Care Home: Marling Court

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What the care home does well Staff continue to have a good rapport with the residents and treat them with respect. Residents spoken to said that they liked the staff. There is a relaxed atmosphere at the home. The home is clean and well-decorated. Staff take health issues seriously and appropriate medical advice is sought. Residents are involved in life at the home through regular residents meetings. What has improved since the last inspection? The home has installed a new adapted bath and a new shower room has been installed. Also some dining chairs, bedroom suites and flooring have been changed. A photo menu has been introduced to help residents to understand the choices on offer. More consultation with residents has resulted in the menus choices being changed to suit them. What the care home could do better: It was discussed with the manager at the time of inspection that the allergy section on the medication records needs to be fully completed. The risk assessments need to be more detailed and important information concerning staff recruitment details needs to be kept at the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Marling Court 2 Bramble Lane Off The Avenue Hampton Middlesex TW12 3XB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sharon Newman     Date: 0 3 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Marling Court 2 Bramble Lane Off The Avenue Hampton Middlesex TW12 3XB 02087830157 02087830078 zsmith@rutcht.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Richmond upon Thames Churches Housing Trust care home 37 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The Registered Person must ensure that all staff are appropriately trained in dementia care. To admit one named female service user aged 63 years. Date of last inspection Brief description of the care home Marling Court is a purpose built residential care home in Hampton providing personal care and accommodation for up to thirty-seven people. Up to twenty-five of whom may have dementia. The number of places registered for service users with dementia was Care Homes for Older People Page 4 of 26 Over 65 0 20 20 25 0 0 Brief description of the care home increased from seventeen in November 2004, when the home applied for a variation to the categories of registration. A condition of this variation was that all staff must be appropriately trained in dementia care. Marling Court is situated close to local facilities and amenities and is set within a residential area. The home?s internal decor is pleasing with a large homely lounge. There are four interconnecting units, each with its own kitchenette, sitting and dining area. The lobby area is welcoming and off this are the Manager?s office, the duty office, the kitchen and laundry. The home has attractive gardens accessible to service users. CCTV cameras monitor the entrance and nearby designated parking spaces. The home is owned and managed by Richmond upon Thames Churches Housing Trust. The Registered Persons have produced a Service User Guide, which includes information on the aims and objectives of the service. The charges for Marling Court are between #547 - 577 per week. Care Homes for Older People Page 5 of 26 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: The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. The inspection of this home included an unannounced visit to the service on 3rd August 2009 by a regulation inspector. We spoke to the deputy manager and service manager. We also spoke to care staff and residents. Documentation looked at included medication records, staff recruitment information, residents care plans and health and safety documentation. A tour was also taken of the premises. The manager has also completed a self assessment of the home which is called an AQAA. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 26 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 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are assessed prior to coming to live at the home this helps to make sure that the home can meet their needs. Evidence: Full assessments of need are in place to help to ensure that residents needs can be met. Assessments of need were seen in the residents files that we looked at. These covered many areas including social, psychological and activities of daily living. For those residents funded by social services the initial assessment is carried out by a social worker. The service manager told us that all residents have been re-assessed in line with the new Mental Capacity Act legislation. Residents and relatives meetings are held at the home to enable them to put forward Care Homes for Older People Page 9 of 26 Evidence: their views and suggestions. A visitor told us that they were given the opportunity to look around the home and meet staff before their relative came to live at the home. They told us that their relative will have the chance to decide if this home is suitable for them over the first few weeks of their stay. They also said that the staff they have met have been understanding and helpful. The manager told us in her AQAA that there is a copy of the statement of purpose and service users guide in every room and that this has recently been updated. Care Homes for Older People Page 10 of 26 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. Residents continue to have access to a range of health and social care services. Staff act promptly when a residents is unwell and summon medical help. Residents were observed to be treated with respect by staff. The recording, storage and handling of medication is good. However, the allergies section is not always completed. Evidence: We looked at four care plans and found them to be detailed and informative. They covered areas including mental health, personal care needs, emotional requirements, activities and the support needed at night. The written information obtained was detailed. However, we discussed with the service manager that the home could make some of this information more person centred and she reported that the home is looking at ways of achieving this. Risk assessments are in place covering areas including falls, moving and handling, Care Homes for Older People Page 11 of 26 Evidence: nutrition, medication and challenging behaviour. We discussed with the serice manager and deputy manager that these need to be more detailed. Also, they are all grouped together on one recording sheet and this does not allow for adequate information to be recorded. As stated in the previous inspection report - risk assessments for moving and handling issues or falls need to have separate sheets. Also any challenging behaviour issues need to have a separate risk assessment which includes the intervention needed. There was evidence in the care plans of input from a range of healthcare professionals incuding district nurses and GPs. We saw information in a residents care plan to show that specialist community palliative care nurses are involved in their care. Records are kept of bathing, personal care given and skin care. As the home admits people with a diagnosis of dementia staff have been attending training in dementia care so that they are aware of the complex needs these individuals may have. The service manager told us that a dementia champion scheme was to start at the home to ensure someone has responsibility for this area and to promote good practice. Staff were seen to respond promptly to a resident who was taken ill and they stated they would call the GP immediately to request a visit. A weekly GP surgey is held at the home on Wednesdays and chiropodists visit sixmonthly. The medication room was locked securely to help ensure the safety of the people who use this service. Medication administration records (MAR) looked at were fully completed. We noted that the allergies section had not always been completed on the MAR sheets this must be fully completed and any allergies recorded, if none are known then this must be stated.Medication audits are carried out three monthly by the manager as part of their quality assurance programme. Staff attend medication training and are not permitted to give medication to residents until they have completed this training. Care Homes for Older People Page 12 of 26 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. Residents are offered a range of activities and do not have to participate if they do not want to. Relatives are encouraged to visit and participate in important events. Residents continue to be offered nutritious food in pleasant surroundings. Evidence: Regular residents meetings are held and the minutes are kept and displayed in the residents communal areas. Recent matters discussed include health and safety, catering and the need for a new handyman at the home. A summer fete was held recently and residents spoken to told us it was an enjoyable experience. One said that the staff worked very hard. The deputy manager reported that relatives and residents were involved in this. Residents Birthdays are remembered and celebrated at the home. Activities offered at the home include reminiscence therapy, singalongs every Friday with an outside entertainer, aromatherapy, pet therapy and music and movement. The organisation Care Homes for Older People Page 13 of 26 Evidence: have a minibus and residents take advantage of this by going on visits to local parks, shops, theatre or to the seaside. The deputy manager reported that all residents have a choice regarding whether they wish to participate in any of the activities.There is a monthly gazette available for residents to read that reflects life at the home and is kept on the units. Church services are offered every Sunday and those residents who are Catholic may have communion if they wish. There is a hairdressing salon at the home and residents were observed to have their hair washed/cut/styled. Lunchtime was observed to be peaceful and residents were not rushed. The food served looked nutritious and well-presented and residents were given a choice of two courses. A resident told us the food is nice, another said that they really enjoyed the meals. We discussed with the manager that fruit, snacks and cold drinks should be put out on the units for residents to help themselves. Photo menu cards have been introduced so that it is easier for residents to understand the choices on offer. We observed residents walking around freely and choosing who they wished to talk to and sit next to. Care Homes for Older People Page 14 of 26 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. There are appropriate procedures for complaints and the protection of vulnerable adults. Evidence: A complaints log is kept at the home with full details of complaints and allegations. There is a rolling programme of safeguarding vulnerable adults training (SOVA) for staff to attend to ensure that they are aware of their responsibilities in this area. There is a whistle blowing procedure in place so that staff can raise any issues about poor practice. The home follows the London Borough of Richmonds Adult Safeguarding Procedures (SOVA). The service manager reported that the home is going the re-introduce the safeguarding champion scheme at the home to ensure that a member of staff has responsibility in this important area. The home informs us of any notifiable incidents by sending us details of these to ensure we are kept informed of any adverse events. The manager writes in her AQAA that we support one another in times of crisis. Residents and relatives are encouraged to voice their opinions or complaints openly, and without fear of recrimination. we endeavour to be as transparent as possible. Care Homes for Older People Page 15 of 26 Evidence: Care Homes for Older People Page 16 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment at the home is attractive and homely. It remains well-decorated and pleasant. Residents can personalise their rooms to their own taste. The home remains clean and hygienic. Evidence: he home is divided into four units and two flats over two floors, each unit has its own lounge, kitchenette and dining area.The two ground floor units have conservatories which adds to the space available. There is a well maintained and attractive courtyard garden for the use of residents and there is also a large communal lounge used for get-togethers and music and movement classes. There is a passenger lift for easier access to all floors and corridors are wide providing good wheelchair access. Residents spoken to reported that they liked their bedrooms. Many were seen to have been highly personalised with their own belongings.A resident told us that they liked Care Homes for Older People Page 17 of 26 Evidence: their room and another said their room was lovely. The bedrooms have ensuite facilities. The home was clean and free from offensive odours on the day of inspection. Antibacterial handwashing facilities were available throughout the home. Care Homes for Older People Page 18 of 26 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. Staff continue to have a good rapport with residents. There is a recruitment procedure in place however at present their is no evidence of recruitment checks on some staff available at the home. There is a good training programme in place for staff to help them to carry out their jobs effectively. Evidence: Staff were observed to treat residents with respect and to offer them choices for example of where to sit or what they wished to have for lunch. Sufficient staff numbers were seen on the day of inspection and the deputy manager reported that the home is now fully staffed. We looked at three new staff recruitment files and one contained evidence (on a signed proforma) of all the necessary information required to help ensure the safety of the residents including evidence of Criminal Record Bureau (CRB) checks and references. Two contained a blank proforma and the organisation needs to ensure that this important information is sent to the home promptly to ensure that the manager Care Homes for Older People Page 19 of 26 Evidence: has evidence that appropriate checks have been carried out on the staff working at the home. We could see from looking at the staff training records that there is a rolling programme of mandatory training in areas such as moving and handling, health and safety, food hygiene and SOVA. There is also more specialised training available including: dementia care, depression in older people, end of life care and the mental capacity act. Staff told us that they are offered much training in many areas. Regular staff meetings continue to be held to ensure that staff have an opportunity to voice their opinions and these meetings also help them to remain up-to-date with developments at the home. The manager tell us in her AQAA that two staff members have completed the training for trainers course in moving and handling and now teach this area to staff at the home. Care Homes for Older People Page 20 of 26 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 home is well-run Quality assurance systems are in place to make sure that residents and relatives views are taken into account regarding the running of the home. There is a rolling programme of health and safety checks to help to ensure the safety of the residents, visitors and staff. Evidence: The manager was on annual leave at the time of the inspection, but the deputy manager was available and was very helpful. She reported that she is well supported by the manager and service manager. The service manager was available for discussions during the inspection visit.She told us that the manager is undertaking training in the area of dementia care. Care Homes for Older People Page 21 of 26 Evidence: The deputy manager told us that she is well supported by both the manager and service manager. The manager tells us in her AQAA that she has over 26 years experience of working in care fifteen of these in the management of residential and nursing homes. Her qualifications include training in nursing, City and Guilds and National Vocational qualifications. There is a quality assurance system in place which includes audits of medication carried out by the manager. The service manager reported that residents views are taken into consideration through the residents meetings that are held at the home. Also an external advocacy service visits the home annually and to meet with all residents. A disaster action plan has also been put into place. Health and safety checks such as gas safety, electrical installations and portable appliance testing were up-to-date. From the documentary evidence we saw - the home has a comprehensive system of health and safety checks in place. We also saw records indicating that three fire drills have been carried out this year. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 (2) The allergy section on records must be completed and accurate. 01/09/2007 Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Risk assessments must be 01/10/2009 more detailed and must give more information on how to minimise risks. To ensure that service user are not placed at risk of harm 2 9 13 The allergy section on medication records must be completed and accurate. To ensure that service user are not placed at risk of harm 01/09/2009 3 29 19 The organisation must 01/10/2009 ensure that their is evidence at the home of appropriate recruitment checks. This may be a signed proforma from the Human Resources department To ensure the safety of the service users Care Homes for Older People Page 24 of 26 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 15 The organisation should consider putting snacks such as fresh fruit and cold drinks out for residents to help themselves. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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