Care Home: Marner House

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What the care home does well The service consistently meets or exceeds the key national minimum standards ensuring positive outcomes for people. The service continues to have information available for prospective new people to the home to help them to make an informed choice. People’s needs continue to be assessed before they move in and they are encouraged to visit and see what the home has to offer before they make a decision to live there. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Peoples’ support plans are detailed and informative, ensuring that staff are able to meet individuals assessed needs. Comprehensive risk assessments enable people to take meaningful risks in a safe manner. People are actively supported to make decisions about their lives both on a daily and more long term basis as they progress through their recovery journey. Consideration is given to peoples’ interests, hobbies and leisure pursuits when planning activities. The involvement of relatives, families and friends is considered to be of paramount importance, and is encouraged by the service. A clean, tidy, well stocked kitchen enables people to choose from a range of meal options that take into account personal preferences, healthy eating and necessary specialist diets. In addition the services’ training kitchen aids the learning or relearning of skills necessary to enable people to keep themselves fed and hydrated when they are ready to move back into the wider community. The service continues to respect peoples’ cultural differences, and works to maintain links that have been forged with the local mosque. Personal support is provided sensitively and discreetly where necessary, in line with individually assessed needs. The health and wellbeing of people is promoted via attendance at routine and more specialized healthcare appointments as necessary. Medication is managed safely on people’s behalf. The service has both a complaints policy and an adult protection policy in place. The complaints procedure has been provided in a format that is meaningful to people. No complaints have been received by the service or us. Staff were aware of their responsibilities regarding adult abuse. No allegations or suspicions of abuse have been made or received by the Commission for Social Care Inspection. One suspicion of and one allegation of abuse have been received by the service, which the manager has dealt with appropriately. The service is decorated to a high standard and furnished with good quality furniture and soft furnishings .The service is also well equipped for wheelchair users, with wide hallways, specialist bath and shower rooms and two en-suite bedrooms with fitted ceiling track hoists. There is a lift to help people to get up and down stairs. The service employs satisfactory staff numbers to meet peoples ongoing and changing needs. The staff team demonstrate a commitment to supporting the people resident with their ongoing rehabilitation. A comprehensive training programme ensures that people are supported by a competent and sufficiently knowledgeable team. The home is managed by a competent and experienced manager who is in turn supported by a dedicated acting deputy manager and senior support team. Both the people living in the service and staff team appeared to have a good Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 8rapport with the manager and spoke highly of him. The home has a quality monitoring system in place that ensures that people’s views are at the forefront of service development. Health and safety is managed effectively within the home. What has improved since the last inspection? Nine good practice recommendations were made at the first inspection of this service. The annual quality assurance assessment completed by the manager and sent to us prior to the inspection confirmed that action has been taken to address all of them. This was checked during the site visit for this inspection, and confirmed as follows: • One person with communication difficulties has been provided with a computerised communication aid, via speech and language therapy services, which both he and the staff team are familiarising themselves with. All of the support plans have been completed, with the exception of the person who has recently moved into the home, and continue to be works in progress as peoples needs change. Specialist healthcare providers have been brought in and trained the staff team with meeting individuals’ needs as necessary. Procedures have been put in place to manage “as and when” medication administration. Staff have been provided with equality and diversity training. Staff are routinely enrolled on the appropriate NVQ as they complete their six month probation period. Risk assessments are in place for each individual that wishes to use the gym equipment available in the service.• • • • • • What the care home could do better: No requirements or good practice recommendations have been made as a result of this inspection. Key inspection report CARE HOME ADULTS 18-65 Marner House Rear of 79 Fitton Street Nuneaton Warwickshire CV11 5RZ Lead Inspector Justine Poulton Key Unannounced Inspection 22nd June 2009 09:30 Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marner House Address Rear of 79 Fitton Street Nuneaton Warwickshire CV11 5RZ 02476 641492 02476 327499 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.voyagecare.com/ Voyage Care Services Mr Marc Russell Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8), Physical disability (8), Sensory of places impairment (8) Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: Physical Disability (PD) 8 Mental Disorder (MD) 8 Sensory Impairment (SI) 8 The maximum number of service users to be accommodated is 8 2. Date of last inspection 30th June 2008 Brief Description of the Service: Marner House can accommodate up to eight people and is designed to be in keeping with the local community. The home is sited near to Nuneaton city centre, behind Fitton Street and is approached via an access road. There is ample parking to the front of the property. There are eight single occupancy bedrooms which all have en suite facilities. Bedrooms are well appointed and furnished There are two bedrooms on the ground floor and six on the first floor. Two ensuite bathrooms have ceiling hoists fitted and all the other bedrooms have adaptations to the en suite bathroom doors, to enable the fitting of hoists should people need this equipment. The home is bright, airy and pleasantly appointed giving a homely and domestic feel despite the size of accommodation. The hallways are wide and provide good wheelchair access and there is a lift to enable people to get up and downstairs. There is a pleasant rear garden mostly laid to patio and lawn that backs onto the local canal. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 5 The range of fees for this service are available directly from the manager. Each person’s fees are identified in their personal Service User Guide. The people at the home are required to pay a contribution to the cost of their care, based on a personal financial assessment. People using the service are also required to pay for personal items, such as clothing and toiletries. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means that people who use the service experience excellent outcomes. This was the second key unannounced inspection of Marner House. A key inspection addresses the essential aspects of operating a care home. This type of inspection seeks to establish evidence of safety and positive outcomes for the people using the service. The inspection focused on assessing the main Key Standards as defined under the Care Homes Regulations 2001. As part of the inspection process we reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents and complaints. We also sent an Annual Quality Assurance Assessment (AQAA) to the manager to complete and surveys to a selection of people currently living in the service and staff. The manager completed and returned the annual quality assurance assessment (AQAA), containing helpful information about the home in time for the inspection. Questionnaires were completed and returned by four people that live at the service and two members of staff. This enabled them to give their views of the service they receive and inform the inspection process. The inspection included meeting four people currently resident in the service and case tracking the needs of two people. This involves looking at people’s care plans and health records and checking how their needs are met in practice. Other people’s files were also looked at, in part. Discussions were held with the manager and the acting deputy manager, as well as with four people currently resident and eight staff members. A number of records, such as support plans, complaints records, staff training information and health and safety records were also sampled for information as part of this inspection. What the service does well: The service consistently meets or exceeds the key national minimum standards ensuring positive outcomes for people. The service continues to have information available for prospective new people to the home to help them to make an informed choice. People’s needs continue to be assessed before they move in and they are encouraged to visit and see what the home has to offer before they make a decision to live there. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 7 Peoples’ support plans are detailed and informative, ensuring that staff are able to meet individuals assessed needs. Comprehensive risk assessments enable people to take meaningful risks in a safe manner. People are actively supported to make decisions about their lives both on a daily and more long term basis as they progress through their recovery journey. Consideration is given to peoples’ interests, hobbies and leisure pursuits when planning activities. The involvement of relatives, families and friends is considered to be of paramount importance, and is encouraged by the service. A clean, tidy, well stocked kitchen enables people to choose from a range of meal options that take into account personal preferences, healthy eating and necessary specialist diets. In addition the services’ training kitchen aids the learning or relearning of skills necessary to enable people to keep themselves fed and hydrated when they are ready to move back into the wider community. The service continues to respect peoples’ cultural differences, and works to maintain links that have been forged with the local mosque. Personal support is provided sensitively and discreetly where necessary, in line with individually assessed needs. The health and wellbeing of people is promoted via attendance at routine and more specialized healthcare appointments as necessary. Medication is managed safely on people’s behalf. The service has both a complaints policy and an adult protection policy in place. The complaints procedure has been provided in a format that is meaningful to people. No complaints have been received by the service or us. Staff were aware of their responsibilities regarding adult abuse. No allegations or suspicions of abuse have been made or received by the Commission for Social Care Inspection. One suspicion of and one allegation of abuse have been received by the service, which the manager has dealt with appropriately. The service is decorated to a high standard and furnished with good quality furniture and soft furnishings .The service is also well equipped for wheelchair users, with wide hallways, specialist bath and shower rooms and two en-suite bedrooms with fitted ceiling track hoists. There is a lift to help people to get up and down stairs. The service employs satisfactory staff numbers to meet peoples ongoing and changing needs. The staff team demonstrate a commitment to supporting the people resident with their ongoing rehabilitation. A comprehensive training programme ensures that people are supported by a competent and sufficiently knowledgeable team. The home is managed by a competent and experienced manager who is in turn supported by a dedicated acting deputy manager and senior support team. Both the people living in the service and staff team appeared to have a good Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 8 rapport with the manager and spoke highly of him. The home has a quality monitoring system in place that ensures that people’s views are at the forefront of service development. Health and safety is managed effectively within the home. What has improved since the last inspection? Nine good practice recommendations were made at the first inspection of this service. The annual quality assurance assessment completed by the manager and sent to us prior to the inspection confirmed that action has been taken to address all of them. This was checked during the site visit for this inspection, and confirmed as follows: • One person with communication difficulties has been provided with a computerised communication aid, via speech and language therapy services, which both he and the staff team are familiarising themselves with. All of the support plans have been completed, with the exception of the person who has recently moved into the home, and continue to be works in progress as peoples needs change. Specialist healthcare providers have been brought in and trained the staff team with meeting individuals’ needs as necessary. Procedures have been put in place to manage “as and when” medication administration. Staff have been provided with equality and diversity training. Staff are routinely enrolled on the appropriate NVQ as they complete their six month probation period. Risk assessments are in place for each individual that wishes to use the gym equipment available in the service. • • • • • • 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. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. The service continues to have information available for prospective new people to help them to make an informed choice. People’s needs continue to be assessed before they move in and they are encouraged to visit and see what the home has to offer before they make a decision to live there. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The service has a detailed Statement of Purpose and Service User Guide available for people being referred. Copies of these are available in the hallway of the service and each person has a copy within their personal support file. Information provided by the manager in the Annual Quality Assurance Assessment (AQAA) states that a Regional Assessment Manager is employed by the organisation to identify and match potential people with any vacancies in the service. This then leads the manager onto a basic initial assessment of any individual which seeks information from all relevant parties, in order to assist with making an accurate assessment of whether the service will be able to meet their holistic needs, desires and aspirations. Evidence of such assessments were available within the support plans looked at as part of the Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 11 case tracking process. This then progresses onto a more detailed assessment once the placement has been agreed. In addition, completed and current assessments from the purchasing authority were available within the two files looked at. The service provides the opportunity for newly referred individuals to visit, spend time with meet people with a view to beginning to familiarise themselves with the environment prior to them moving in. Visits to the person in their current placement are also be made by staff from the service. One person spoken with confirmed that they had visited prior to moving in. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. Peoples support plans enable staff to effectively meet individually assessed needs. Risk management processes enable people to take controlled risks with a safe framework as part of their rehabilitation process. People continue to be supported to make everyday choices thus exercising some control over their everyday lives. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Each person currently residing at the service has their own support plan. The manager explained that these have been adapted from the learning disability support plans used by the organisation, to accommodate people with acquired brain injury. He also advised that the organisation is planning on developing a support plan format that will be targeted to the needs of people who have Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 13 acquired a brain injury, and that Marner House is to trial these plans to ensure that they consistently and effectively support people with an acquired brain injury. The support plans are compiled by the individual concerned, the manager of the home, key support staff and family members where the individual agrees. Each person has to agree to their support plan upon completion before it is implemented. Individuals signatures were available within the plans looked at to confirm that they have been involved in the planning of their support. Two peoples’ support plans were looked at as part of the case tracking process. A third was looked at in part. It was noted that a completed pre admission assessment of need was in place in these files, along with information about any professional support networks, preferred daily routines, likes and dislikes, a suggested weekly plan of activities, communication abilities, health care support and prescribed medication. Reports from other associated healthcare professionals were also in place. In addition to this information, individual areas of support ranging from personal care needs through to activities undertaken were thoroughly documented along with how best to provide such support. The manager and the deputy said that although the support plans are formally reviewed a minimum of three monthly, realistically each identified area within them are reviewed and rewritten as peoples needs change through their rehabilitation process. Staff spoken to throughout the inspection were clearly aware of each persons support needs and were observed to work with people in a positive manner. Similarly people were seen to respond well to the staff team. Three people spoken to indicated that they are happy with the staff team, they are approachable and that they support them where necessary to live their lives as they wish. In discussion the manager clearly demonstrated a belief that enabling people to take risks as part of their rehabilitation positively promotes well being within their recovery journey. As such each individually assessed area of support was seen to have an accompanying risk assessment attached to it. These were comprehensively completed and ensure that each person is able to take controlled risks within a safe framework. Throughout the inspection people were clearly able to make decisions about their lives with as much or as little support as necessary from staff. This extended from choosing what time to go to bed and get up, what to eat, what to do, whether to go out and eat or stay at home. One person was offered the opportunity to go out for lunch, which he declined, saying “I’d rather stay here and get it for free.” Two other people spoken with said that they were happy living at the home, and were supported to do what they wanted. “I like it here, it beats being at home, I can stay in rather than having to go out all of the time…” Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 14 The aim of the service upon someone moving in is to support them through their rehabilitation onto the next phase, which maybe moving back into the wider community. The manager said that since it opened, the service has successfully supported two people to do this, and that a further two people currently resident are fast approaching the point where they will be ready to move onto the next stage of their recovery journey. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience good quality outcomes in this area. People have opportunities to redevelop their social, emotional, communication and independent living skills through positive staff support. People choose and participate in suitable leisure activities. Relationships with families and friends are promoted. A healthy, nutritious diet is provided for people. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: It was apparent during the inspection that each person currently living in the service is respected as an individual. Their daily activity schedules are reflective of their individual lifestyle choices and cultures and each person is allocated some one to one time each day, as part of their day service, to ensure that they are able to participate in their chosen activity. Similarly, staff spoken with were clear that should someone choose to do something different Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 16 to their planned activity this is facilitated as they wish. One person has developed a talent for art, and had a number of original art works on display throughout the service. He was clearly proud of his work, and keen to show off other works in progress. The manager said that at the present time the service was without a vehicle as people currently resident had expressed a dislike of the minibus, stating that they felt it singled them out within the community. This was taken on board by the organisation, and at the time of the site visit the arrival of a new car to replace the minibus was awaited. Information provided in the services’ annual quality assurance assessment states that “high staffing ratios ensure that lifestyle choices are supported and good systems of communication are in place to ensure that the activities offered or chosen are meaningful and enjoyable”. This was clearly the case during the inspection visit, as people were seen to participate in various activities. Other activities planned for the week were on display on a white board in the kitchen for people to refer to. This included a night out to a local live music venue. One survey received from a person currently resident in the service indicates that they are supported and able to do what they want to do throughout the day. Another person spoken with said “it’s nice here; I am able to choose what I do…” The manager said he has developed positive links with the local beat policeman who pops into the service on a regular basis to chat with whoever is around. He also stated that the service has forged good links with the local mosque who ensure that the cultural beliefs of people currently resident are supported where desired. All of the people currently resident in the service have close family, relationship and friendship ties that the manager and staff team demonstrated a commitment to supporting. The manager said that the service currently does not have an overnight facility for visitors, and this is something that he is looking into, however he needs to ensure that all of the necessary legal aspects are covered, before facilitating this. Two people invited us to their personal space, and it was nice to see plenty of photographs of family members and friends on display. At the time of this visit no one currently resident in the home was the subject of Deprivation of Liberties legislation. The service has a large, modern kitchen/diner with all of the necessary appliances available for use. It was clean, tidy and the hub of the service with people gathering there to chat, participate in activities or just chill out. There was a variety of fresh, frozen and processed foods available for people. Opened foods were seen to be covered and dated. Foods specific to identified diets or particular cultures were seen to be stored appropriately. Cooking Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 17 utensils used for preparing meals in line with specific cultures were also stored separately. A menu is planned on a weekly basis with people that takes into account their preferences, healthy eating principles and any special diets. People are encouraged to participate in making their own meals as far as they are able. One person has been provided with a fridge and weekly food budget. Staff provide support for this person with budgeting, shopping and meal preparation in readiness for when he moves on from the service to more independent living. Staff were able to explain how they practice safe food hygiene principles and records such as daily fridge and freezer temperatures and core food temperatures were available. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. Personal support is provided sensitively and discreetly where necessary, in line with individually assessed needs. The health and wellbeing of people is promoted via attendance at routine and more specialized healthcare appointments as necessary. Medication is managed safely on people’s behalf. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: It was apparent throughout our visit to the service that people had varying personal care support needs. These were clearly documented within their support plans, and staff were seen to assist people as they requested both discreetly and sensitively. It was also apparent that individual preferences based on personal lifestyles were respected. All of the necessary equipment required to support people with their personal care needs was in place. The manager recorded in the annual quality assurance assessment (AQAA) that Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 19 aids and adaptations used or required are “the most suitable for the individual”, and are obtained following advice from relevant professionals”. Peoples individual healthcare needs were clearly identified within the support plans looked at. Each person also has a healthcare file which included both their routine health matters such as visits to the dentist, optician and chiropodist along with more specialised healthcare information such as diabetes support, speech and language therapy, physiotherapy and dietician input. In addition the organisation employs a Behavioural Therapist and a Neuropsychologist who are available to provide guidance and support to the staff team. Information in the annual quality assurance assessment (AQAA) states that the service is looking into the “implementation of a health action plan with support from the local authority/PCT that is linked to any physical health needs that have been identified within each persons individual support plan”. The acting deputy manager said that it was hoped that this would be facilitated within the next 12 months. Recommendations regarding the healthcare of people resident in the service made at the first inspection of this service have been addressed. A diabetes nurse specialist has provided training in diabetes management for the staff team and pressure area care training has been provided to ensure that staff are able to monitor the skin health of those people who may be susceptible to skin breakdowns. The acting deputy manager has responsibility within the service for ensuring that medication is managed safely. She is supported with this by the senior staff team. People are risk assessed upon moving into the service with regards to self administering their medication. Facilities and support are provided to assist people with this where appropriate. The service currently manages each persons medication on their behalf. Medication is supplied to the service by a local pharmacy utilising the multi dispensing system (MDS). This is accompanied by medication administration record charts (MARS). Any medication that is not suitable for the MDS is accounted for on a separate chart that is signed by staff to confirm the number of tablets received and administered against the number that are left. Photographs were available next to each persons medication area within the lockable cupboards used for storing medication. They were also with each MAR chart to aid with ensuring that medication is administered to the correct person. The MAR charts looked at were completed accurately and codes for non administration were used appropriately. Information in the annual quality assurance assessment (AQAA) states that “staff receive accredited training on the principles of administration and controls of medicines as well as specific training on the use of the Boots MDS system…” Staff spoken with and training records looked at confirmed this. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 20 The recommendations regarding “as and when” medications made at the first inspection of this service have been addressed. Protocols signed by the relevant GP’s were seen to be in place for the storing, recording, administering and monitoring of these medications. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. The homes policies on complaints and protection from abuse ensure that people’s views are listened to and acted upon, and that people are safeguarded from harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The service has a robust complaints management system in place which is known as “I Want to Complain” This procedure was available within each persons Service User Guide, as well as the Statement of Purpose and an information pack available in the main hallway. In addition each person has been provided with confidential “I am Worried” cards complete with pre paid envelopes that they can post off to head office should they wish to talk to someone about the service they are receiving. Three people spoken with said that they knew who to talk to if they were unhappy about anything and would feel comfortable in doing so. One person said that he had no complaints; “ place is nice, staff are good, food is good, bed is clean”, another said “it’s a nice place, I like it here, everything is good”. The annual quality assurance assessment (AQAA) records that no complaints have been received by the service. This was confirmed by the manager and records looked at. We have not received any complaints about the service during the last 12 months. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 22 As well as a complaints procedure the service also has a prevention of adult abuse procedure in place and adheres to the local joint working policy and procedures on safeguarding vulnerable adults. Staff training records indicated that all of the staff team have received training in this area over the last 12 months. This was confirmed by eight staff members spoken with, who were able to say what they would do should abuse be suspected, disclosed or witnessed. Up until the inspection there had been one suspicion of abuse involving missing money. An allegation was received during the inspection of alleged abuse from an external source. Both incidents were reported appropriately to the safeguarding lead within the local authority and we were notified of them and the subsequent actions taken by the manager under regulation 37. (which is a regulation that requires that the Care Quality Commission be notified of anything that does or may adversely affect the health and welfare of service users). The outcomes of each investigation have also been reported appropriately. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. The service is decorated to a high standard and furnished with good quality furniture and soft furnishings .The service is well equipped for wheelchair users. There is a lift to help people to get up and down stairs. Staff are aware of infection control procedures and implement them to ensure that individuals are free from potential risk. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Marner House is a relatively large, purpose built service that provides a welcoming atmosphere for anyone residing in, working in or visiting the service. The service is sited near to Nuneaton city centre, behind Fitton Street and is approached via an access road. There is ample parking to the front of the property. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 24 There are eight single occupancy bedrooms all of which have en suite facilities. Two of the bedrooms are on the ground floor and six are on the first floor. Two ensuite bathrooms have ceiling hoists fitted and all the other bedrooms have adaptations to the en suite bathroom doors, to enable the fitting of hoists should people need this equipment. Two bedrooms were seen, both of which were personalised with photographs, ornaments and pictures along with other personal effects belonging to each individual. There is a spacious lounge, large kitchen/diner and gym facility available for people to use, along with a well appointed rear garden, that backs onto the local canal, that is accessed via french doors from the dining area. Décor, furniture and soft furnishings throughout were modern and of a high quality, creating a pleasant homely feel. Artwork by a current resident of the service is displayed throughout. There is plenty of space in the communal rooms and individual bedrooms seen, the hallways are wide and provide good wheelchair access, there is a lift to enable people to get up and downstairs and everywhere was clean, tidy and well ordered with fresh and pleasant smells throughout. Gloves and aprons continue to be available for staff to use as necessary. Good infection control procedures were in place and staff were aware of them. Training records seen confirmed that all staff have received training in infection control. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. People benefit from sufficient numbers of competent, knowledgeable staff who are recruited appropriately in order to safeguard them from potential harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The service employs 14 support staff, one day support staff member, an acting deputy manager and the registered manager. In addition there are two bank workers available to cover shifts as necessary. During the inspection there were three support staff on duty along with the day support worker. This was reflected in the rota and staff spoken with throughout the visit confirmed that that staffing levels were satisfactory based on peoples assessed needs. Over night there is one waking night staff and a sleep in staff member available should anyone require assistance or support. The manager confirmed that when there are eight people resident he will be increasing the staff numbers on shift during the day accordingly. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 26 In discussion with staff it was apparent that they come from a wide variety of backgrounds and experience which creates “a staff team that is rich in diversity, skills and experience”. For a number of staff this is their first job in the social care field. Those spoken with said that they were enjoying the challenge, and were “glad they had taken the step into care”. The service has also been proactive in recruiting a bank member of staff who is a brain injury survivor. The manager said that he is an asset to the team, as he can relate to the people currently living in the service in a manner that no other staff member can. Four staff files were looked at during this visit. All of the necessary records required to demonstrate that the service operates safe recruitment practices were in place. These included two written references, confirmation of satisfactory criminal record bureau and PoVA First checks and completed application forms. One staff member recently employed confirmed that she had been subject to a rigorous recruitment process, and was currently working her way through her induction. The organisation provides in house training through a computerised system called EL BOX. In addition external training is sourced as necessary in order to equip the staff with the skills required to meet individuals assessed needs. One staff member explained what the EL BOX system of training was and how it worked. All staff complete training in the mandatory subjects such as fire safety, first aid, moving and handling and basic food hygiene as part of their induction. In addition training records confirmed that staff have participated in training in infection control, medication, diabetes awareness and care, tissue viability, managing behaviours that challenge, the protection of vulnerable adults and equality and diversity. Four staff have completed an appropriate NVQ II and two staff have completed their NVQ III. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. The home benefits from a competent, dedicated manager who ensures that people get the support that they need. The manager runs the service appropriately, with an open approach that makes both the people living in the service and the staff team feel valued and respected. An effective quality monitoring system ensures that people’s views are at the forefront of service development. Health and safety is managed effectively. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 28 The home is managed by a competent and experienced manager who is in turn supported by a dedicated acting deputy manager and senior support staff. Both the registered manager and the acting deputy demonstrated a positive commitment to supporting people who have acquired a brain injury through their rehabilitation process. This was clearly reflected throughout the staff team, and created a person centred ethos. Both the staff team and people living in the home appeared to have a good relationship with the manager, who was cheerful, approachable and amenable. He also displayed a good knowledge of the needs of each individual in discussion. The service routinely undertakes an annual service review that looks at all aspects of the service provided. This takes into account the views of service users, staff and other key stakeholders to ensure that they are at the forefront of service development. Areas included within the annual service review are the environment, staffing, catering, personal support, management, provision of information and service user/relative perceptions of the support they receive. The results of this review are collated into a report that is then used to inform the services’ ongoing development plan. The process is robust and clearly demonstrates a commitment by the organisation to listening to the views of people living and working in the service along with other key stakeholders. The annual service review undertaken in 2009 indicates an overall satisfaction level of 77.51 . The manager said that amendments made to the annual service development plan and suggestions that have been implemented within the service already will reflect in the next annual service review and show a marked improvement. Day to day consultation with people who use the service is undertaken as a routine part of the service and support they receive. More formal meetings for the people who live in the service are held on a monthly basis, and minutes were available for these. Minuted staff meetings and key worker meetings also take place on a monthly basis. Health and safety is maintained within the home. Dates of when the most recent maintenance checks were undertaken were provided in the annual quality assurance assessment (AQAA). A sample selection of health and safety records which included fire alarm tests, portable appliance testing, the gas safety certificate and water temperatures all confirmed that they were in place and up to date. Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 4 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 4 14 x 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 x 4 x 4 x x 3 x Version 5.2 Page 30 Marner House DS0000070707.V375977.R01.S.doc Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Marner House DS0000070707.V375977.R01.S.doc Version 5.2 Page 31 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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