Care Home: Marlowe House

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What the care home does well Marlowe House is a small home and employs a stable and committed team of staff. The atmosphere is friendly and relaxed. The home encourages and supports people to maintain contact with families by making them welcome at the home. People`s choices are respected. People have the opportunity to spend their time as they choose. People living in the home are happy with the care and support they receive. Their comments included `always offering all the help and support I need`. `The care home provides a homely and relaxed atmosphere together with a clean environment. All staff are very approachable and my personal experience has been they are all very helpful and caring. Overall I am very happy with my care`. `My needs are well catered for`. `I`m happy here no complaints`. `I have nothing but praise for it`. `It`s very good I`m well looked after`. `Its alright the attention is very good`. When asked what the home does well comments included `quality of care, listening to problems, making sure I am comfortable`. `Look after me`. Staff are happy working at the home and feel supported. When asked what the home does well their comments included `very good caring for the residents, very good with staff and residents`. `Looking after the residents and seeing to their needs and making them feel this is their home`. `The home provides a very friendly atmosphere. The families, visitors and professionals comment on the warm and happy environment that they sense when coming to Marlowe House`. Most relatives were satisfied with the care and support received. Their comments included `its good, they look after X needs adequately, the staff are fine any problems they tell you and it can be sorted out`. `The care is of a reasonable standard, all in all quite happy`. `Been very happy here, X is well looked after and food is good`. What has improved since the last inspection? Improved written information is now available about the home and what people can expect living there for existing residents and also people considering moving in. The format used to assess people`s needs prior to moving in has been improved to ensure a full assessment is undertaken. Considerable work has gone into improving peoples care plans which have resulted in good information being available to staff in order that they can deliver care in a consistently way. Daily records are now recorded to ensure individuals confidentially. To ensure a safer system the system for controlled drugs and individuals finances records have been improved. A controlled drugs cupboard should be fitted in the home shortly to ensure safer storage. The manager has secured two work placement professional students to look at improving the amount and quality of activities for people. Some policies and procedures have been updated and staff have received further training to ensure staff have guidance on best practise and so this can be reflected in their practise.Visits have been made to the home by the Fire Officer and Environmental Health Officer to ensure the home is safe and working within legislation. Some repairs, redecoration and maintenance have been undertaken as well as any necessary action to resolve the previous unpleasant odour to improve the environment in which people live. There is now an accurate account of staff working in the home and in what capacity to ensure sufficient staff are on duty to meet the needs of people living in the home. Recruitment information has been improved although further improvement is required to fully protect people living in the home. The owner and manager have reviewed the management and quality assurance systems within the home and some improvements made although further action is required to ensure people living in the home really have a say in how the home is run and systems implemented are effective. What the care home could do better: People should be involved in the planning of their care reflecting their preferred outcomes, wishes and preferences. Medications records and practises should be tightened further to ensure systems are really safe. People must have all their dietary needs met with suitable menus and meals. Records must be evident on staff files to evidence people are protected by a robust recruitment process. In areas where the home has already made some improvements work needs to continue to improve these further to really benefit people living in the home and ensure they have a real say in how the home is run and the care and support they receive. Details can be found in the text of this report. Key inspection report Care homes for older people Name: Address: Marlowe House School Lane Hadlow Down East Sussex TN22 4HY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sally Gill     Date: 2 5 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Marlowe House School Lane Hadlow Down East Sussex TN22 4HY 01825830224 01825830924 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): AUM Care Limited Name of registered manager (if applicable) Mrs Janet Moseley Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 20 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: old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Marlowe House is registered to provide accommodation for up to 20 older people. Janet Moseley the registered manager is in day to day control. The premise is a detached property situated on the junction of the main road and school lane. The property has a garden with lawn, flower borders and established shrubs. There is a separate paved area with tables and chairs to the rear of the home. Care Homes for Older People Page 4 of 31 Over 65 20 0 2 3 0 9 2 0 0 9 Brief description of the care home Accommodation is on two floors. All bedrooms are used as singles and are situated on the ground and first floor. Thirteen rooms have ensuite facilities. People have the use of three bathrooms only one of which is assisted. The home has two lounges (one on the first floor), a dining room and conservatory. The home has a chair lift to the first floor although people will also need to negotiate steps within the home. Hadlow Down has a pub and a church. There is a bus stop across the road to Uckfield which has a variety of shops and main line train station. There is limited car parking in addition to on street parking. The staff compliment consists of a manager, senior carer and carers plus ancillary staff. Care staff work a rota that includes a minimum of two staff on duty during the day and two on duty at night (one of which sleeps in for emergencies only). At the time of the visit current fees charged ranged from £320.00 to £420.00 per week. Additional costs would include toiletries, hairdressing, newspapers and magazines. Previous inspection reports are available from the home or can be viewed and downloaded from www.cqc.org.uk Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The previous inspection took place on 23th September 2009. This inspection was carried out over a period of time and concluded with an unannounced visit to the home between 09.15am and 4.00pm. The manager and staff assisted during the visit. People that live in the home, relatives and staff were spoken with. Observations were made through the day. Fifteen people were living at the home on the day of the visit, one was in hospital and the home had five vacancies. Surveys were sent to the home for the manager to distribute to people living in the home and staff. Seven were returned from people living in the home. Four of which were completed with the help of relatives or staff. Three were returned by staff. All surveys received were positive about the care and support received. In addition the Commission has received letters from relatives regarding the home. Two contained very positive feedback and one had some negative feedback. Care Homes for Older People Page 6 of 31 The care of two people was tracked to help gain evidence as to what its like to live at Marlowe House. Various records were viewed during the inspection and a part tour of the home undertaken. The home sent their annual quality assurance assessment (AQAA) to the Commission within the required timescale. The AQAA is a self-assessment picture of how the manager/owner thinks they are doing against the national minimum standards. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Improved written information is now available about the home and what people can expect living there for existing residents and also people considering moving in. The format used to assess peoples needs prior to moving in has been improved to ensure a full assessment is undertaken. Considerable work has gone into improving peoples care plans which have resulted in good information being available to staff in order that they can deliver care in a consistently way. Daily records are now recorded to ensure individuals confidentially. To ensure a safer system the system for controlled drugs and individuals finances records have been improved. A controlled drugs cupboard should be fitted in the home shortly to ensure safer storage. The manager has secured two work placement professional students to look at improving the amount and quality of activities for people. Some policies and procedures have been updated and staff have received further training to ensure staff have guidance on best practise and so this can be reflected in their practise. Care Homes for Older People Page 8 of 31 Visits have been made to the home by the Fire Officer and Environmental Health Officer to ensure the home is safe and working within legislation. Some repairs, redecoration and maintenance have been undertaken as well as any necessary action to resolve the previous unpleasant odour to improve the environment in which people live. There is now an accurate account of staff working in the home and in what capacity to ensure sufficient staff are on duty to meet the needs of people living in the home. Recruitment information has been improved although further improvement is required to fully protect people living in the home. The owner and manager have reviewed the management and quality assurance systems within the home and some improvements made although further action is required to ensure people living in the home really have a say in how the home is run and systems implemented are effective. 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 9 of 31 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 10 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to choose a home. Assessments are undertaken but judgements made that the home can meet an individuals needs do not always take into account legislative requirements. Evidence: Information is available to people and their representatives in order that they can make an informed choice about whether this home is right for them. The statement of purpose and service user guide has been updated since the last visit and now contains all the information required. A copy of both documents can be located in the front hallway. One relative spoken with did not think they had received any written information prior to admission. The manager told us people are given a copy during the pre-admission assessment visit. Most people surveyed indicated they received enough information to decide if this home was right for them, one did not know. Care Homes for Older People Page 11 of 31 Evidence: People are protected by written contracts of terms and conditions. People surveyed indicated they all had written contracts in place. Relatives confirmed that a written contract had been agreed with the home and that regular invoices are received. One felt they are advised in advance of increases of fees in writing another felt this was not the case. Both relatives stated they did not get a receipt for monies paid and one felt they would prefer a receipt. People can be sure their needs are assessed prior to moving in. A new improved format for the pre-admission assessment has been developed and introduced. Two completed assessments were examined. They covered all areas as recommended in the standards and each section was completed with adequate or good information. At times it was stated that the individual needed assistance but the assistance was not detailed. The manager told us this would be detailed in a care plan drawn up prior to admission. It is suggested that this document is then attached to the assessment for records. From discussions it is evident that individuals and their representatives are involved in the assessment process therefore it would be good practise for the individual to sign the assessment. It would also be good practise for the assessor to sign and date assessments. Following a recent safeguarding investigation it was recommended that a question about behavioural issues be added/asked and the manager told us this has not yet been added. Relatives are also given a questionnaire to complete in relation to individuals interests and history which if completed can be a good source of information. A letter is sent to individuals to confirm whether or not the home based on the assessment can meet their needs. People cannot be confident the home they move into will meet their needs. One preadmission assessment examined highlighted that the home has accepted an individual with needs outside of their registration category. The manager told us they had checked this with the local authority but not the Commission. The Commission will be taking action as the home is in breach of their registration conditions and must take action to resolve this. People have the opportunity to visit the home prior to admission. People spoken with confirmed they had been able to look round prior to moving in. A relative told us the home was recommended, they looked round several but this one had a nice feel, their X also looked round and stayed about four hours which included having a meal. Another told us they had not looked round because another relative had lived here previously and they had been very happy with the care provided. One relative said they had visited three times and stayed for tea. All our questions were answered honestly and the procedure was transparent. We were offered many Care Homes for Older People Page 12 of 31 Evidence: choices about the best way to begin this huge transition in my Xs life and everything was handled sensitively and with respect. Indeed we looked around other homes that had more superior furnishings but we realised that the really important criteria was that the staff should be friendly, warm, compassionate, approachable and that the home should be as a home not an institution. Marlowe House stood out in these areas. Intermediate care is not provided. Care Homes for Older People Page 13 of 31 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 health and personal care that people receive is based on their individual needs although care plans do not reflect their involvement in planning care. The principles of respect, dignity and privacy are put into practise. Medication systems should be tightened to better protect people. Evidence: Peoples health and personal care needs are set out in their care plan. The manager told us new care plans have been introduced and the home has worked hard to improve these since the last inspection. These now include a medical history, better detail and are reviewed monthly. Staff spoken with confirmed the new care plans were an improvement and they felt had had a positive outcome on care delivery for people living in the home. Staff surveyed indicated they are always or usually given up to date information about the needs of people. Six care plans were examined all which showed good detail in relation to individuals needs and the action needed by staff to meet those needs. Care plans examined were reviewed monthly although not all care plans contained a photograph of the individual which would be good practise. Risks associated with care needs have been assessed and recorded including actions to be Care Homes for Older People Page 14 of 31 Evidence: taken where appropriate to reduce the risk. It would be good practise for the home to work on involving individuals in their care plan, reviews and recording their preferred outcomes. A recommendation is made. Daily notes recorded by staff reflected care needs being met. People surveyed indicated they always or usually receive the care and support they need although one felt this was only sometimes. One relative said in relation to personal care X is very well catered for nothing I could suggest that would make things better. Peoples health care needs are met. Records and discussions evidenced people have access to district nurse, chiropodist, doctors, opticians, dentists and hospital appointments. People surveyed indicated the home always makes sure they get the medical care they need. The manager told us the home works closely with the GP surgery and a recent referral has been made to the Occupational Therapist team. People are protected by safer medication systems although further improvements will better protect people. A new controlled drugs register had been purchased and was in use. However one packet of tablets put up by the chemist on 07/05/10 was held in the controlled drugs cupboard but not entered in the register. This is not good practise; medications must be entered in the register when they arrive in the home. On checking the schedules for controlled drugs the medication being treated as a controlled drug is not a controlled drug. The manager was informed on 01/06/2010. Written confirmation from the owner states a specific controlled drugs cupboard will be fitted in the home by 15/06/10 to meet the outstanding requirement. The manager told us the pharmacy has recently visited the home. Medication Administration Records (MAR) charts were examined and found to be mostly in order. Although not all handwritten entries were dated and signed and none were witnessed which is good practise. A recommendation is made. Medication is logged into the home on the MAR chart. The system for returning medication was not examined. Several bottles of eye drops had been opened but none were dated which is good practise. A recommendation is made. A relative expressed concern that the medication administration process undertaken by staff does not always follow safe procedures. They felt on occasions medication and the MAR charts had been taken to the dining room and left unattended on the dining table whilst staff went off to administer individual medication in other areas of the home. This was not the case on the day of the visit and safe procedures were followed. The manager told us that all staff have received medication training which is a twelve week college course. People are treated with respect and their right to privacy upheld. People spoken with feel they are treated with dignity and respect. Observations confirmed staff adopt a kind and caring approach with people. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the services are able to make choices about their life style. Social, cultural and recreational activities meet individuals expectations. Menus and meals do not reflect the dietary needs of all individuals are met. Evidence: People have some opportunities for activities although the home is looking to enhance these. An activities programme is in place, which is displayed. This includes board games, dominoes, nail care, quoits and exercise. An outside motivation group come into the home every 4-6 weeks. A religious service is held each month. Some people have newspapers or magazines delivered. People spoken with said they were happy with the activities or wanted to do their own thing. Activities records examined showed a limited variety of activities are happening. These included television (films, sport, church services and other celebrations), sitting or walks in the garden, cross stitch, bingo, motivation group, hairdresser, music, snakes and ladders and holy communion. Records also indicated that people are offered activities but decline to join in. The manager told us that individuals had planted the spring hanging baskets and were also involved on mothering Sunday flower arranging with the local church and that a PAT dog visit the home monthly. She also said recently a trip to the local theatre has been organised but when the actual time came no one want to go. Care Homes for Older People Page 16 of 31 Evidence: The manager also told us that two Occupational Therapy students will be on placements at the home from September and it is intended that they work on introducing a wider range of suitable activities for people to enjoy. On the day of the visit the television was on in the lounge during the afternoon although on enquiring everyone present said they were not watching it. People surveyed indicated there were always or usually activities to take part in. One person commented activities are offered on a daily basis but most residents are disinterested. I feel this is very difficult for the manager. One person spoken with said theres enough to do. One staff surveyed commented I think we need more staff for a few extra hours a week to help with activities for our residents. Feedback from quality assurance questionnaires indicated people would like television aerial points in their rooms for a better picture and also satellite television. People are able to maintain contact with family. People spoken with say they have family visits and some go out with family. On the day of the inspection people were having visitors. One person has a telephone in their room and a pay phone is available in the conservatory. Most relatives were extremely positive about the home and felt staff kept them well informed. Comments included they phone if there are any issues, we are always made welcome and feel at home it is a relaxed atmosphere and Marlowe House has involved us in every situation that has arisen with my X. Although one relative felt they were not always kept up to date. Their relative had been poorly but they were only informed when they were on their way to hospital. People choose how to spend their time and make day-to-day decisions about their lives. Most people said they are able to get up and go to bed when they wish and have a bath when they wish, one felt they fitted into the routine but did not wish to change it. People benefit from a varied diet but meals do not meet all dietary needs. People spoken with felt the food was lovely, not bad, good, the majority is quite good or very good. One relative said of the food they cater for Xs needs. People surveyed indicated they always or usually like the meals. One commented food is good and portions are more than adequate. Staff told us there is a four-week rotating menu although this is flexible. They also told us there were no special diets at present which contradicted the manager and care plans. The main meal served on the day of the visit did not reflect the special diets that according to care plan should be in place. The home should ensure that the meals served meet the dietary needs of all individuals. A requirement is made. Breakfast is fruit juice, cereals or toast. Lunch is the main meal and on most days there is a choice. Supper is a light meal or sandwiches and soup Care Homes for Older People Page 17 of 31 Evidence: followed by something sweet. People are asked their choice of meals each day. Lunch on the day of the inspection was cod in parsley sauce with mashed potatoes or pasta and bacon bake. Both were served with broccoli and carrots. Desert was a meringue nest with fruit. Care Homes for Older People Page 18 of 31 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. People who use the service are able to express their concerns, have access to a complaints procedure and are protected from abuse. Evidence: People feel confident any complaints would be resolved but say they do not have any at present. People confirmed who they would speak to should they have any concerns and felt confident these would be addressed. People said they had brought up little issues and these had quickly been resolved. People surveyed indicated staff always, usually or sometimes listen and act on what they say, there is someone they can speak to informally if they are not happy and they know how to make a complaint. One relative said things crop up and are resolved. The complaints procedure has been reviewed and is displayed within the front hallway. There is also a suggestions box. The manager told us there have been no complaints made to the home since the last inspection. A complaints and concerns log are now in place should any arise. Staff surveyed indicated they know what to do if someone has concerns about the home and the ways information is shared about people they are supporting always or usually work well. People are protected from abuse. The home has policies and procedures in place regarding safeguarding adults and whistle blowing and these have recently been reviewed and updated. Staff have received safeguarding training and a staff member spoken with was aware of the routes to report any suspected abuse. There was a Care Homes for Older People Page 19 of 31 Evidence: safeguarding alert as a result of the previous poor rating. A full care review was undertaken for all individuals and the alert is now closed. The home has obtained a copy of the local safeguarding protocols. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home could better enable independence. People live in a safe, homely and comfortable environment. Evidence: People live in a homely, clean and adequately comfortable environment. A part tour of the home was undertaken and some areas require attention. These include peeling ceiling paper in the lounge and peeling fabric on chair arms or stained fabric, unsuitable chairs in the upstairs lounge and conservatory, loose bathroom floor tiles, peeling paint on a toilet frame, exposed plaster in the laundry and some areas of the garden are still untidy or unsafe. These areas must be addressed. One staff surveyed commented we need to have a maintenance person and a gardener. People are happy with their rooms which they feel meet their expectations. The manager told us two rooms are under the minimum size. People spoken with confirmed they are happy with their room and things are all in working order. Since the last visit the manager told us three bedrooms have been redecorated and had a new carpet. Further restrictors have also been fitted to upstairs windows to ensure safety. Independence and outcomes could be maximised with better adaptations/equipment. The home has a stair lift fitted from the ground to first floor. Although for some Care Homes for Older People Page 21 of 31 Evidence: bedrooms there is a further step. Currently there is only one assisted bath downstairs although all but one individual use the assisted bath. Development plans for the home should look at improving this. When renewing furniture thought should be given to aiding independence. For example further higher easy chairs. Access in an out of the front door and conservatory also involves step(s). Some areas of the garden do not have level paving or handrails where there are slopes. Consideration could be given to providing a more pleasant level seating area which looks out to the garden. Currently the seating area looks onto the building or fencing and can also be a sun trap. One staff member surveyed commented the garden needs improving so the residents can enjoy sitting in the garden. There is a variety of communal space including two lounges (one upstairs), a dining room and a conservatory. Although as previously mentioned not all seating is ideal and those with mobility problems may not be able to access all areas independently. Some people do spend time in their rooms and those that use the communal areas tend to sit in the downstairs lounge. The home has a garden which has recently been considerably tidied although would still benefit from further tiding. People have a seating area at the back which is all laid to concrete and has table and chairs. A sign has been put up in front of the side gate to advise of the busy road if using this exit. The home was clean and generally hygienic. People spoken with confirmed the home is clean and tidy. One relative said we have never smelt an odour. People surveyed indicated the home is always clean and fresh. There were no paper towels in some toilets. The towels in the bathroom were exposed. Currently people access the garden seating area through the kitchen which is not ideal. The manager told us one toilet flooring has been replaced to improve hygiene. Care Homes for Older People Page 22 of 31 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 in the home are trained, skilled and in sufficient numbers to support the people who use the service and the smooth running of the service. Recruitment procedures could better protect people. Evidence: Peoples needs are met by the numbers and skill mix of staff. The rota and staffing on the day of the visit indicated there are two staff on duty 8am to 8pm in addition to the manager. There is one member of staff on duty at night 8pm - 8am and another sleeps in for emergencies. The manager told us no individual currently requires the support of two staff. In addition there is a cook seven days a week, a domestic Monday to Friday and maintenance as required. All comments about the staff were positive. People spoken with said they are very kind, get on with most alright, night staff are marvellous, good, not bad, some and some or very good. People surveyed indicated staff are always or usually available when they need them. Staff surveyed indicated there are always enough staff to meet the individual needs of people. One commented I think we need more staff for a few extra hours a week to help with activities for our residents. One relative said my X knows all the staff because it is a small team of dedicated people who have worked consistently at the home over a long period. People receive care from a qualified staff team. The manager told us that five staff Care Homes for Older People Page 23 of 31 Evidence: have obtained their National Vocational Qualification (NVQ) level 2 or above. The manager told us another one is working towards this. When completed this will meet the 50 recommended by the National Minimum Standards for good practise. People could be better protected by the homes recruitment processes. Two staff files were examined of staff recruited since the last inspection. These showed appropriate checks are in place such as application form, references, Independent Safeguarding Association (ISA) check and Criminal Records Bureau (CRB) check. However both files showed gaps in employment history and there was no written explanation as required by legislation. All staff files must contain a full employment history with written explanations of any gaps therefore a requirement is made. It is suggested the application form is reviewed as it does not currently ask for a full employment history or explanations of any gaps. Staff surveyed indicated the employer did carry out appropriate checks before they started work. People receive support from a trained staff team. The manager told us an orientation induction is in place which includes three days shadowing an experienced member of staff. Staff then go onto to complete a Skills for Care induction workbook. Staff surveyed indicated their induction covered everything they needed to know and they receive training relevant to their role. The manager told us further staff training has taken place. Training includes in house training delivered by the manager plus competency questionnaires, computer training and questionnaires plus outside courses and trainers. Most staff are now trained in mandatory subjects (fire, first aid, infection control, moving and handling and food hygiene). Most staff have also completed Deprivation of Liberty training. Care Homes for Older People Page 24 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home has improved although further work is required regarding quality assurance and quality monitoring to ensure these systems are use to develop the home, people really have a say in how the home is run and the home works within legislative requirements. Evidence: The manager told us she has completed a City & Guilds Advanced Management for Care qualification which the college has advised her is at least equivalent to an NVQ in care level 4. She told us she has recently completed manual handling and safeguarding training and her first aid certificate is up to date. At the previous inspection a recommendation was made for her to undertake training in supervision which has not been completed. The internet should be a resource for the manager and home but as yet the home does not have this access. Feedback regarding the manager was on the whole very positive. One relative said the manager knows her residents perfectly and we would prefer that she continues to be visible to them and talk and spend time with them. Care Homes for Older People Page 25 of 31 Evidence: The homes own pre-admission assessment has highlighted an individual with dementia was admitted to the home although the home is not registered for this category of service user. The manager must ensure she is fully aware of her legal responsibility when agreeing to an individual moving into the home. Some quality assurance work has been undertaken but this needs to be developed further as does quality monitoring. There is a lack of residents meetings, staff meetings and staff supervision which should all form part of the quality monitoring processes within the home. Relatives and professionals have been sent quality assurance questionnaires to complete and a few of these have been returned. These were examined and were very positive about the home. Questionnaires for staff are still to be given out. When questionnaires are returned a system must be in place to analyse the data and ensure people receive overall feedback. A good questionnaire is also in place for people to feedback on how they felt their move to Marlowe House went unfortunately neither of the last two admissions had completed these. One residents meeting has been held since the last inspection. These must be a regular occurrence to ensure people have proper opportunities to have their say in home the home is run. The home sent in their Annual Quality Assurance Assessment (AQAA) to the Commission. This was poorly completed. Information within sections was very muddled; some key standards were not covered at all and some questions not answered. Information required by the Commission in future must be far more robust. Regulation 26 visits as required by legislation are now in place with reports produced. Although the home has worked hard to address the shortfalls highlighted by the Commission and those also highlighted by the local authority some progress is slow and there is a lack of proactive development in the home. Recommendations for good practise in relation to some training, staff meetings and supervision have not been implemented. The owner and manager must work together to develop an action plan to enable the home to continue addressing shortfalls, be in a position to meet future legislation and improve outcomes and the environment for people living in the home. People do not benefit from a staff team who receive regular supervision despite previous recommendations. One staff meeting has been held. The manager told us that there has been some supervision but records showed this is not to the frequency recommended. Files examined evidenced staff had received three supervisions in the Care Homes for Older People Page 26 of 31 Evidence: last twelve months instead of six. As the previous recommendation has not been met a requirement is now made in relation to supervision. One staff member spoken with said they feel supported. Staff surveyed indicated the manager gives them enough support and meets with them regularly or often. The manager told us that the home currently holds a small amount of savings for four people. Records were examined and found to be in order. Peoples best interests are mainly safeguarded by the homes records. Records examined were individual and stored securely. However in the front hallway a list of all the people living in the home was on display as was the front page of the fire risk assessment which again contained personal data. The manager was advised these displays do not promote peoples confidentiality. Improvements have been made to promote and protect peoples health, safety and welfare. A fire risk assessment is now in place. The Fire Office has visited and made no requirements. The emergency lighting has been repaired. Fire extinguishers are serviced appropriately. The Environmental Health Officer has also visit and made two requirements. Both have been addressed. Care Homes for Older People Page 27 of 31 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 28 of 31 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 15 16 The registered provider must provide in adequate quantities, suitable wholesome and nutritious food which is varied and properly prepared to meet the dietary needs of each individual. Regulation 16(2)(i) of the Care Homes Regulation 2001 requires that registered person shall provide, in adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared and available at such time as may reasonably be required by service users 06/07/2010 2 29 19 The registered person must ensure all staff files contain a full employment history with written explanations of any gaps 06/07/2010 Care Homes for Older People Page 29 of 31 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 Regulation 19(1)(b) of the Care Home Regulations 2001 states the registered person shall not employ a person to work at the care home unless - he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2; 3 36 18 The registered person shall 23/07/2010 ensure that persons working in the care home are appropriately supervised Regulation 18 (2) of the Care Homes Regulations 2001 require the registered person shall ensure that persons working at the care home are appropriately supervised. 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 7 People should be involved in the planning of their care which should also reflect their preferred outcomes, wishes and preferences. Handwritten entries on the Medication Administration Records (MAR) charts should be dated, signed and witnessed. Medications such as eye drops with an expiry date should be dated upon opening. 2 9 Care Homes for Older People Page 30 of 31 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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