Care Home: Marlstones Care Home

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What the care home does well People can expect to receive a full assessment before the manager confirms that the home has the facilities and services that the prospective resident requires to make sure that their needs can be met at the home. People can expect to have a care plan that helps staff to know how to support them and this will be based on their wishes for how they want to be supported. The staff review people`s care plans regularly and call in health staff when this is needed. There are lots of activities available to participate in and a varied nutritious diet is provided. The staff listen to people and give them lots of opportunities to have their say about the services provided at the home. The manager and staff team are safely recruited and trained to make sure they understand the needs of the people living at the home. What has improved since the last inspection? The manager shows she has continued to improve the services at the home with the provision of improved garden areas providing raised vegetable beds and a gazebo. The home has been maintained and the decor kept clean. The staff have been trained in the Mental Capacity Act, a new legislation that protects people`s interests and ensures that people`s rights and choices are respected. What the care home could do better: The manager must improve the way medicines are administered, there must be a robust medicine policy that staff adhere to in practice to make sure that people are safe and receive their medicines as prescribed. The manager must ensure that people have their nutritional risk assessed from the start of their admission and at regular intervals to make sure any problems are dealt with by appropriate referral to health care specialists. The manager must also have copies of the staff recruitment files available for inspection. We have made 8 good practice recommendations which include the need to make sure that staff receive the planned refresher training that the manager tells us is being organised. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Marlstones Care Home Adgate Close off Rock Street Bulwell Nottingham NG6 8QU     The quality rating for this care home is:   one star adequate 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: Mary OLoughlin     Date: 1 6 0 7 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 29 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 29 Information about the care home Name of care home: Address: Marlstones Care Home Adgate Close off Rock Street Bulwell Nottingham NG6 8QU 01159270629 01159760452 celia_broughton@nottinghamcity.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Nottingham City Council care home 48 Number of places (if applicable): Under 65 Over 65 48 old age, not falling within any other category Additional conditions: 0 Up to 8 service users may be under the age of 65 years, but over 55 years Date of last inspection Brief description of the care home Marlstones is residential care home for older people, owned and managed by Nottingham City Council. It is located to the north west of the city centre in the Bulwell area, and is close to local shops, pubs and churches. The building covers two floors, with the upper floor being accessed either via a staircase or a passenger lift; as a result people with restricted mobility can be accommodated, and can access all parts of the building. Marlstones is currently registered for forty-eight places of which four might be emergency/ short term care beds. Fees: from £265.00 per week dependant on benefits and a social worker assessment. The last inspection report and information on the homes facilities and services is available at the home and on request. Care Homes for Older People Page 4 of 29 Brief description of the care home Care Homes for Older People Page 5 of 29 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 focus of inspections undertaken by the Care Quality Commission is about the outcome of care provided to people who use the service. This process considers the providers capacity to meet regulatory requirements and focuses on aspects of the service that need further development. Prior to the visit we (Care Quality Commission) looked at all the information we had received about the service since our last inspection. This included what the manager had told us in the Annual Quality Assurance document (AQAA). We received good responses to our have your say surveys, 36 from people living at the home and 19 from care staff, this helped us plan what areas we looked at during Care Homes for Older People Page 6 of 29 the inspection. The main method used in this inspection was case tracking, this involves selecting the care records and looking at the quality of the care people receive by talking to them, examining their care files and discussing how support is offered to them. People living at the home, the manager and staff were spoken with as part of the inspection, documents were read and the medication systems inspected to form an opinion about the quality of care provided. The Quality rating for this service is 1 star which means that people who use this service receive adequate outcomes. 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. Care Homes for Older People Page 8 of 29 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 29 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 29 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. Before moving to the home people can expect to have an assessment of their needs and the home confirm that they can meet those identified needs. Intermediate care is not provided at the home. Evidence: From looking at the information we received within the AQAA and from previous inspections we know that the manager has always ensured people are provided with lots of written information about the home which gives people a clear idea of what services the home has to offer and people tell us they have an opportunity to visit and choose a room if they wish. The records we looked at during this inspection show us that the manager continues to Care Homes for Older People Page 11 of 29 Evidence: make sure people receive a full assessment of their needs before they agree to provide care for them, this enables the manager to be sure the home has the skills and resources to meet the persons needs before they agree to stay. One recently admitted person told us that staff had spent time with her and were helping her to regain her independence for when she moved to more independent living arrangements. We saw how the staff had recorded in her care plan the need to respect her independence and choice. Care Homes for Older People Page 12 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to have their care and support needs recorded and agreed with them but not all health risks are regularly assessed and the management of medicines does not ensure people receive their medicines safely. Evidence: The results from our surveys showed that all 36 people living at the home felt they were receiving the care and support they needed at the home. The AQAA provided us with information on how people had their health care managed and when we case tracked 3 people we found that peoples care and support needs are included in their care plan but there was some plans were not fully up to date. For example, we saw how one person required treatment for a foot ulcer but this had not been used to inform the care plan, in practice the staff were supporting the person safely and external health care professionals were involved to provide support but the lack of information within the plans showed us that staff do not routinely review plans as conditions change. The manager does tell us in the AQAA that they plan to provide Care Homes for Older People Page 13 of 29 Evidence: staff with training in care planning and risk assessment over the next year. The AQAA told us that the staff do not routinely screen people for the risk of malnutrition and that only 1 person had received training in malnutrition care and assisting people to eat. We saw one care plan that reflected how the person had lost weight and had a poor appetite but there was minimal information in the care plan to show how this was being addressed. Since our last inspection the manager has ensured that the staff responsible for managing medicines have received a comprehensive training course over a 3 month period that is accredited and provides them with the competencies required to administer medicines safely. We looked at how medicines were stored and found that they were being stored in the right way. However, when we examined the medicine records of 4 people we found that in one case the amount of medicine, which was a variable dose was being administered wrongly, the manager took immediate action to ensure the person was reviewed by the Doctor and an investigation was initiated immediately. When we observed how medicine was being administered we also saw that staff left medicines with 2 people and signed that they had been given without ensuring that they had actually been taken. The staff member told us this was their normal practice when dispensing medicines. There was no evidence that the risks of leaving medicines with these people had been assessed or whether anyone else sitting with them would be at risk of taking the medicines. We saw signage warning that oxygen was in use but the medicine policies did not include guidance to staff on how oxygen was to be managed safely. The manager told us that there were no residents self administering medicines at this time, however when case tracking one person we found that they had not been assessed for their ability to self medicate and they told us that they had not been offered the opportunity to manage their own medicines. The staff were seen to take time with people and support them with care and we know from our surveys that people tell us I am happy at the home, the staff look after me well Staff are always so good to me. We also saw that there is better understanding within the staff team about new legislation around peoples capacity to consent to treatment, the manager told us the staff team have received training in this area and more is planned. Some care plans Care Homes for Older People Page 14 of 29 Evidence: we looked at included information on peoples capacity to make decisions and the manager said she is continuing to work and develop this area to make sure that people have their rights and choices respected. Care Homes for Older People Page 15 of 29 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. People using the service can expect to be provided with a choice of activities and receive a wholesome and nutritious diet. Evidence: From the information we received within the AQAA it was clear that the manager recognises the importance of enabling people to live meaningful lives whilst living at the home. She has ensured that staff understand what is important to people, from the normal daily activities of choosing clothing and having regular hairdressing to taking part in activities such as crafts or music therapy. All 36 people living at the home who responded to our surveys told us they always or usually take part in activities arranged at the home. We saw how the weekly activities are clearly displayed along with photographs of special events for people to see. These included lists of external entertainers and the dates they were planned. The home provides a hydration bar to encourage people to drink more which the Care Homes for Older People Page 16 of 29 Evidence: manager tells us has improved peoples well being and alertness. The care plans show that staff take time to learn about peoples preferences and try to provide activities that would suit the individual. We observed lunch being served and this appeared nutritious and appealing, people were being assisted in the dining room by a team of staff who were discreet and respectful in their care delivery. During the inspection the Environmental Health Officer was undertaking an inspection of the homes kitchen and food storage areas, the report we saw of the inspection said there was good food safety practices taking place. Care Homes for Older People Page 17 of 29 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 listened to and have their concerns taken seriously and dealt with appropriately. Evidence: Responses to our surveys told us that residents know who to speak to if they have concerns about the home or care they are receiving and we saw that the manager has clearly displayed the complaint procedure in the home for people to access if they are unclear of what they can do if they have concerns that are not addressed. There are also opportunities to raise concerns through regular meetings in the home and during care plan reviews. The Commission have not received any complaints about the home in the last year but one issue we were made aware of needed investigating under the local safeguarding of adults procedures. This investigation has not yet concluded and the manager said that she would notify us of the outcome. We were satisfied that the information the manager has provided us with shows that appropriate action has been taken to safeguard people from any risk to their safety. The staff training files show some slippage with ensuring people are up to date with safeguarding procedures and one staff member had not received any refresher training Care Homes for Older People Page 18 of 29 Evidence: since 2006. The manager told us in the AQAA that they are planning more refresher training for staff in the next 12 months Care Homes for Older People Page 19 of 29 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. People using the service live in a clean and well maintained environment that has aids and equipment to assist them to be more independent and maintain their safety. Evidence: The home was clean and clutter free and all 36 residents responding to our survey told us that the home is always clean and fresh. The manager has also informed us of plans to install a talking shaft lift that will help residents to feel more confident in using it. We saw that the improvements the manager told us about in the AQAA have taken place, there is now a gazebo in the garden area and raised beds for residents to plant out vegetables. The residents are offered the choice of wearing a personal alarm pendent for their safety. The manager told us in the AQAA that they have a policy for controlling infection and we saw how they take great care when dealing with soiled linen and disposing of clinical waste which helps prevent the spread of infection. Staff have also got access to hand cleansing and protective clothing. The AQAA told us that only 2 staff had received training in infection control and staff training records also showed some slippage with Care Homes for Older People Page 20 of 29 Evidence: this training which would not ensure that staff had up to date knowledge of infection control procedures. Care Homes for Older People Page 21 of 29 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. People using the service can expect to be supported by a consistent staff team who are safely recruited and trained in their role. Evidence: The information in the AQAA told us that the manager has ensured that there is a mix of different genders and cultures within the staff team which will enable people to have a key worker that can be matched to the residents preference. We saw 2 staff files but these were incomplete and the manager said the original information is held within the local authority offices, staff told us they had to provide references before starting work and we did see the evidence that they had all undergone a criminal reference check that would make sure they were suitable to work with vulnerable people. Staff training records show they receive a thorough induction to make sure new staff are not left in situations they cannot handle. Ongoing training showed some slippage with Moving and Handling, Infection control, nutrition and safeguarding adults, and the manager told us that she is aware of this and planning to address the shortfalls. Care Homes for Older People Page 22 of 29 Evidence: The manager also told us that all of the staff are trained to at least level 2 in National Vocational Training in Care which exceeds the National Minimum Standard. Care Homes for Older People Page 23 of 29 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 manager continues to develop the service in the best interests of people living there and maintains the health and safety of people through robust monitoring and compliance with health and safety legislation. Evidence: The manager is registered with the commission and she tells us that she continues to update her knowledge through ongoing training, she also demonstrates that she is aware of recent changes in legislation and has ensured that the staff team have received training in the Mental Capacity Act and associated safeguards which is good practice. Throughout this inspection the manager showed that she was very willing to put shortfalls identified right, she took immediate action as required and she demonstrated that she understands her responsibilities to safeguard vulnerable adults. Care Homes for Older People Page 24 of 29 Evidence: The AQAA gave us a reasonable picture of the service and the ways it intends to improve, some of the information was not relevant to the questions being asked and some of the data sections were not filled in. 17 of the 19 staff responses to our surveys told us that the manager gives them regular support and meets them to discuss how they are working. We know from previous inspections that there is a robust system of seeking peoples views of the services provided at the home, people are asked to complete annual surveys and this information is used to make changes where necessary to improve the outcomes for people living at the home. The manager also holds regular monthly meetings with residents and staff and information from these meetings and the annual surveys are made available to interested parties. Our last inspection evidenced that there was a robust accounting system in place for people wishing to have small cash sums held securely at the home. On this inspection we spoke to people using this service and they told us they were happy and felt that their valuables were safe and receipted appropriately. From the records we viewed during this inspection and from the information we have received within the AQAA we found that the staff work to clear health and safety policies, ensuring they report all accidents and incidents, keep fire protection systems maintained and ensure that hoisting equipment is regularly serviced. The staff team are trained in First aid and Fire awareness. Care Homes for Older People Page 25 of 29 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 26 of 29 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 8 13 You must assess each 31/08/2009 persons nutritional needs on admission and on a periodic basis maintaining a record of nutrition and actions taken to address weight gain or loss. To ensure that people are appropriately nourished and referred to a dietitian or medical specialist when risks are evident. 2 9 13 You must ensure that you have an up to date policy and that staff adhere to the procedures for receipt, storage, administration, handling and disposal of medicines. To promote and make proper provision for the health and welfare of people at the home. 31/08/2009 Recommendations Care Homes for Older People Page 27 of 29 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 2 3 8 8 10 Care plans should be audited regularly as part of your quality assurance system. Make sure that any changes in peoples condition are used to inform a revised care plan. Care plans should include reference to the Mental Capacity Act to ensure that peoples rights and choices are protected. Staff should have access to the local safeguarding of adults procedures at all times. Make sure that staff receive up to date training in the safeguarding of adults procedures. Make sure that the staff complete up to date training in infection control. Make sure you complete all sections of the AQAA and that the information that is being asked is appropriately answered in each section. 4 5 6 7 18 18 26 31 Care Homes for Older People Page 28 of 29 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 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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