Care Home: Marlyn House

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What the care home does well We have recognised the achievements made since the last key inspection, in that requirements and recommendations made at that inspection have been satisfactorily addressed. We have found that Marlyn House offers a satisfactory commitment to care with an open and personable approach, which reflects the homeliness of a confident relationship between carers and those people using the service. Comments received from surveys and talking with people during the inspection included: "Makes me feel amongst friends, and are wanted by all the staff and patients". "It provides a friendly family atmosphere for everyone". From our examination of care records we established that there are effective pre admission assessments, and care planning of individual needs, which are meaningful in formulating a satisfactory standard of personal care. When we discussed the quality of care with those people using the service and visitors, it was clear that they appreciated this personable attitude and approach to care. The housekeeping, administrative and support services have all contribute to the team approach, and are recognised by the management for their efforts. Comments we received from relatives during the inspection include: "We are more than happy and satisfied with the care". "I have everything I need, warmth, good food and caring staff". "Everyone who works there is so helpful and friendly, I couldn`t wish for a better place for my mother to be cared for, excellent". We considered that the overall management style demonstrated a solid approach in maintaining an environment conducive to the care of the elderly. What has improved since the last inspection? Our inspection has identified a positive `person centred` approach to care, increasingly sensitive for people with dementia, and more activities and socialisation, accomplished to offer people an inclusive quality of life, and a sound foundation to provide a good standard of care. We recognise the attention given to streamline the procedures and practice of administering medications, with systems geared to protect people living in the Home. We have acknowledged that there have been improvements in the furnishings and decor throughout the home, presenting a comfortable, safe environment, and to assist people, increasingly those with a higher dependency of care or dementia needs. What the care home could do better: We considered that much could be achieved by a review of activity and motivation, to facilitate and promote stimulation and diversion for people living in the Home. More variety in indoor activities would be beneficial, especially for people with dementia and other cognitive impairments. From our inspection we advised that the Care Manager ensures that every person admitted to the Home has a letter of confirmation following the appraisal of lifestyle and social needs, and that all assessments, care plans and ongoing monitoring is evidenced consistently through signature, and dating ownership. We consider that there be a review the state of maintenance of external facilities to enhance the surroundings for people to enjoy and use constructively. The summer house and side fencing are in need of renewal, and the garden area needs preparing for use. The cook was advised to maintain a consistent record of temperatures of fridge freezers, and a cleaning schedule, that reflects the good standard observed We advise that the Controlled Drug storage unit must be a metal cabinet, Rag Bolted to a solid adjacent wall, and a formal Controlled Drug Register is to be obtained. We also suggest that a separate fridge for storing medicines be obtained, to safely store appropriate medication, at a correct temperature, as prescribed. We advised that the staff record be reviewed in the way information is organised and presented, and to establish the practice of recording interviews, and follow up with letters of appointment to enhance the system and reinforce the agreements made on employment of staff, and to ensure that supervised practice meet the required six sessions a year, to capture the level of understanding of the staff`s expectations and perceptions of the work they undertake in a more structured manner. The procedures manual as presented, needs updating to meet recent changes and new initiatives. The achievements have been recognised, attention to areas of further recommended detail will significantly enhance the provision of an honest, solid and homely service. Key inspection report Care homes for older people Name: Address: Marlyn House 41 Cannock Road Blackfords Cannock Staffordshire WS11 5BU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Keith Jones     Date: 1 4 0 6 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 33 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 33 Information about the care home Name of care home: Address: Marlyn House 41 Cannock Road Blackfords Cannock Staffordshire WS11 5BU 01543504009 01543465750 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Renu Ghai Name of registered manager (if applicable) Ms Denise Philomena Seymour Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 18 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 18 Dementia - over 65 years of age - (DE(E)) 2 Mental Disorder, excluding learning disability or dementia - over 65 years of age (MD(E)) 4 Physical Disability - over 65 years of age - (PD(E)) 2 Date of last inspection Care Homes for Older People 2 3 0 6 2 0 0 9 0 0 0 0 Over 65 2 4 18 2 Page 4 of 33 Brief description of the care home Marlyn House is a detached residential home about a mile from the centre of Cannock, where all services, shops, entertainment, hospital, and transport can be found. It is a two-storey brick rendered building facing onto Cannock Road, but with ample car parking and domestic garden to the rear. The Home provides 24-hour permanent care for up to 18 older people of both sexes. The home offers one shared bedroom, all remaining rooms are for single occupancy. Most bedrooms have en-suite facilities and several bedrooms are available on the ground floor. A vertical lift is provided for people using the service and appropriate toileting and bathing facilities. A large lounge is available with television, and a separate dining area. A loop system has been fitted in the lounge to improve the quality of life for hearing aid users. At the rear of the home patio doors open onto a level garden area where appropriate garden seating and a summerhouse is available. The weekly fees are not included in the Service User Guide, and should people require more information they should contact the Care Manager direct. Care Homes for Older People Page 5 of 33 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: We conducted this unannounced inspection with the Care Manager, Registered Provider, and senior care staff on duty, whose input contributed to this report. Our inspection of the Home allowed us free access to all areas and open discussion with people who use the service, relatives and staff. There were 17 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with personal care needs. To do this we looked at (case tracked) three peoples files from admission referral to the present time, and three staff files were examined. We also looked at other information such as complaints, incidents, events and other professional reports. We took the opportunity to speak with a number of people who are using this service, relatives and members of staff, who took an active role in our inspection process; their input contributed to the subsequent report. We acknowledged receipt of the Annual Quality Assurance Assessment (AQAA), eight survey forms returned to us that we sent Care Homes for Older People Page 6 of 33 out to people who use the service some weeks before the inspection, and six staff responses were received. We inspected a sample review of administrative procedures, practices and records, confirming satisfactory practice and management. There followed an inspection report feedback, involving the Registered Provider and Registered Manager, in which we offered an evaluation of the inspection, indicating those requirements and recommendations resulting from the inspection. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: We considered that much could be achieved by a review of activity and motivation, to Care Homes for Older People Page 8 of 33 facilitate and promote stimulation and diversion for people living in the Home. More variety in indoor activities would be beneficial, especially for people with dementia and other cognitive impairments. From our inspection we advised that the Care Manager ensures that every person admitted to the Home has a letter of confirmation following the appraisal of lifestyle and social needs, and that all assessments, care plans and ongoing monitoring is evidenced consistently through signature, and dating ownership. We consider that there be a review the state of maintenance of external facilities to enhance the surroundings for people to enjoy and use constructively. The summer house and side fencing are in need of renewal, and the garden area needs preparing for use. The cook was advised to maintain a consistent record of temperatures of fridge freezers, and a cleaning schedule, that reflects the good standard observed We advise that the Controlled Drug storage unit must be a metal cabinet, Rag Bolted to a solid adjacent wall, and a formal Controlled Drug Register is to be obtained. We also suggest that a separate fridge for storing medicines be obtained, to safely store appropriate medication, at a correct temperature, as prescribed. We advised that the staff record be reviewed in the way information is organised and presented, and to establish the practice of recording interviews, and follow up with letters of appointment to enhance the system and reinforce the agreements made on employment of staff, and to ensure that supervised practice meet the required six sessions a year, to capture the level of understanding of the staffs expectations and perceptions of the work they undertake in a more structured manner. The procedures manual as presented, needs updating to meet recent changes and new initiatives. The achievements have been recognised, attention to areas of further recommended detail will significantly enhance the provision of an honest, solid and homely service. 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 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people who may use the service are appropriately assessed before they are offered a place. They and their relatives can be confident that the service will be able to meet their needs. Evidence: We examined the services recently updated Statement of Purpose and Service User Guide, and found them to provide an informative description of Marlyn Houses aims, objectives, and the way it operated, and we acknowledged that the documents were presented to all enquirers, and produced in large print as and when necessary. We advised that the Guide be updated to reflect changes that have occurred recently, and that an audio and pictorial version would help people to make an informed choice. We also advised that a letter of confirmation be sent to the person and family as soon as an agreement has been reached. The weekly fees are not included in the Service User Care Homes for Older People Page 11 of 33 Evidence: Guide, and should people require more information they should contact the Care Manager direct. Our examination of three peoples care records and plans, confirmed that each person had an individualised pre-admission assessment, and were invited to visit the Home with family members, before any decision is made. We identified that the Care Manager or her deputy, at the point of reference, conducts the pre-admission assessment. We found that each record showed the attention to individuality, with the assessment formulating a care support plan, based on assessed, individual needs. This assessment is produced with the involvement of those people admitted and family, allowing them to have an influence in the direction of care. Following an assessment the assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage any special needs. Likewise people are informed of those facilities, and are encouraged to seek clarification concerning the general and specific services available for people who may use the service. Comments we received through the surveys returned and with speaking with people on the day: Makes me feel amongst friends, and are wanted by all the staff and patients. It provides a friendly family atmosphere for everyone. Quite happy with the home, the staff and the care I receive. Its what I expected. The plan of care presented a profile with physical, mental and social assessments, stimulating a daily living plan. We acknowledged through case tracking that any special needs of the individual were discussed fully and documented, ensuring their individual needs would be met. We saw that contracts had been exchanged and signed in a timely fashion, and from our discussions it was evident that people are able to visit and assess the quality, facilities and suitability of the Home at any reasonable time, to meet with staff and the management. Care Homes for Older People Page 12 of 33 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. A wide range of needs are addressed through the care planning process, meeting clear principles of respect, dignity and privacy towards people who use the service. Medicine administration systems are safe and secure. Evidence: Our examination of care records and case tracking showed a good quality process of assessment, with individual care plans developed for person admitted to the home. We found that the pre-admission assessment represented the foundation for a well considered, and detailed care planning process, including risk assessments for mobility and falls, tissue viability and nutrition. We recognise that peoples profiles offered an individual plan of care, based upon dependency assessment and activities of daily living. Each persons health, personal and social care needs were found to be appropriately assessed in an individual plan of care that is reviewed monthly, to reflect their changing needs and adapting care profiles, supported with an informative daily progress report. The AQAA stated, and we confirmed that those people who use the service, families and friends are invited to participate in the care planning process, and established monitoring systems following a process of goals, care, and evaluation Care Homes for Older People Page 13 of 33 Evidence: of quality care plans. Case tracking confirmed to us that specialist support and advice are sought as needed, with each person using the service having access to a local Doctor, Dentist, Optician, Chiropodist, and District Nurse as required. We consider that the strength of planned care lies within the frequency of the review process in monitoring and adapting care profiles and risk assessments. We, however, noted a consistent lack of ownership through failing to date and sign some records, to which the Care Manager responded immediately. Included in the care records were applications of established monitoring systems following a process of recognition and evaluation. Our observations showed that generally people using the service appeared to be content, comfortable and happy with their lifestyle, complimentary regarding the quality of their lives and the care they were receiving at Marlyn House. Comments we received in the course of inspection: I have everything I need, warmth, good food and caring staff. Care for the residents, ensuring they are happy and their individual needs are met, as well as giving support and reassurance to relatives. It provides the best care and understanding of the individual needs of our residents, we provide a homely environment for everyone. We continue to keep up to date at all times with the individual needs of our residents, and provide a safe and homely environment for everyone. Communications are good and they soon get the GP if medical problem. Always clean and tidy. Admin is good and helpful and the carers are friendly. We examined the Accident/incident records, and although a fair record of events, the Care Manager was advised to store accident records to care plans to comply with Data Protection. Cross referencing accidents and events with care plans showed a connection of appraisal. The administration of medicines adhered to procedures to maximise protection to people. We saw that ordering and storage was secure. We looked at the Controlled Drug (CD)arrangements, which were satisfactory, the records was examined and found it to be in order, although needs to be replaced with a formal Controlled Drug register. The metal cabinet used for storage requires Rag bolting to the wall. Random checks of medicine stocks against Medicines Administration Record (MAR) sheets Care Homes for Older People Page 14 of 33 Evidence: confirmed a consistent and accurate administration. Records were seen to be complete and easy to follow through, with no observed breaches in the system. Self medication and risk assessment policies were seen to be satisfactory with no one in at the time who wished to participate in the scheme. We confirmed that only senior care staff administer medication, all have received training in the Safe Handling of Medications. We found an effective and smooth process of ordering, receiving, storing, administering and disposing of medicines, although a suitable de-naturaliser container needs to be obtained to dispose of Controlled Drugs effectively. We advised that a separate fridge for storing medicines be obtained. Records were seen to be complete and easy to follow through, with no observed breaches in the system. All three people being cases tracked were found to have appropriate medication. It is stated in the services Statement of Purpose and the AQAA, that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of people. This was confirmed in our discussions with people who use the service. visitors and staff, and that relatives have freedom of visiting, which emphasised the importance of maintaining social contact. We looked at bedrooms presented to facilitate privacy for the individual, which included medical examinations and personal care procedures being performed in private. Our discussions with people confirmed that individual spiritual persuasions, and individual diversity was seen to be respected. There are regular weekly Church of England services held, and a Roman Catholic priest attends on a request basis. No other diverse religious needs were identified at the time of inspection. We were impressed with the confidence and closeness within the Home and the mutual respect that prevailed. Our discussion with visitors on the day was a fruitful exchange, with all being very complimentary of care. Care Homes for Older People Page 15 of 33 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. The care team promote the health, safety and welfare of people using the service, and working practices are satisfactory. There remains a need to promote social stimulation and activities to enhance daily living and quality of life. People who use the service can be assured that the home is run in their interests, based on openness and respect. People are offered a healthy, well balanced diet. Evidence: Throughout the period of inspection we found the daily routine to be flexible, offering choices and diversity for personal and social activities, religious needs and meals. Our discussions with people who use the service, and staff, identified a relaxed and informal atmosphere in which the peoples needs were respected, with the security that there are familiar events to the day they could relate to. People also exercise choice in the time they get up and go to bed. One daughter expressed her views: It provides a friendly family atmosphere for everyone. They make sure my mom eats and drinks so that she keeps well. Its a happy home. Always made me feel welcome, staff are helpful. Care Homes for Older People Page 16 of 33 Evidence: We reinforced the principle that activities are a key element in the socialisation and motivational approach to care, and involvement. The Home has a part time (two hours a week) activity coordinator, working with a limited budget, in an unstructured format, which showed deficiencies in the programme of events and commitment. During the course of the inspection we saw staff interact with people in a positive and polite manner, including a meaningful contact with people with dementia. We advise that attention be drawn to providing a substantial activity process and presence, to achieve a meaningful social, health and care programme. We recommend that creative ways of providing activities such as adapted equipment for those with disabilities; life story work and seeking individual interests would enhance life for people living in Marlyn House. This would be consistent with a Person Centred Care approach as stated in the Statement of Purpose. We also recognised that people would like the opportunity to enjoy outside activities in a potentially attractive garden and patio area, well suited for the task. Comments we received from surveys issued to people who use the service before the inspection: They could do more activities and things to do, and spend time with us. There are always activities arranged each week, but now I am not able, or interested in taking part in them. It provides the best care and understanding of the individual needs of our residents, we provide a homely environment for everyone. The staff are all well motivated, and great efforts are made to stimulate the residents. It is stated in the Statement of Purpose that personal choice and relative self determination are respected in policy and action. Throughout the inspection we found this to be true. Those individuals rooms inspected showed an influence of personalisation in the inclusion of belongings, some furniture and general decor, although attention was drawn to addressing the personal needs of people with dementia, in the furnishing of bedrooms. Our inspection of the Home demonstrated a degree of expressed individuality in most of the bedrooms inspected. Relatives and friends are encouraged to maintain social links as part of the planning of care, and are actively encouraged to participate in the daily life of the home, with no restriction being placed on visiting times. During the course of the inspection we saw staff and visitors interact with people in a positive and polite manner. Comments received from relatives on the day confirm their appreciation and involvement with the progress of their loved ones health and social status They are very good at providing a very caring, loving, homely atmosphere. Care Homes for Older People Page 17 of 33 Evidence: We found that the standards of catering continue to offer a satisfactory service, to which those people we spoke with were complimentary. A menu, organised by the cook and Manager on a weekly basis offered a varied and suitable choice. We observed a pleasant lunch served during inspection, a choice of two main meals, and desserts. The quality and quantity of the food offered on the day was observed to be of a satisfactory standard, confirmed by those people we talked with, served in a comfortable and clean dining room. Most people were able to eat independently, but where assistance was needed it was offered in a polite and respectful manner, and at a level appropriate to individual need to encourage independence and maintain dignity. The choice of dining room, lounge or bedroom was at the discretion of people living in the home. People interviewed confirmed that that the quantity and quality food provided was good: Very good standard of cooking and choice available. Its always set out so nice. I have everything I need, warmth, good food and caring staff. We confirmed that the cook knew each person using the service, and some of the relatives. We discussed diversity with the cook, who indicated an awareness in meeting individual needs; there were no special (cultural) needs at the time. Individual preferences were recorded in assessment and conveyed to the catering staff, who met with, and discussed their requirements. Care Homes for Older People Page 18 of 33 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. The service has a meaningful complaints policy. People are given opportunities to freely express any concerns, and these are quickly responded to. People are protected from abuse, and their human rights are promoted. Evidence: We found that peoples legal rights are protected by the systems in place in the service to safeguard them, including their contract, the continual assessment of care planning and policies in place, for example, the complaints procedure, which we examined. There were few minor concerns dealt with through a record of concerns, complaints and safeguarding, to record peoples concerns in a meaningful and effective manner. From our talks with people who use the service, and staff, it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. We saw evidence in case tracking that people had received information on the procedure to complain, including reference to us. This process was evidenced through the Service User Guide, on examination and case tracking and discussion. We identified that there had been no complaints made to us directly since the last inspection. We identified that there had been no formal complaints received by the Registered Provider, although minor issues had been handled and dealt with by the Care Manager. There have been no safeguarding issues raised concerning people who Care Homes for Older People Page 19 of 33 Evidence: are living in the home. Comments we received from people on the day of inspection: As I have lived here for a few years I know who to speak to if Im not happy, the matron is very approachable and always listens, and is very good at sorting things out. If I have any little problem there is usually some one to speak to. Our discussion with the Care Manager confirmed that there is satisfactory evidence of a protocol, and response to anyone reporting any form of abuse, to ensure effective handling of such an incident. The policy and procedure for handling issues of abuse was examined, and found to be appropriate. We examined three staff records to confirm that staff were suitably checked through Criminal Records Bureau (CRB), and Protection of Vulnerable Adult (POVA) disclosure. We found staff received training on abuse at induction, this includes the right to Whistle blowing, consistent with the Public Disclosure Act, 1998. Care Homes for Older People Page 20 of 33 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 Home provides a safe, well-maintained, clean and comfortable environment for the people who use the service, which encourages independence. Evidence: Marlyn House is a detached residential home about a mile from the centre of Cannock, where all services, shops, entertainment, hospital, and transport can be found. The service provides care to older people, some of whom may have a physical disability or dementia care needs, and providing accommodation for eighteen people. External access is satisfactory for visitors, with adequate parking available. We found the gardens providing a pleasant outlook, although needing some maintenance. We found an unsecured, and damaged gate to the side of the building, and the summer house needs upgrading. There is adequate exterior security lighting, and all external doorways are secure. There was level access into the building, which was suitable for people who use wheelchairs, or have mobility problems. Comments received from people we met through inspection were all complimentary of the quality of their place of living, indicated: We always find the home clean and tidy, my father seems to be very comfortable with his situation. It provides a friendly family atmosphere for everyone. Care Homes for Older People Page 21 of 33 Evidence: I came here from another home, but it is almost as good as my own home, Im very comfortable, and my room is lovely. On admission the Care Manager or her deputy assesses each individual persons needs for equipment and necessary adaptations. Internal access was equipped with ample fittings of hand and grab rails, facilitating wheelchair access throughout most areas of the home. We found sufficient hoists and a range of aids and adaptations to assist people who are dependent. The Care Manager confirmed to us a willingness on the part of management to meet any reasonable demand for special needs. Efforts had been made to provide a homely atmosphere, and the decor in most areas of home was found to be of a good standard. The home provides lounge areas that were pleasantly decorated, providing essential furnishings and items to provide comfortable areas where people were able to interact, or to entertain their guests. A compact, homely dining area was clean and conducive to enjoy a good meal. The carer call alarm system was satisfactorily tested, with a good response from staff on duty. Our inspection of bedrooms found them well equipped and maintained to provide for peoples individual needs and preferences, personalised, with most displaying the personal furniture and belongings. There is a need to consider the individuality of personal space, especially in recognising the needs of people with dementia. We found the overall quality to be an improving good standard, presenting a homely and comfortable environment. Several people we spoke to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. Bathrooms, showers and toilets are located on both floors, near to bedrooms and communal areas, and fitted with appropriate aids and adaptations to meet the needs of people who use the service. We found them to be of a good quality, clean, and odour free, visible with appropriate recognisable features, although one on the first floor was found to have a collection of toiletries, and a unsecured air freshener. The care manager dealt with the issues immediately. Sluice facilities have suitable arrangements to assist in control of infection. Notices regarding chemical handling in the areas that store chemicals are displayed. The laundry was equipped to a good standard, wiith appropriate notices regarding chemical handling openly displayed. Disposable gloves and aprons were seen in use, and liquid soap and paper towels were evident throughout. The Home presented a clean and pleasant, mainly odour free atmosphere, much to the credit of staff. Comments from a survey we sent out, and from people we met in the course of inspection: They are good at presenting a caring, loving, homely atmosphere. Care Homes for Older People Page 22 of 33 Evidence: Our mum has returned to a lovely area and very comfortable bedroom, altogether a very pleasant environment. The home achieves a good standard of cleanliness. The heating arrangements throughout the home are by central heating with guarded radiator convection, providing an ambient temperature. Lighting facilities, including individual bed lights, and overall emergency lighting were installed and regularly maintained by the handyman. Water temperature were randomly tested and found to be slightly high, requiring regulating. Each room was fitted with a tested fire/smoke alarm. Ventilation is by direct door and window airing. The kitchen presentation showed good standards of cleanliness and evidence of sound food hygiene practices. All fridges and freezers were seen to be used in the appropriate manner, and were checked daily by the kitchen staff, and a cleaning schedule was in place, although both records are inconsistently signed off, needed to evidence the good quality of cleanliness observed. We spoke with the cook who confirmed to us that she actively engages with people who use the service to determine their needs and likes and dislikes. She was aware of the issues of culture, ethnicity and age diversity, having had experience in dealing with a diverse population. The Annual Quality Assurance Assessment completed by the service prior to the inspection confirms that the building complies with the requirements of the local fire service and environmental health department, and records are kept accordingly. Care Homes for Older People Page 23 of 33 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 fulfill the aims of the unit and meet the changing needs of people using the service. Evidence: We confirmed that there were 17 people living in the home on the day of the inspection. Three weeks of staffing rotas showed to us an adequate balance between skills, experience and numbers to provide a good standard of care. Discussions with staff also confirmed their commitment to providing a quality service and their awareness of the principles of good practice. At the time of the inspection the average care staff coverage was seen to be: Morning 1 Senior 2 carers Evening 1 Senior 2 carers Nights 1 Senior 1 carer We recognised that the Care Manager is supernumerary to the staffing roster. Flexible rostering with agreed overtime are used to accommodate shortfall due to sickness and absence, and we noted that the use of agencies are at minimum. Discussions with staff also confirmed their commitment to providing a quality service and their Care Homes for Older People Page 24 of 33 Evidence: awareness of the principles of good practice. The catering, maintenance and domestic hours were determined and found to be appropriate for the size of the home and the needs of people. The Provider and Care Manager have established procedures for interview, selection and appointment of staff, although lacking consistency for all employees. The thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of people. All new staff goes through an induction process, that will ensure that they are going to be the right person for the home. We advised that the staff record be reviewed in the way information is organised and presented, and to establish the practice of recording interviews, and follow up with letters of appointment to enhance the system and reinforce the agreements made on employment of staff. Staff are employed in accordance with the Code of Conduct and Practice set by the General Social Care Council. Discussions with the Registered Care Manager confirmed that more than 80 per cent of care staff had receipt of the National Vocational Qualification (NVQ) at level II or III. There was evidence that a training schedule has been established, and that an effective training programme is undertaken to ensure that all staff have up to date portfolios of achievement and qualification to maintain quality of standards. We recognised that five staff had received dementia awareness training. All staff advised us that they received a good induction programme on starting work at Marlyn House. We found on speaking to staff that staff morale is very high with a strong motivation towards their work. We have also recognised the efforts to establish an awareness of Mental Capacity Act and Deprivation of Liberties with increased training sessions, and a First Aid session booked for nine staff in July. A staff photograph in each file would be helpful. Comments we received from people we spoke with on the day and staff members we interviewed: We are more than happy and satisfied with the care. Makes me feel amongst friends, and are wanted by all the staff and patients. It works well as a team and has good relationships with residents and family. The home meets all residents individual needs very well. Training is always available to staff to keep us up to date with new ways of working in the relevant job role. It works well as a team and has good relationships with residents and family. Care Homes for Older People Page 25 of 33 Evidence: The home meets all residents individual needs very well. Training is always available to staff to keep us up to date with new ways of working in the relevant job role. Records were available to demonstrate an inconsistent process of supervised practice, failing to meet the required six sessions a year. There is a need to capture the level of understanding of the staffs expectations and perceptions of the work they undertake in a more structured manner. Care Homes for Older People Page 26 of 33 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 care team promote the health, safety and welfare of people using the service, and working practices are safe. People who use the service can be assured that the home is run in their interests, based on openness and respect. Evidence: The experienced Home Manager Denise Seymour, has over the years demonstrated effectiveness in establishing a solid management foundation, implemented to achieve a good standard of set aims, objectives and care. She has been actively engaged in quality reviews and audits with the Registered Provider, following our last inspection and registration with us, meeting compliance to requirements, and addressing recommendations we made. She is presently completing the Registered Managers Award (RMA) qualification. We observed an openness, professional and pleasing confidence in the interactions of staff, relatives and people who use the service, based on mutual trust and respect. Comments from those people we met in the course of Care Homes for Older People Page 27 of 33 Evidence: inspection told us: It provides the best care and understanding of the individual needs of our residents, we provide a homely environment for everyone. Denise operates an open door policy, whenever I wanted to talk she will come along and sits with me, which makes me feel better.. Marlyn House is a home from home, very relaxed, friendly, homely atmosphere. Through the inspection process we found appropriate risk assessments in place for people using the service, through care planning and monitoring, staff selection and of the general environment, these are up to date and accurate. Health and safety notices can be seen throughout the Home, although Chemicals safety notices (COSHH) should be prominent in areas of use and storage. An examination of administrative, monitoring, planning and care records showed to us that record keeping has not been consistent, especially on staff training and appointment schedules, and maintaining dating and signature ownership of record updates. Records inspected included surveys asking people who use the service their opinion, these are conducted annually. The Manager offered evidence of procedures and safe working practices including: Challenging Behaviour, Medications, and missing persons procedure. We consider that the procedures manual as presented needs updating to meet recent changes and new initiatives. Records were available to demonstrate an inconsistent process of supervised practice, failing to meet the required six sessions a year. There is a need to capture the level of understanding of the staffs expectations and perceptions of the work they undertake in a more structured manner. The accident book was seen and found to be in order, with a regular analysis of trends and frequency. Our examination of those records showed an effective follow through of action taken, including a review of care plans if necessary. The Care Manager was advised to archive accident records to individual care files, in accordance with Data Protection requirements. We were informed through the AQAA, and by the manager that financial arrangements are supervised and administered by the Registered Provider and care manager in respect of pocket money, comfort fund and petty cash management. Care Homes for Older People Page 28 of 33 Evidence: The administration and management of the home is considered by us to be efficient, uncomplicated, and sensitive to the needs of people. Care Homes for Older People Page 29 of 33 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 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 We would recommend that a letter of confirmation be sent to the person and family as soon as an agreement has been We noted a consistent lack of ownership through failing to date and sign some records, which are required to effectively appraise the effectiveness of care planning. The Care Manager was advised to store accident records to care plans to comply with Data Protection regulations. The Controlled Drug storage unit must be a metal cabinet Rag Bolted to a solid adjacent wall, and a formal Controlled Drug Register is to be obtained. We advised that a separate fridge for storing medicines be obtained, to safely store appropriate medication at a correct temperature, as prescribed. We advise that attention be drawn to providing a substantial activity process and presence, to achieve a meaningful social, health and care programme That the Registered Provider ensures that the external fabric and security are addressed to make those facilities Page 31 of 33 2 7 3 4 7 9 5 9 6 15 7 19 Care Homes for Older People 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 safe for peoples use. 8 9 10 21 21 26 That all bathrooms and showers have a lotion thermometer available to check water temperatures. The Care Manager will ensure that bathrooms are free of collective toiletries, and that air fresheners are secure. That the kitchen manager maintains a consistent record of temperatures of fridge freezers and a cleaning schedule that reflects the good standard observed. That the arrangements for activities need review, with people requiring more in the way of effective motivation to socialise and engage, especially in addressing dementia care needs. We advised that the staff record be reviewed in the way information is organised and presented, and to establish the practice of recording interviews, and follow up with letters of appointment to enhance the system and reinforce the agreements made on employment of staff. We consider that the procedures manual as presented needs updating to meet recent changes and new initiatives. Records were available to demonstrate an inconsistent process of supervised practice, failing to meet the required six sessions a year. There is a need to capture the level of understanding of the staffs expectations and perceptions of the work they undertake in a more structured manner. 11 28 12 29 13 14 33 36 Care Homes for Older People Page 32 of 33 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. 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