Care Home: Marwood

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What the care home does well What has improved since the last inspection? Assessments of potential residents are more comprehensive so staff are aware of all their needs as soon as they move into the home. Staffing levels have improved and a new staff training/supervision programme is in place. This will help to ensure staff have the support and skills they need to carry out their work. CARE HOMES FOR OLDER PEOPLE Marwood 57 Ashby Road Shepshed Leicestershire LE12 9BS Lead Inspector Kim Cowley Unannounced Inspection 15th May 2008 11:00 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 Marwood DS0000070333.V364543.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. Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marwood Address 57 Ashby Road Shepshed Leicestershire LE12 9BS 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) 01509 600625 01509 600625 None Shankar Leicester Ltd Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Marwood DS0000070333.V364543.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 - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home is within the following category: 2. Old Age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 18 3rd January 2008 Date of last inspection Brief Description of the Service: Marwood is a registered care home that accommodates up to 18 older people. It is situated on the outskirts of Shepshed, and can be reached by private and public transport. There is car parking to the front of the home. The accommodation is a modern two-storey detached house with a purpose built extension to the rear. There is a lounge, dining room, and large conservatory on the ground floor. Behind the home is a large paved terrace with seating. This overlooks the home’s large secluded garden. Residents’ bedrooms are on both the ground and first floors. There are double and single rooms, some of which have ensuite facilities. Access to the first floor is via the stairs, or by using the stair lift or passenger lift. The fees range from £325 to £450 per week. There are extra charges for hairdressing, chiropody, newspapers and personal items. A copy of the latest CSCI inspection report is available from the home. Marwood DS0000070333.V364543.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. This was a key inspection that included a visit to the home and inspection planning. Prior to the visit, we (throughout the report the use of ‘we’ indicates the Commission for Social Care Inspection) spent half a day reviewing information relating to the home. During the course of the inspection, which lasted four hours, we checked the ‘key’ standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means we looked at the care provided to three residents living at the home by meeting them; talking with the staff who support their care; checking records relating to their health and welfare; and viewing their personal accommodation as well as communal living areas. Other issues relating to the running of the home, including health and safety and management issues, were examined. We also talked to six residents, three relatives, the Acting Manager, and one carer. What the service does well: Marwood provide homely and comfortable accommodation for the older people who live there. It has a friendly and sociable atmosphere, and residents and staff get on well with each other. All the residents we spoke to said they were happy at Marwood. One said, ‘It’s a wonderful place – I wouldn’t be anywhere else.’ Although Marwood is a relatively small home (18 beds) there is a good range of communal areas so residents can choose where they sit and with whom. During the inspection we saw residents chatting to staff and visitors in the lounge, socialising amongst themselves in the conservatory, and resting in their rooms. One resident told us she was looking forward to the summer so she could sit outside on the terrace. We observed that staff treat residents with respect and help to maintain their dignity by providing care discreetly and sensitively. Residents praised the staff and told us, ‘The staff let us take our time and never rush us’, ‘The staff are lovely and helpful’, and ‘The staff do so much for you here.’ Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 6 A full-time cook is employed and records showed that a wholesome and varied diet is provided. All the residents said they liked the food. One told us, ‘The food is very good – second to none’, and another said, ‘If you don’t like something they’ll bring you something else.’ During the inspection we saw that all residents, whether in their rooms or in the lounges, had juice or water next to them, as well as regular hot drinks. The Acting Manager said this is because her staff are aware of the dangers of dehydration and encourage residents to drink fluids as much as they can. A resident told us, ‘We drink gallons of water here!’ What has improved since the last inspection? What they could do better: Mental health needs must be included in care plans to prevent them being overlooked and to ensure staff know how to respond should a resident become distressed. Only limited activities and entertainment are provided and some residents said they would like more. Residents must be consulted and a suitable programme of activities put in place. This will help to ensure residents’ social needs are met. At present there is no clear procedure for staff to follow if a safeguarding issue arises. One should be put in place so staff know what to do and who to contact. When we toured the premises we found some radiators were hot to the touch and could put residents at risk of scalding. A risk assessment must be carried out and action taken, where necessary, to make radiators safe (for example by providing covers for them). This will reduce risk to residents. Marwood DS0000070333.V364543.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. Marwood DS0000070333.V364543.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 Marwood DS0000070333.V364543.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): Quality in this outcome area is good. Residents’ needs are assessed prior to admission to ensure the home is suitable for them. This judgement has been made using available evidence including a visit to this service. (Standard 3 was inspected.) EVIDENCE: People who are interested in coming to Marwood are invited to visit prior to making a decision. If they are unable to their families sometimes come instead. We asked residents why they chose to Marwood. One told us, ‘I came here because it’s the best home in the area’, and another said, ‘My family went to four different homes before they found this one.’ All prospective residents have an assessment to determine what their needs are. The Acting Manager carries these out, visiting people in their own homes, in hospital, or during a visit to Marwood. The assessment process helps to ensure the home is suitable for those who are considering living there. Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 10 Since the last inspection a new, more comprehensive assessment form has been introduced. This will help to ensure that residents’ needs are fully documented so they can be met as soon as they move into the home. Standard 6 was not inspected, as this home does not provide intermediate care. Marwood DS0000070333.V364543.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): Quality in this outcome area is good. Staff in the home, and in the wider community, meet residents’ health and personal care needs. This judgement has been made using available evidence including a visit to this service. (Standards 7, 8, 9, and 10 were inspected.) EVIDENCE: All residents have care plans, which set out how their health, personal and social needs are to be met. At the last inspection those we inspected were not detailed enough, and some areas of care had not been documented. Since then all care plans have been updated and improved and most areas of need have been included. To further improve care plans mental health needs must be included. Older people are more prone to depression and confusion and may need extra support because of this. Putting appropriate care plans in place will help to ensure residents’ mental health needs are not overlooked, and staff know how to respond should a resident become distressed. Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 12 All residents are registered at a local health centre. GPs and District Nurses visit the home regularly to provide health care to residents and advise staff. One resident told us, ‘If I need the doctor I tell the staff and they get him to come out and see me. But since I’ve been here I hardly ever have to see the doctor because they look after me so well.’ Medication is well managed with good records kept. Residents’ photographs are now kept on their medication charts. This reduces the risk of a resident being given someone else’s medication by mistake. One resident partially administers her own medication, helped by staff, as this enables her to maintain her independence. We observed during the inspection that staff treat residents with respect and help to maintain their dignity by providing care discreetly and sensitively. One resident told us, ‘The staff let us take our time and never rush us.’ Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good. Residents’ social and cultural needs are identified and met. This judgement has been made using available evidence including a visit to this service. (Standards 12, 13, 14, and 15 were inspected.) EVIDENCE: The main activity provided for residents is bingo (three times a week), and occasional visiting entertainers. A hairdresser visits twice a week and there is a church service once a month. Some of the residents we spoke to said they would like more to do. One said, ‘We’ve had a singer come in and a violinist, but we’d like more musical entertainment – songs we can sing along to.’ Two other residents also asked for this. Discussions with residents and staff indicated that activities are restricted because there is no budget for them apart from the residents’ ‘comfort fund’. This is not appropriate, as providing activities are part of the home’s service and should not be reliant on charitable donations. Residents must now be consulted and a suitable programme of activities put in place. This must include both group and individual activities so no residents are left out. This will help to ensure residents’ social needs are met. Visitors can come to the home at any time. During the inspection three sets of visitors arrived. All were made welcome by staff who they appeared to have Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 14 good relationships with. The visitors we spoke to told us they were happy with all aspects of the home and the care provided. A full-time cook is employed and records showed that a wholesome and varied diet is provided. All the residents said they liked the food. One told us,‘The food is very good – second to none’, and another said, ‘If you don’t like something they’ll bring you something else.’ During the inspection we saw that all residents, whether in their rooms or in the lounges, had juice or water next to them, as well as regular hot drinks. The Acting Manager said this is because her staff are aware of the dangers of dehydration and encourage residents to drink fluids as much as they can. A resident told us, ‘We drink gallons of water here!’ Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. Residents and their representatives are encouraged to talk to staff about any concerns they might have. This judgement has been made using available evidence including a visit to this service. (Standards 16 and 18 were inspected.) EVIDENCE: All the residents we spoke to said they would speak out if there were anything they were unhappy about in the home. One said, ‘If you don’t like something you tell them and they do something about it.’ And a relative told us, ‘We have no concerns about this home but if we did we would tell the Manager.’ The Acting Manager told us she wanted all residents and relatives to tell someone straight away if they had a complaint so it could be put right as soon as possible. Minor complaints, for example items of laundry going missing, are recorded in residents’ files to ensure they are addressed. There is also a formal complaints procedure that residents and their representatives can use. Copies of this are given to all residents when they first come to the home. It is also displayed on the home’s notice board. Records showed there have been no complaints since the last inspection. At the last inspection we advised that staff should have further training in ‘safeguarding’ (protecting residents from abuse). The Acting Manager has made enquiries about a course and is waiting for confirmation that staff can go on it. Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 16 We looked at the home’s safeguarding policies and procedures. There is a copy of ‘No Secrets’ (local guidance on safeguarding) and other information in the home, but no clear procedure for staff to follow if a safeguarding issue arises. It is recommended that one be put in place emphasising the role of social services as lead agency in any safeguarding investigation. This will help to ensure that staff know what to do and who to contact. Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. Residents live in an environment that is safe, comfortable, and well maintained. This judgement has been made using available evidence including a visit to this service. (Standards 19 and 26 were inspected.) EVIDENCE: The accommodation is homely and comfortable. For a relatively small home (18 beds) there is a good range of communal areas so residents can choose where they sit and who with. Bedrooms are individually decorated and personalised. All areas inspected were clean and tidy. Residents’ comments about the premises included: ‘I love sitting in the conservatory with my friends.’ ‘The rooms are big – I brought all my pictures and put them up to make my room nice.’ ‘This home is lovely and clean.’ Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. An established staff team meets residents’ needs. Relationships between staff and residents are warm and caring. This judgement has been made using available evidence including a visit to this service. (Standards 27, 28, 29, and 30 were inspected.) EVIDENCE: Marwood has a friendly, lively atmosphere and this is partly due to how well staff and residents get on. The staff are warm and caring in their dealings with residents, and also engage in plenty of joking and banter, which the residents enjoy. Residents’ comments about the staff included, ‘The staff join in with all the fun’, ‘The staff are lovely and helpful’, and ‘The staff do so much for you here.’ At the last inspection we asked for staffing levels to be improved to ensure residents didn’t have to wait too long for staff assistance. This has been done and there are now two waking members of staff on duty at night, and two during the day, plus the Acting Manager. Cooks and cleaners are employed so care staff can spend most of their time looking after residents. Recruitment procedures were discussed with the Acting Manager. She confirmed that all staff are subject to CRB and POVA checks, and references are obtained. Staff files were sampled and had the appropriate documentation in place. This helps to ensure residents are safeguarded. Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 19 Staff receive good training opportunities. The majority are either studying for, or have obtained, NVQ Level 2 in Care or its equivalent. Since the last inspection the Acting Manager has reviewed staff training and developed a training programme, which has commenced. A programme of appraisal and supervision has also been developed to ensure staff have the support and skills they need to carry out their work. Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. Residents live in a home that is safe and well managed. This judgement has been made using available evidence including a visit to this service. (Standards 31, 33, 35, and 38 were inspected.) EVIDENCE: An Acting Manager is presently in charge of the home. She has 12 years experience in care and is currently studying for NVQ Level 4 in Care, and the Registered Manager’s Award (recognised qualifications for people who run care homes). She is committed to Marwood and both she and her staff have worked hard to bring about the recent improvements to the service. Both residents and relatives told us they thought the home was running well. A resident said, ‘The Manager’s good and very approachable’, and a relative commented, ‘I don’t think twice about going to the Manager if I need to.’ Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 21 The Responsible Individual (who represents the Owning Body) visits the home every week and a record is kept of when he comes and what is discussed. This demonstrates that the Responsible Individual is taking an active role in the running of the home. Quality assurance questionnaires have been distributed to relatives and most of these have now being returned. The feedback received so far is positive. The Acting Manager said the feedback will be analysed and a summary of the results included in the next printing of the ‘service users guide’ (which tells residents about the home). Since the last inspection a ‘Personal Allowance Record’ has been put in place for all residents. This is used when the Acting Manager looks after small amounts of money for residents and will help to ensure their money is safe. When we toured the premises we found some radiators were hot to the touch and could put residents at risk of scalding. We told the Acting Manager and she immediately turned them down (all can be individually adjusted). She said they had been turned up because that was how some residents wanted them. While it is good that residents can choose the temperature in their rooms and other areas, steps must be taken to reduce risk. A risk assessment must be carried out and action taken, where necessary, to make radiators safe (for example by providing covers for them). This will make the home safer. Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 22 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 3 X 3 X 3 X X 2 Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15(1) Requirement Care plans must be put in place for residents’ mental health needs to ensure they are met. Timescale for action 15/08/08 2 OP12 16(2)(n) Residents must be consulted and 15/08/08 a suitable programme of activities provided. This must include both group and individual activities so no residents are left out. This will help to ensure residents’ social needs are met. Radiators must be risk assessed and action taken, where necessary, to make them safe (for example by providing covers for them). This will help to prevent the risk of scalding in the home. 15/08/08 3 OP38 13(4)(c) Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP18 Good Practice Recommendations A clear safeguarding procedure should be put in place emphasising the role of social services in any safeguarding investigation. This will ensure that staff know what to do and who to contact should a safeguarding issue arise. Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG 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 Marwood DS0000070333.V364543.R01.S.doc Version 5.2 Page 26 - 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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