Care Homes for Older People Page 11 of 25 Evidence: In discussion, some residents verbally confirmed they were consulted about and participated in the production of the plan, others could not remember. All of the residents spoken with and responses to our pre inspection satisfaction survey confirmed they were very satisfied with the care and support they received. They advised us they were contented, liked the staff and management and were treated with respect. They felt wanted and would recommend the home to anyone. Comments such as They do almost everything well,very homely, Friendly atmosphere and staff, Staff know residents well, The staff and Manager are very kind and look after us all very well, Better than hotel service. Resident also confirmed that their individual privacy was respected and that staff always knock on their bedroom door and wait before entering, a practice we observed during this visit. Residents right, and the opportunity to take risks is seen as fundamental. Residents were supported to make decisions for themselves within a risk assessment framework with the help of staff if required. This process identified individual risks and how they were to be managed. Staff who had a good understanding of the contents of the care plans and risk assessments and were able to explain how the care plan was put into day-to-day practice. Residents informed us were able to see the doctor of their choice (including one of the same gender) or any other health and social care professional when they needed to. The records viewed indicated that apart from doctors, district nurses other specialists would be consulted as required. Records were kept of appointments with GPs, dentist, optician, chiropodist and any other external health and social care professionals and included details of any advice and treatment given. In response to our questions relation to equality and diversity, in there AQAA we were told the home applies all of the Hampshire County Councils Corporate policies which are available to the public on line or in hard copy from Adult Services offices. They stated: Whilst we apply these policies for both residents and staff in this home, including in our recruitment program, we do not inquire about the specific gender identity and sexual orientation of the residents and staff, and may not have this information unless Care Homes for Older People Page 12 of 25 Evidence: they choose to disclose it, or it becomes evident as part of their care planning. The Corporate Equalities Officer, informed by legislation, research and stakeholder consultation, regularly updates this policy. A review is currently in progress. We undertake a Race & Equality Impact assessment whenever necessary, as a systematic way of finding out whether an existing or proposed policy or strategy of our service will affect different groups differently. In this way we are able to challenge and eradicate any residual institutional discrimination in this home, and ensure that policies, services and strategies do not, and will not, impact in a discriminatory way. A disability impact assessment is integral to our care planning. We ensure that specific cultural and religious needs are incorporated in our care planning. We actively encourage the involvement of carers, family, friends and community groups in the daily life of the residents. We are able to provide specific issue training for our staff where necessary, and when possible we prefer to undertake this in liaison with the community. The staff program of e:learning is progressing, with more than 75 of the staff having undertaken the on-line course. We have religious leaders (C of E; Methodist, Roman Catholic), who visit both individual residents and small groups, socially and for services and communion. Medication records confirmed all prescribed drugs, which are securely stored are administered in accordance with the homes medication policy and procedure by staff all of whom have received training in recording and handling residents drugs and medication. All staff handling medication told us they were aware of and had read the procedure. The record of drugs and medicines administered to residents and unwanted drugs disposed of were complete and accurate. A procedure was in place to enable residents who wish to assume responsibility for their own medication. At the time of the inspection no resident was managing his or her own medication in accordance with an individual risk assessment. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities, family contacts and the provision of varied and nutritious meals were wellmanaged and reflected residents interests and choices. Evidence: The home employs a full time activities organizer who in consultation with the residents is responsible for the availability and organization of activities. Residents in their responses to our pre inspection survey expressed satisfaction at choice of activities available. Currently activities available include, craft, music, keep fit, cards, reminiscence photography etc all of which can take place in a dedicated activities room. We were informed by the activities coordinator and residents participation was up to the individual; no one was forced to join in. All residents were encouraged to participate and arrangements would be made to assist the less able. This was confirmed by a visiting health care professional in a response to our pre inspection satisfaction survey who stated Offer activities on a 1 to 1 basis for residents who cannot manage in a group situation. Care Homes for Older People Page 14 of 25 Evidence: Residents spoken with informed us they were fully consulted and were able to exercise choice in all aspects of their lives for example; when to get up and go to bed, mealtimes and where meals are taken, visiting times, the right to receive and converse with visitors and to make and receive telephone calls in private. The quality, quantity, presentation and choice of food served came in for particular praise from the residents. A written daily menu based on residents likes and dislikes was displayed. We were informed that vegetarian options are always available. Persons on special diets for religious or medical reasons can also be catered for, following individual written nutritional assessments, which are carried out, on all residents. Although a daily menu is displayed, we highlighted the need to ensure that the menu was displayed in format that all residents would understand. This is of prime importance for persons with dementia who may find the addition of pictures would be beneficial to understanding the daily menu and when making choices. The manager gave a verbal undertaking by telephone she would look into the way menus were displayed in future to ensure all residents were aware of the choices available on a particular day. We observed residents taking their mid day meal. This was conducted in a relaxed unhurried manner with staff available to give any resident assistance should they require it. Residents informed us meals could be taken in their own rooms if they wished. Tea and coffee were available to residents and visitors at all times as was water and fruit squash. Since our last visit the home had undergone a food hygiene inspection by East Hants District council and had been assesses as excellent. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to a robust complaints procedure in which they have confidence and are protected from abuse by polocies, procedures and staff training. Evidence: The homes complaints procedure was which was also included in the service users guide included information on how to contact CQC who have received no complaints since our last visit. Resident and staff s spoken with stated they felt comfortable in discussing any concerns they had with the homes management and confident any matters raised would be dealt with fairly and promptly. A corporate Adult Protection policy and procedure designed to protect vulnerable residents was available. Records viewed, management and staff spoken with confirmed they had received training in recognizing abuse and demonstrated they knew the procedure to follow should they witness or suspect the abuse of any resident. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A safe, well maintained, clean and suitably furnished home is provided for residents which meets their needs. Evidence: All areas of the purpose built home were very clean and free from unpleasant odors and obvious hazards. Residents confirmed the home is always clean and smells fresh. Furniture was comfortable, homely and in a good state of repair, in keeping with the decor and met residents individual and collective needs. All communal areas were accessible by residents including the well-tended established and safe garden. Apart from personal mobility aids a number of communal aids had also been provided to assist residents, these included special beds, lifts, hoists, grab rails, and ramps. Parking is available at the front of the home for visitors. Residents commented how satisfied they were with their accommodation some of which had en suite facilities and fitted with a track hoist for those with mobility needs. Television aerial points are provided in each bedroom and residents can have their own telephone line installed. Attractive nameplates with a signature picture have been placed outside each bedroom door this is of particular value to residents with dementia. Corridors are painted in a variety of pastel colors deliberately designed to have a Care Homes for Older People Page 17 of 25 Evidence: calming effect and to assist residents orientate themselves. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are met by sufficient numbers of well trained and supported staff who are recruited and selected using a procedure designed to protect all residents. Evidence: The home operates with two separate staff teams one caring for residents on the nursing wing the other for residents who do not require nursing care on a second wing. The planned daily staffing levels for the nursing wing during the day and evening is two nurses plus eight care assistants. At night two nurses and four care staff. plus on call emergency arrangements. On the non nursing wing during the day there is an expectation there would be four care staff plus a shift leader and at night two night carers plus on call emergency arrangements. These numbers are supported by a manager an administrator, a cook, laundry assistants, cleaners and an activities coordinator. At night there is always on call emergency arrangements available. Care Homes for Older People Page 19 of 25 Evidence: At the time of our visit, in our view, the number of management, care and support staff available were sufficient to meet residents needs, a view supported by the staff and residents who informed us there was usually enough staff and they rarely had to wait for attention. To ensure that residents are protected by a robust and safe staff selection and recruitment policy and procedure in tandem with a comprehensive staff and training programme we viewed four staff recruitment and training files selected at random. All files viewed included evidence that staff are employed in accordance with a robust corporate equal opportunities recruitment and selection procedure, which is designed to protect residents. This involves the completion of an application form, the signing of a rehabilitation of offenders declaration, an interview, and satisfactory Criminal Record Bureau (CRB) disclosure, Protection of Vulnerable Adults (POVA) and reference checks. Following their appointment, records also confirmed that all staff are subject to an in house and Hampshire County Council induction and training programme that include first aid, handling medication, food handling, moving and handling, POVA, infection control and dementia. All staff are expected to undertake a National Vocational Qualification N .V. Q.) Course. We were informed by the manager in the homes AQAA that apart from registered nurses 55 of staff has been trained to at least NVQ level two. Additional training is available to all staff and can be accessed via a very comprehensive corporate training programme. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home ensures the health, safety and welfare of residents and staff are promoted and the home is run in the best interests of the residents, whose views about living in the home are formally sought. Evidence: The manager who has been in post since April 2009 is a qualified nurse, has experience of managing resources for older persons is currently in the process of applying for registration. In talking with staff we were satisfied that the home has a clearly defined management structure. Staff were aware all of their responsibilities and the limits of their authority. Staff described the management both internally and externally as supportive, approachable, accessible and willing to listen to any ideas they may have for the improvement of the service. Care Homes for Older People Page 21 of 25 Evidence: Hampshire County Council has a corporate quality monitoring system that requires residents and residents representatives and staff are invited to participate in satisfaction surveys. The views expressed in the surveys are seen as key in highlighting areas that may require improvement or attention and the future development of this service. The manager informed us that due to the questionnaires being revamped no surveys had been undertaken recently. The manager gave us a verbal undertaking that when advised the work on the survey forms had been completed she would conduct a survey as a matter of urgency. We were informed that some monies were being held on behalf of residents. We carried out an audit on four residents monies picked at random. All monies held reconciled with the records.Receipts were available for all monies spent. An in house health and safety policy was in place to ensure the day-to-day safety of staff and residents. Procedures include, health and safety checks, the regular servicing of equipment, staff training in the techniques of moving and handling infection control, control, first aid, health and safety, procedures to follow in the event of fire (including evacuation). All staff are issued with protective gloves and aprons and have access to antiseptic hand gel and soap. We were informed that all of the hot water supplies to baths were fitted with thermostatic controls set at 43 degrees centigrade and all radiators and hot pipes were covered to prevent a resident or staff being burnt. Care Homes for Older People Page 22 of 25 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 Older People Page 23 of 25 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 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 Older People Page 24 of 25 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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