Care Home: Marriott House and Lodge

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What the care home does well There is a variety of information available to help people looking for a care home to move into to make an informed choice about whether it is the right care home for them. People have their needs assessed before they are offered a care service at the home and there are opportunities for people to test-drive the service for periods of respite care and visits. The activities programme encourages people to join in and socialise with other people living at the home and in the community. There are opportunities to go on outings. The environment at Marriott House is of excellent standards with improvements continually being made for the benefit of the people who live there. People are encouraged to make their bedrooms their own and bring familiar items and furniture to put on display in their rooms. What has improved since the last inspection? Care plans have been improved with a more robust care planning system introduced . They are based on a holistic approach to meeting peoples needs on an individual basis and are reviewed regularly. We are told that the activities programme has improved with a wider range of choice and opportunities to maintain community links with some people attending external clubs. The service now has a mini bus so that people can have more trips out. Marriott House has undergone major refurbishments in the past 12 months. Showering facilities are now available on every floor and bathrooms now contain puropose built baths catering for all disabilites. The communial and dinning areas are pleasant areas for socializing and dining. Staff recruitment practice has improved so that staff have the required documentation in place. The staff-training programme has improved with regular fire training, moving and handling and safeguarding adults training and staff supervision. What the care home could do better: The continued improvements to Marriott Lodge being undertaken during our visit will enhance the whole service for people who live there. For some people living at Marriott House the standard of food and choice of menus could still be improved. The registered persons should make sure that everybody knows how to make a complaint using the homes complaints procedure. Environmental risk assessments must cover all risk including the practice of wedging doors open. CARE HOMES FOR OLDER PEOPLE Marriott House and Lodge Tollhouse Close Chichester West Sussex PO19 1SG Lead Inspector Diane Peel Unannounced Inspection 09:55 14 August 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marriott House and Lodge Address Tollhouse Close Chichester West Sussex PO19 1SG 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) 01243 536652 01243 783006 sandy.owens@barchester.com www.barchester.com Barchester Healthcare Homes Ltd Mrs Sandra Kay Owens Care Home 119 Category(ies) of Old age, not falling within any other category registration, with number (119), Physical disability (119), Physical of places disability over 65 years of age (119) Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of 72 service users who require nursing care may be accommodated of whom up to 15 may be in category PD. Only service users in the PD category over 50 years of age may be admitted. 14th August 2007 Date of last inspection Brief Description of the Service: Marriott House and Lodge is a care home registered for nursing care. The registration is for older people and the complete service can accommodate up to one hundred and nineteen people. It is a large property that has been arranged into two houses. Marriott Lodge is the smaller of the two houses and on the day of this visit was unoccupied due to the major refurbishment being undertaken. Marriott House provides accommodation for up to seventy-two people who need residential or nursing care. This building is arranged on three floors and has a lift between floors. Accommodation is provided in single and double bedrooms some of which have en-suite facilities. Communal areas include lounges and a large dining room. There is a garden, which is pleasant and well cared for. The property is situated in the centre of Chichester. Fees range from £310 to £1000 per week. Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. Mrs Diane Peel carried out this unannounced visit to Marriott House and Lodge on the 14th August 2008. Marriot Lodge was closed on the day of our visit for major rebuilding and refurbishment work. During this visit the intended outcomes for 30 standards were assessed; these included the key standards for care homes providing a service to older people. The Annual Quality Assurance Assessment (AQAA) was returned to The Commission for Social Care Inspection (CSCI) prior to this visit to the home and this was used to address areas of improvements during the inspection process. During the course of the visit we met with people living at the home to discuss their experiences of living at Marriott House and spoke to a visitor to get their views of the service. Staff spoke to us about their experiences of working at the home, the training provided and the process of recruitment. All people consulted with had positive comments to make. There were some concerns expressed that the standards would drop after the departure of the most recent manager. A case tracking exercise was undertaken for five people living at the home to see how the assessed needs of these people were being met. We looked at other records in the home at random to make sure that the homes record keeping and working practices promote and protect people living at the home. What the service does well: There is a variety of information available to help people looking for a care home to move into to make an informed choice about whether it is the right care home for them. People have their needs assessed before they are offered a care service at the home and there are opportunities for people to test-drive the service for periods of respite care and visits. Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 6 The activities programme encourages people to join in and socialise with other people living at the home and in the community. There are opportunities to go on outings. The environment at Marriott House is of excellent standards with improvements continually being made for the benefit of the people who live there. People are encouraged to make their bedrooms their own and bring familiar items and furniture to put on display in their rooms. What has improved since the last inspection? What they could do better: The continued improvements to Marriott Lodge being undertaken during our visit will enhance the whole service for people who live there. For some people living at Marriott House the standard of food and choice of menus could still be improved. The registered persons should make sure that everybody knows how to make a complaint using the homes complaints procedure. Environmental risk assessments must cover all risk including the practice of wedging doors open. Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5,6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Information about the home is available in a variety of formats. People are encouraged to visit the home prior to making a choice about its suitability and people’s needs are assessed so that they can be assured that the home can meet their needs. EVIDENCE: The organisation has a website on which people looking for a care home can locate a care home in the area in which they want to live. The information on the website provides details about the facilities and services available at the home, information about the staff and maps to show details of how to find the home. Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 10 The Statement of Purpose and Service users guide was observed to be on display in the main entrance of the home and the AQAA returned from the service told us “Copies of the service users guide are located in each bedroom”. We received Have Your Say surveys from nine people living at the home. When asked the question “Did you receive enough information about this home before you moved in so you could decide if it was the right place for you?” Seven people said “yes”, one person said “no” and one person didn’t answer the question. Additional comments were: “I had a weeks trial.” “ I had heard that Marriott was a very good home,” The AQAA returned from the service to us in June 2008 said: “ Prospective residents and their representatives are welcome to view the home at any time, either by ‘dropping in’ or by appointment. They are also invited to spend the day, at the home and have lunch, or tea and cakes, during their visit at no cost. Residents are also encouraged to take a period of respite prior to making their final decision. During their visit there is generally an opportunity to have a chat with staff, which provides a time for them to ask any questions. With an emergency admission we endeavour to inform the resident about key aspects of the placement within 24 hours and that a placement agreement is agreed and met within five working days.” During our visit we spoke to people living at the home about the process of moving to the home. One person who had recently moved in told us “ I have been here about six weeks. My daughter had a look at a few care homes for me and then brought me to look at this one. It’s taking a bit of getting used to.” We looked at care records for seven people during our visit and saw that pre assessments were in place. We also saw an enquires folder which included some assessments for people who hadn’t moved into the home or were still considering moving into the home. The organisation has a system of monitoring the information provided to prospective customers by using mystery shoppers. The outcomes of enquiries are fed back to the service the home as part of the organisational quality assurance process identifying how enquiries and information provided to prospective customers can be improved. We saw the results of the most recent surveys during our visit. Intermediate care is not provided at Marriott House. Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home have a plan of care which takes into account their health, personal and social care needs so that they know that what they expect from the service will be delivered in a way which respects their privacy and right to be treated as an individual. EVIDENCE: We looked at seven care plans and associated care records during our visit and carried out a case tracking activity for five of the seven people to see how far the pre assessment carried out prior to moving into the home had contributed to the basis of the care plan developed. Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 12 Care records were observed to include: admission information sheets, care profiles, end of life wishes, admission assessment, pressure area assessments, risk assessments, environmental hazards, moving and handling assessment, nutritional profiles, fall risk assessments, information about social interests, records of medical professionals involvements and friends and family involvement. All care plans viewed had been reviewed monthly and included daily monitoring records. There were records of the involvement of other health care professionals and information about appointments ant hospitals and eye clinics. Whilst we were looking at these records a care assistant told us that they were just about to escort a person to the hospital for an appointment. They confirmed that this was the usual practice. AQAA returned said “Service user care plans are comprehensive and sets out in detail the action which needs to be taken by care staff to ensure all aspects of health, personal and social needs are met. These are reviewed on a minimum of monthly basis, or when residents need change. Risk assessments are completed if a risk has been highlighted during initial care planning. Health care professionals, as denoted below are sourced as the residents needs require them to be, and are encourage documenting their visits in the appropriate areas. The care plans are audited and action plans raised from the audits copies of which are located in the Managers office. A range of health care professionals including General Practitioners, Physiotherapists, Opticians, Chiropodist and Speech/Language Therapists, dieticians, tissue viability specialists and terminal, continence advisors, care specialists attending the home to provide advice/support to the Service user’s health care needs. We ensure that residents have regular sight tests and hearing tests as required. The outside clinic attend the home for residents who are unable to attend an optician. We observe residents for signs of pressure sore development by completing a Waterlow assessment monthly and implement various measures to ensure that they do not develop. This can be evidenced by the fact that we have very few in house pressure sores. A pressure sore record is completed every month.” When asked the question “Do you receive the care and support you need in Have Your Say surveys: one person didn’t respond four people said “always”, three people said “usually” and one person said “sometimes” Additional comments received from people living at the home were: “Nursing has improved.” and “the senior nursing officer is excellent.” Six people living at the home returning who returned Have Your Say surveys to us told us that they “always” got the medical support that they needed and Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 13 three people told us that they “usually” got the medical support that they needed. During our visit we looked at the procedures for administering medication and observed medication being administered to people during lunchtime. We saw that three lockable metal trolleys were being used to store medication and this was taken into the dining room. People received their medication from a monitored dosage system dispensed by the contracted pharmacist. When we looked at medication record sheets we saw that they had been completed up to the day of our visit with reasons for medication not been taken explained on the recording sheets. One of the qualified nurses who we spoke to told us that two people currently self administer their medication and that this is risk assessed at the admission stage and reviewed. We also saw that people have a lockable facility in their bedrooms in which to store any medication and we also saw someone who self medicates being reminded to take their medication when having a late breakfast in the dining room. We were shown the medication storage room and looked at the facility for storing controlled medication. Controlled medication records were sampled at random and found to be correct. Disposal of medication arrangements are in place and records of medication awaiting collection by the disposal contractors were observed. During the visit to the home it was observed that staff spoke to people living at the home respectfully and treated people as individuals. Two surveys returned which asked the question “ Does the service respect individuals privacy and dignity?” both had a response of “usually”. Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are encouraged to maintain contact with their family and friends so that they can satisfy their social and emotional needs and the social activity programme is flexible to cater for individual residents abilities and to offer variation to daily living. There should be more consultation with people living at the home about the menu so that it meets their expectations. EVIDENCE: On the day of our visit we saw that people able to make choices about how they wanted to spend their time could do so for example one person was arriving for breakfast in the dining room after 10am. Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 15 In the afternoon when some people were watching a film show and others were playing scrabble we saw other staff talking to people being nursed in bed. Two activities co-ordinators are employed and records of what activities each resident has taken part in is kept in peoples care records, which demonstrated that there is an extensive programme on offer. We spoke to one of the activity co-ordinators who told us about the programme offered and the trips out in the new minibus. They also told us that they were able to take people out into Chichester. We also saw photographs of event and activities, which had taken place on a notice board and in, photograph albums in the lounges. Out of the nine people living at the home who returned Have Your Say surveys to us four told us that there is “always” activities arranged by the home which they take part in, two said “usually”, two said sometimes and one person said “never”. The person who said never did explain by commenting: “this is my fault as I do not want to play bingo, scrabble or paint.” However we are acquiring a mini bus and I am hoping to get some trips out”. A relative commenting on behalf of a person living at the home said: “activities are well arranged and organised by a team of staff. Events and trips out are generally well supported by residents.” During our visit we saw monthly newsletters in peoples bedrooms and available in the communal areas which advertised activities, for July and August. These included quizzes, bingo, music therapy, visiting church services, music and movement, stories and poetry, film shows, visits by George the Pat dog, residents meeting on 4th August 2008, minibus trips and visiting entertainers. We also saw the minutes of the residents meeting held in August when a person living at the home had congratulated the staff in the organising of the fete and discussed activities and trips out. During our visit we spoke to a visitor who told us that they could visit at any time and was always made to feel welcome. We saw that the visitor’s book showed many visitors to the home and that there was a small book for visitors to request meals during their visits. The AQAA returned to us from the service said “the presentation of food and arrangements for dining are of a high standard at the home. Menus are displayed in all dining areas for residents to see. We involve our residents by asking them to contribute ideas and suggestions for improvement. Recent Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 16 refurbishment of the dining area in the House has significanlty improved the surround making it a more congenial setting to enjoy a meal with family and friends. There is also a larger table set in a private area for residents who wish to have a family dinner. Drinks and snacks are available 24hours a day. Timings of meals are set to ensure residents are not left without food and drink for any longer than a five hour period. Residents have the choice of where they would like to have there meals. All food is presented in an attractive manner and all diets are catered for in the same way.” He AQAA also said “menus have been reviewed to ensure that resident’s wishes and preferences are reflected. Planned 4 week menus made available to relatives on request to enable them to choose appropriate meals for residents who are unable to express their own preferences.” We joined people for the main meal of the day in the dining room. The choices on the menu on each table were toad in the hole with cheesy mash, mixed vegetables and courgettes or chicken curry. Also advertised on the menu for each lunchtime as an alternative are: omelettes and chicken, ham or cheese salads. The main meal of the day the pervious day had been shepherds pie or liver and bacon with cauliflower cheese and green beans. People returning surveys to us had varied views of the food offered with comments such as: “ Typical frozen vegetables, not very attractive.” “We have sherry before dinner and wine.” “ The food is well cooked and presented but it is the same boring menu week by week.” “The cooking of the food is not up to standard. The potatoes are cooked to a level you cant eat them. It seems to be carrots and Brussels sprouts with not much variety.” Out of the nine people living at the home who returned surveys to us two told us that they “always” liked the meals, three told us that they usually liked the meals and four people told us that they “sometimes” liked the meal. People who we spoke with during our visit also had differing opinions of the food and for some people they commented about the timing of the main meal of the day, which they thought, was too early. One person who chose to have a late breakfast said “12 o’clock is then too early for my dinner.” We discussed this matter with the operations manager at the end of our visit who agreed to consider this further with the staff at the home. Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home wants to encourage people to voice any concerns, which they have, but to do so must ensure that everybody knows about the complaints procedure how to make a complaint. Arrangements are in place to protect people using the service from being place of harm or abuse. EVIDENCE: The homes complaints procedure is on display on a sideboard in the entrance to the home for people to see and is included in the Service User Guide, which we saw on display in the entrance to the home and in a number of bedrooms. The AQAA received prior to the visit to the home recorded that four complaints had been received in the last twelve months of which one had been substantiated. The complaints record was examined during the visit to the home that demonstrated the complaints had been responded to appropriately. Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 18 Three people out of the nine people living at the home who returned surveys to CSCI reported that they did not know how to make a complaint and two of these people told us that they did know who to speak to if they were not happy. The other person said that they didn’t know who to speak to if they were not happy. Out of three staff returning surveys two said that they knew what to do if someone had a concern about the service, one person said that they didn’t. A visitor who we spoke to during our visit told us that they had raised a concern with the manager who had recently left and told us that they would now speak to the acting manager. People living at the home that we spoke to did know how to make a complaint. The minutes of the most recent residents meeting, which we saw, recorded people raising concerns. At the end of the visit we spoke to the operations manager who agreed to look into a way of making sure that everyone knew how to make a complaint or raise a concern. The home has its own safeguarding adults procedure, which it uses in conjunction with the West Sussex Multi Agency Adult Protection Procedures. Training records, which we saw during our visit, showed that the service has an ongoing training programme for staff, which included safeguarding adults with forty-one staff having completed the training since January 2008. The AQAA returned to us in June 2008 told us that the service had raised a safeguarding adults alert itself in the last year, which it had informed us about. Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the Marriott House part of the service and not Marriott Lodge. People living in Marriott House have a well-maintained, homely environment to live in and so that they can feel more at home are encouraged to bring personal items to the home and make their private accommodation their own. EVIDENCE: Marriott Lodge is not currently being used and is undergoing major building works and so on this visit to the service we did not visit Marriott Lodge. Since we last visited Marriott House has undergone major refurbishments. The communial areas including the dinining room have been redecorated and upgraded for socializing and dining. There are a range of comfortable Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 20 communal areas varying from small sitting areas to small lounges and larger lounges. The standard of furniture and fittings in communal areas were observed to be above average. During our visit we looked at twelve bedrooms in various areas of the home and those bedrooms, which we saw were well decorated and clean. All bedrooms had a good standard of furniture and fittings including a lockable drawer in bedside tables. We observed that most people had brought personal items to display in their rooms and some people had some items of furniture, which they had bought, to the home with them. The AQAA returned to us said, “All bedrooms are decorated when vacated prior to the new resident being admitted.” “There have been improvements to the showering facilities which are now available on every floor and bathrooms now have purpose built baths.” Bathrooms, shower rooms and toilets were observed to be clean and tidy during with different types of facilities for people to choose from with a variey of aids and adaptions. Out of the nine people living at the home returning Have Your Say surveys to us five people said the home was “always” fresh and clean, three people said it was “usually” fresh and clean and one person said it was “sometimes” fresh and clean. All areas, which we visited on this unannounced visit to the home, were observed to be clean. Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Marriott House are protected by the recruitment procedures and staff receive appropriate training so that they can meet the needs of people living at the home. EVIDENCE: During our visit to Marriott House we saw the staffing rota in the nurses office on the ground floor. A qualified nurse who we spoke to told us that in addition to care staff on he rota there were always two qualified nurses on duty in the day time and one at night. The AQAA returned to us by the service told us “The staffing levels and the skill mix of the staff at the home are more than sufficient to meet the needs of the service users. The staff are encouraged to discuss with the manager if they feel the staffing levels are not adequate at a particular time. The manager keeps up to date with residents and their dependancy levels and flexibility in staff rotas can be done. We are able to demonstrate that service users are supported and cared for by trained and qualified staff that are able to carry out their roles competently and confidently. We rarely use agency staff, only in the last case, and do so only in the event of Barchester staff Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 22 being unable to cover absence. We have a selection of Bank staff who can provide cover if required.” and “50 of staff have achieved their NVQ2 and above. We also have 3 A1 assesors and have a continuing programme of NVQ training.” The records of five staff were observed during this visit to the home, which included someone recently employed. For four people they were observed to include evidence of Criminal Record Bureau (CRB) and Protection of Adults (POVA) checks and for one person recently employed a POVA First statement. For this person we saw a “ signed working under supervision” agreement. Further discussion with a qualified nurse on duty described how this person had to work alongside another carer until a full CRB disclosure was received. Job applications were on file, two written references, photograph, proof of the person’s identity and completed equal opportunity monitoring forms and health declaration forms. A Statutory Requirement made at our last visit to the home to ensure that all the required information to show that people are protected when new staff are employed is now met. Training records which we saw during our visit showed that since January 2008 training had been provided for safeguarding of adults for forty one staff, fire training for fifty seven, manual handling for thirty nine. Further training for moving and handing and fire training were displayed on the nurse’s office door on the ground floor. Staff returning Have Your Say surveys told us: “ I have competed lots of training that enables me to do my job well and improve my skills.” “There is a good induction process in place.” All three staff returning Have Your Say Your Say surveys to us said that they are been given training relevant to their role, which helps them understand and meet the needs of individuals and keeps them up to date with new ways of working. Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place for the management of the home and support from senior managers within the organisation are ensuring that people continue to benefit from a well-run service. EVIDENCE: When we arrived at Marriott House we were told that the person who had been the Registered Manager no longer worked at the home. The AQAA returned from the service said “the home carries out monthly audits covering areas such as infection control, resident care, medication, catering, Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 24 nutrition and dining experience, documentation, health & safety and activities. These audits are completed by the manager or her deputy, or in certain areas by heads of department. Actions and outcomes are reviewed by people external to the home and a documented action plan is produced accordingly.” During our visit we saw the results of Clinical Quality Audits carried out in November 2007, Health and Safety audits carried out in January 2008, Activity audits, nutrition audits and audits carried out by the “Mystery Shopper”. Residents have meetings, which are facilitated by the activity staff. We saw records of these meetings during our visit showing how people are involved in the quality of the service. We saw records during our visit, which confirmed that staff now has formal supervision and we spoke to staff that told us about the process of supervision. We checked the frequency of supervision for those staff whose recruitment records we had seen and saw that on average people had had supervision on three occasions since January 2008. A Statutory Requirement made during our last visit to the home to ensure that staff are supervised has now been met. The Operations Manager visiting the home during our visit told us that the service does not manage any people’s monies and that any expenditure not included in the fee s are invoiced to people’s relatives or advocates if they do not manage their own monies. During our visit the was a first aid emergency for which a first aider was requested to attend. This was responded to immediately. During our visit we saw the Fire Logs whish showed regular checking of the fire systems and equipment. We looked at training records, which showed that staff are having fire training. A member of staff returning a Have Your Say surveys told us “ I have had training as a fire warden over and above the usual training.” A Statutory Requirement made at out last visit to the home to make sure staff attend mandatory fire training so that they know how to prevent risk of harm to people in the event of a fire. Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 X 4 3 4 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 4 3 4 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 3 X 2 Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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. 1 Standard OP38 Regulation Reg 13 (4) (c) Requirement Environmental risk assessments must cover all risk areas including identifying the risk from the practice of wedging doors open and these risks must be eliminated or at least reduced where possible. Timescale for action 14/10/08 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 Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Marriott House and Lodge DS0000069309.V369253.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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