Care Home: Martham Lodge

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What the care home does well The care provided to people living in the home is good and comments were made by visitors during the inspection to this effect. The staff talk to people in the home at every opportunity and in a way that is inclusive and caring. What has improved since the last inspection? There were no requirements or recommendations from the last inspection. The maintenance staff have redecorated one of the bathrooms to make it more homely. What the care home could do better: There was an offensive odour under the stairs near the main entrance to the home. Although this is not something the home could do better, it needs to be noted that information provided by the placing authority was sparse on the file of someone who came into the home for respite. The home has also not received a contract. The manager acknowledged that some staff have not received supervision and is looking into a better system to enable all staff to have 1-1 time. The carpet in the hall has started to fray in some areas, which could affect the wellbeing of people living in the home. Other carpets in some bedrooms are stained and should be replaced. All staff must complete training in safeguarding adults. Bathrooms must not have unnamed personal toiletries in them. CARE HOMES FOR OLDER PEOPLE Martham Lodge 34 The Green Martham Great Yarmouth Norfolk NR29 4PA Lead Inspector Alison Hilton Unannounced Inspection 7th December 2007 08:10 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 Martham Lodge DS0000027450.V356175.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. Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Martham Lodge Address 34 The Green Martham Great Yarmouth Norfolk NR29 4PA 01493 748740 01493 740794 susan.hollyman@virgin.net 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) Mr Raymond John Hollyman Mrs Susan Fiona Hollyman Mrs Emma Phyllis Douglas Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (20) of places Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Twenty (20) Older People may be accommodated. Twenty (20) people, over sixty-five (65) years of age, with dementia may be accommodated. The total number not to exceed twenty (20). Date of last inspection 15th March 2007 Brief Description of the Service: Martham Lodge is a care home offering personal care and accommodation to 20 people with dementia. The home is privately owned and has been run by the current proprietorsince May 2001. It stands in the centre of the Norfolk village of Martham. The coastal town of Great Yarmouth is a short drive away. The service is located in an old house with newer extension. Accommodation is offered on 2 floors and the home has a shaft lift. There are 16 single and 2 double bedrooms, none of which are en-suite. There are attractive enclosed and secure gardens suited to the needs of people with dementia. Details of the cost of placement is available on request. Copies of the inspection report are available in the foyer. Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We (Commission for Social Care Inspection) carried out an inspection of Martham Lodge using the Commissions methodology. This report makes judgements about the service based on the evidence we have gathered. The manager completed an Annual Quality Assurance Assessment (AQAA), which was received just prior to this inspection. Our evidence also includes an unannounced inspection of the home which Alison Hilton, Inspector, made on Friday 7th December 2007. The manager was present throughout the inspection. A number of records were seen, together with staff personnel files and files of people living in the home. We spoke to staff, visitors and people living in the home during the visit. There were 19 people in the home and one person in hospital who was due to return on the day of the inspection. Surveys were sent to those living in the home, their relatives and staff. Prior to the inspection only 4 surveys had been returned. Before the report was written a further 6 were returned and they have been incorporated here. 5/10 relative’s surveys were returned. Two other relatives were spoken to during the inspection. Comments were received such as “the carers are wonderful”; “ they (staff) are very caring to all those in the home and make visitors feel welcome”; “ (relative) not always as clean or well cared for as I would like. (This is) due to ratio of staff to patients is unacceptable and inadequate”; “ staff are knowledgeable and give me confidence”; “sometimes the smell of the place is overwhelming” and “I am very happy with the care”. 3/10staff surveys were returned, and one member of staff completed the relatives survey in error. 1/10 service user survey was completed with the assistance of a relative. Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: 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. Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 7 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 Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 8 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 good. Sufficient information was received by relatives for them to ensure the home could provide the care their relative needed. This judgement has been made using available evidence including a visit to this service. Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 9 EVIDENCE: The home does not provide intermediate care so Standard 6 does not apply. Details provided in the AQAA showed that each person has an individual preadmission assessment to see whether the home can meet their needs. In one file inspected the information provided by the placing authority, for someone who had initially come into the home for respite, was sparse. Each person and their relatives are invited to visit the home and spend time there before any decision is made. The manager also visits them prior to them being admitted. Relatives spoken to during the inspection said that this was the case. The home offers a two-month settling in period so that all parties involved can make an informed decision as to the appropriateness of the placement. The manager is aware of recent legislation that relates to requirements within the Mental Capacity Act, for example whether service users have advance directives or lasting powers of attorneys. The home provides pre-admission documentation in large print to allow visually impaired people access to the same information. Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 10 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. The home completes risk assessments to ensure the health and well being of those living in the home is assured. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details provided in the AQAA showed that the home works closely with the local health care centre to provide prompt medical attention when required from a range of health care professionals such as physiotherapists and district nurses as well as doctors. Medication administration was observed and Medication Administration Records were seen. All was in order. The controlled drugs register was seen and correct. Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 11 The home has risk assessments for identifying those at risk of pressure areas and the actions being taken to reduce the risks; risk assessments for identifying those at risk of slips, trips and falls as well as risk assessing the environment to identify and reduce high hazard areas. The home has care plans and risk assessments to identify those at risk of malnutrition following the guidance of M.U.S.T taught by the in house trainer. Decisions regarding end of life care including wishes, choices and preferences for those living in the home are detailed in their care plans. Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 12 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. The home offers some activities which help people living in the home to maintain as much independence and choice as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does not have an activities co-ordinator but all the staff are expected to provide some level of interaction such as 1-1 chats, manicures, reminiscence and games to stimulate people living in the home. The manager said the home has a shed outside so that in the nice weather people can go and sit in it and it has items to aid reminiscence. There are entertainers, including an accordion player and operatic group, who come into the home. Information provided in staff surveys showed that entertainment is provided once a month and staff use any spare time to talk with people living in the home. Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 13 The manager said the home plans to purchase items for activities and music sessions to increase and improve mental stimulation and enable all people living there to be involved in activities regardless of their physical or mental abilities. Visitors spoken to during the inspection were very happy with the home but believed more could be done to stimulate and encourage their relatives. They said the home supported personal relationships. Lunch on the day of inspection was fish and chips with peas or savoury mince with mash, carrots and peas. Dessert was banana and custard or ice cream and banana. Most people ate in the dining room but some chose to eat in the living room, whilst others walked about eating bits of their meal over a period of time. Lunch was reasonably relaxed and staff were aware of who was eating where. Some people needed prompting to eat and others needed more help. Staff were helpful; but encouraged people to do as much as possible for themselves. Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 14 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. The home has a complaints procedure and policies on whistleblowing and abuse to ensure people living at the home are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear and accessible concerns/ complaints procedure. Neither the home nor the Commission has received any complaints since the last inspection. One staff member spoken to said she had not received Protection of Vulnerable Adults (PoVA) training, although the manager said all staff had completed this some time ago. Details in the AQAA showed the home has policies and procedures regarding whistle blowing, neglect, suspected abuse with details of actions to follow if required. There have been no PoVA enquiries at the home. The manager was aware that with the introduction of the Mental Capacity Act the use of Independent Mental Capacity Advocates (IMCA) may be useful. The Manager has attended a training course on The Mental Capacity Act. Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 15 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): 19,20,23,24,25,26 Quality in this outcome area is adequate. There is an overwhelming odour which means that those living in the home do not always have clean and hygienic surroundings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details provided in the AQAA showed that the home employs a dedicated housekeeper to maintain the cleanliness of the home. On the day of inspection there was an odour all day in the home emanating from under the stairs by the front door. The manager said that some people living in the home mistakenly used under the stairs as a toilet. Although it is cleaned twice a day it does not make much difference to the overpowering odour. The home must look at ways to improve the system of cleaning so that people living in the home do not have this odour all the time. Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 16 All staff receive training on the prevention of cross infection and personal protective equipment is provided to reduce the risks. Communal space is available for everyone living in the home both inside and outside with access for those with mobility needs. The gardens are enclosed and safe for those who are confused. The home has a call bell system with an accessible alarm in every room, which is routinely maintained. Evidence was seen that those living in the home could reach the emergency alarms when in their rooms. Picture and word references are displayed to promote recognition of these areas for those living in the home. There is a wooden gazebo in the courtyard to give a shady place to sit when the weather is warmer. The courtyard has had a makeover which incorporated new gravel, plants, wind chimes and a water feature, some of them paid for by donations from relatives of people who had died whilst living at the home. The home employs two maintenance workers who ensure the home and garden are maintained. The dining room has been recently redecorated to make it a more stimulating environment in which to eat and new furniture bought to improve comfort. The home has a decoration programme, with plans for all hallways leading to bedrooms to be re-decorated. The manager said that the carpet on the main stairs to the first floor bedrooms will be replaced next year. On a tour of the building some bedrooms were seen to be in need of replacement carpets as they were stained and dirty. In the relatives surveys one person commented on the temperature in the home. On the day of inspection the home was adequately heated. One person commented that the sorting of laundry could be improved by ensuring only their relatives labelled clothing (not other peoples) be placed in her room. Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 17 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. The homes recruitment procedure ensures the safety of those living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager said that there are three staff on during the day and two at night. Information provided in the AQAA and evidence seen on file showed that the home has a training programme and staff receive and are encouraged to pursue training to improve their knowledge, skill sets and abilities. All staff have a training record. The manager said that moving and handling training was being undertaken the two weeks following this inspection. Training to be provided in January 2008 includes basic food hygiene and fire safety. Staff spoken to during the inspection said they received all statutory training as well as other courses to extend their knowledge. Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 18 The home’s recruitment process ensures that at least two references, a working history, a CRB and POVA check are received before the commencement of employment and this was confirmed by the inspection of personnel files. All newly recruited staff have an induction period, up to twelve weeks following the Common Induction Standards 2006 and have regular supervisions to ensure best, safe working practice. Details provided in the AQAA showed that all staff have regular appraisals to ensure their views, opinions, aspirations and achievements are acknowledged and implemented where possible. Staff surveys showed that staff felt they supported each other by covering shifts in the event of sickness or holiday, ensuring a continuity of care. Senior staff meetings are undertaken regularly. Relatives surveys and those spoken to during the inspection were very positive in their feedback about staff. Some comments such as “ everyone is treated with the same patience and understanding for their individual needs”; “ The staff are very knowledgeable and give me confidence”; “the carers are all wonderful” and “Very caring and they make visitors feel welcome”. One survey did express a view that staff are rushed off their feet and that more staff would allow them to take care of peoples emotional as well as care needs. Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 19 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): 31,33,35,36,37,38 Quality in this outcome area is good. The home has policies and procedures in place to ensure the safety and well being of those living and working there. This judgement has been made using available evidence including a visit to this service. Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 20 EVIDENCE: Details provided in the AQAA showed that the proprietors work closely on a daily basis with the Manager. One of the proprietors was present at the beginning of the inspection. The home has a clear accountable management structure. The manager is available to both relatives and people who live in the home to discuss any issues, concerns or complaints they may have. The manager has worked at the home for over 6 years and holds the NVQ Level 4 qualification and has completed a Level III award in Management, certificated by the Institute of Leadership & Management. She has been elected to sit on the committee of the local branch of the Alzheimer’s Society, and is up for election to become a Governor of The Norfolk & Waveney Mental Health NHS Foundation Trust. Staff receive some supervision and appraisals. Details of these were seen on files inspected, however some staff had not had supervision since January and February 2007. There are regular meetings for senior and other staff The home has up to date policies and procedures. The home does not hold money for any person living there. A variety of records and checks were seen and found to be satisfactory. Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 21 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 3 x 3 x 3 N/A 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X 3 3 3 2 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 3 X 3 X 3 2 3 3 Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 22 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 OP19 Regulation 23 (2) Requirement The carpets in the corridor upstairs and in some bedrooms must be replaced to ensure the home is well maintained. The home must be free of offensive odours so that people live in a pleasant and clean home. Staff must receive regular supervision to ensure best practice is maintained and those living in the home are safe. Timescale for action 31/05/08 2 OP26 16 (2) (k) 31/01/08 3 OP36 18 (2) 31/03/08 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 Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Martham Lodge DS0000027450.V356175.R01.S.doc Version 5.2 Page 24 - 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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