Care Home: The Marshes

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What the care home does well Staff were seen interacting in a positive inclusive manner with the service users in the home; staff were friendly and helpful during the inspection process. Care plans are person centred, clear documents which contain relevant information. Comments taken from cards and professionals surveys which had been returned to the home stated `they treated X and us with respect and guided x appropriately`,`they were absolutely amazing`.`Staff who care so well for my x`.`I see happy well cared for service users and staff who enjoy their work`. What has improved since the last inspection? At the last inspection the service was issued with no requirements, however they have reformatted the care plans in the service and each service users has a clear, and well laid out person centred plan of care. In discussion with the unregistered Manager and from information obtained in the AQAA it is also evident that the needs of the service users are met and any changes in their mental health are addressed by the unregistered Manager by ensuring that staff receive appropriate training. What the care home could do better: The service has been issued with one requirement following the inspection, in that the Manager of the home, although registered at a different site as manager, must ensure they complete a application for registration at The Marshes. One training need was identified through the inspection and this had already been addressed by the unregistered Manager. The gate to the home had been damaged the previous day, and by the time the inspector had finished the inspection the gate had been mended and secured. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Marshes 3b Nursery Close Hailsham East Sussex BN27 2PX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alexis Reilly     Date: 1 1 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: The Marshes 3b Nursery Close Hailsham East Sussex BN27 2PX 01323440843EX21 01323449555 nursery@regard.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Regard Partnership Ltd Name of registered manager (if applicable) Mr Jonathan Borthwick Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home The Marshes is a purpose built bungalow, situated in a quiet residential area of Hailsham. The home shares the same site and Manager as Lynfords, another home owned by the same organisation. Resident accommodation provides six single bedrooms, a large communal lounge and a kitchen/diner. The two bathrooms are fitted with the necessary adaptations. The grounds are secure and provide a well-maintained garden and ample parking. The home is registered to accommodate six younger adults with learning disabilities. Care Homes for Adults (18-65 years) Page 4 of 26 care home 6 Over 65 0 6 Brief description of the care home The Registered Providers of the service are The Regard Partnership. This organisation owns a large number of homes across England and Wales. Information received from the Manager details that the current fees at The Marshes are based on a block contract rate of £1315.62 per week. More detailed information about the services provided at The Marshes can be found in the homes Statement of Purpose and Service User Guide - copies of these documents are available in the hallway of the home and can be obtained directly from The Regard Partnership. Latest CSCI inspection reports are on available on request from the home. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection began at 10am and finished at 2.30pm. The inspector saw service users in the home and spent time in the company of four service users in the dinning area, case tracking three of these service users. The inspector spent time observing all three service users who were part of the case tracking; and spent time with one service user in particular. The inspector used case tracking, examined care plans and the associated documents such as risk assessments and the activities plans for these individuals. Other documents examined were copies of notifications, accidents and appointments, evidence of external reviews, the record of complaints and the complaints procedure. Staff recruitment files, training sheets and records of supervision were also examined. Pictorial menus were seen. The inspector spent time with the unregistered Manager, interviewed two members of staff, one senior and one care assistant, and spent time Care Homes for Adults (18-65 years) Page 6 of 26 with a further senior staff member. A partial environmental tour was carried out of the home which included the dining area, living area, hallways, main office, kitchen and one service users bedroom. Medication is stored in individual rooms, the medication storage system was seen and a sample of the sheets which record the administration of medication were seen and found to be in good order. Information was also taken from the AQAA which was comprehensively filled in and returned by the due date. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has had no recent admissions. Service users are assessed and receive a staged induction into the home. However evidence was supporting to suggest that previously the unregistered Manager carries out a comprehensive assessment and induction into the home. Evidence: As part of the inspection the inspector case tracked three service users in the home and spent time in the company of four service users. As part of the case tracking the inspector examined the person centred care plans and the associated documents such as risk assessments and activities plans for these individuals, also evidenced were the external reviews from the community learning disability team to ascertain if the needs identified in the assessment are used as a basis for a comprehensive care plan. The service ensures service users have an introduction to the home to familiarise themselves with the home, and for staff to again assess individuals needs. Prospective service users are given opportunity to express their preferences regarding the Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: prospective placement. Service users are given a service user guide to the home, contract and a booklet outlining their rights in an easy to use format. Care Homes for Adults (18-65 years) Page 11 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have care plans in place which are person centred and are clear documents to work from. Risk assessments are detailed and clear. Service users are able to make their own choices and decisions, and are treated as individuals. Contact with advocacy services is promoted. Evidence: As part of the inspection the inspector case tracked three service users in the home and spent time in the company of four service user. As part of the case tracking the inspector examined the new person centred care plans and the associated documents such as risk assessments and the activities plans for these individuals, also evidenced were the external reviews from the community learning disability team this helped the inspector to ascertain if the needs identified in the assessment are used by the unregistered Manager as the basis for a comprehensive care plan. Other documents examined were copies of notifications, and accidents and appointments. The inspector Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: spent time with the unregistered Manager, interviewed two staff one of these was a senior care team member, and spent time with an additional senior care team staff member. Care plans are person centred in an easy to access style and contain clear, relevant information. Risk assessments are comprehensive and detailed, with guidance included specifically for dealing with individuals behaviour. Contact with advocacy services is promoted. All service users have regular monthly one to one meetings with their key workers during which if they are able they are encouraged to make their wishes and opinions known. Each service user has six monthly reviews which include the service user, family and other professionals as appropriate, service users are encouraged to be fully involved in this process. Annual reviews are carried out by the funding authority. Through out the inspection the inspector found supporting evidence to suggest that individuals needs are met and staff are knowledgeable about individuals behaviour, promoting choice and independence. Care Homes for Adults (18-65 years) Page 13 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users do benefit from regular and planned activities. Service users benefit from freedoms and flexible routines, and appeared to enjoy the food. Service users are consulted and listened to regarding the choice of daily activity. Evidence: As part of the inspection the inspector case tracked three service users in the home and spent time in the company of four service users observing them in the home. As part of the case tracking the inspector examined the person centred care plans and the associated documents such as risk assessments and the activities plans for these individuals, also evidenced were the external reviews from the community learning disability team. Other documents examined were copies of notifications, and accidents and appointments, the record of complaints and the complaints procedure. The inspector spent time with the unregistered Manager and three members of staff. Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: Service users have pictorial activity plans in place, and are given the choice on a daily basis if they wish to attend the activities set. The activities schedule is displayed on the notice boards and in individual bedrooms and care plans. Evidence was supporting to suggest that service users independence is promoted, an example given on the day of the inspection was of a staff member encouraging and enabling a service user to make a snack in the kitchen. Family relationships are encouraged, and the service users in the home have input into the choice of the menu. Staff have NVQ training, which incorporates in its units equal opportunities, discrimination and sexuality awareness. A percentage of the staff have completed Sexuality awareness training. Should any service user express a wish to attend church or any other religious gathering then the provision is made to accommodate this. College courses have been accessed for service users to meet their individual needs and choices. This has been achieved with support of the college coordinator who has attended informal meetings at the home. Day time and evening in house activities include music, aromatherapy, cookery, arts and crafts. Community based activities are also offered including bowling, swimming, theatre trips and dining out. Club nights are held fortnightly with other local services where a variety of activities take place. A Christmas party for families and service users have also been arranged. Contact is maintained with family members and friends, all of whom are encouraged to attend house parties and functions and to be involved in the service users lives as much as possible. Care Homes for Adults (18-65 years) Page 15 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a comprehensive plan of care and input from the community learning disability team. The unregistered Manager has a good relationship with the general practice and service users health care needs are reviewed and referrals made were appropriate. The procedure for administering medication was found to be in good order. Evidence: As part of the inspection the inspector case tracked three service users in the home and spent time in the company of four service users. As part of the case tracking the inspector examined the new person centred care plans and the associated documents such as risk assessments and the activities plans for these individuals, also evidenced were the external reviews from the community learning disability team. Other documents examined were copies of notifications, and accidents and appointments, evidence of external reviews, the record of complaints and the complaints procedure. All service users have a health care action plan in place and care needs assessment that is reviewed six monthly. Individual health support needs are documented in each service user plan and gender specific care is provided where necessary. All service Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: users are registered with a local GP and other professionals such as chiropodist and dentist. Service users also have access to the local community learning disability team and can access professional services as required such as occupational therapy, speech and language therapy and a learning disability nurse. The inspector examined a sample of MAR sheets and can confirm these were found to be in good order. No service user currently self medicates in the service. Care Homes for Adults (18-65 years) Page 17 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service records complaints and deals with these effectively; the unregistered Manager notifies the CSCI and social services of all significant incidents in the home. Service users are protected by the homes recruitment procedures. Evidence: As part of the inspection the inspector examined copies of notifications, and accidents and the record of complaints and the complaints procedure. The inspector spent time with the unregistered Manager and gained views about the services from visiting professionals and relatives to the home these comments have been included in the report. The unregistered Manager has notified the CSCI of any significant incidents which have occurred in the home, and has produced evidence to show these had also been forwarded to the relevant member of social services. The service has a policy in place with regard to complaints and the inspector evidenced complaints sheets which were produced in picture bank, and widget symbol format. The recruitment documents of staff employed in the home since the last inspection were examined and found to be in good order. Care Homes for Adults (18-65 years) Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The building is well maintained and reasonably decorated, therefore ensuring that service users live in a bright, accessible, clean and well maintained home. Evidence: As part of the inspection the inspector carried out a partial environmental tour of the home, this included the kitchen dining area, lounge, communal hallways, one bedroom and the main office. The home was clean and reasonably decorated with comfortable and homely seating in the lounge. Service users can decorate their rooms to their own personal tastes and choice, where possible. Families are involved in this process to advocate for their family member if they are unable to do so. The inspector did not tour the garden or outside of the building. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff interact well with service users and have an understanding of the needs through, training and supervision. Staff are working within the new care plan documentation and provide a person centred approach to the delivery of care. Evidence: As part of the inspection the inspector examined the recruitment files of staff recruited to the service since the last inspection these were found to be in good order. The inspector also gained evidence of staff training and the record of completed staff supervisions. Ongoing training for staff is identified in a timely manner ensuring the service users are well cared for. Members of staff were seen on the day of the inspection interacting positively with service users in an encouraging manner and were knowledgeable and helpful through out the day. The Regard Partnership have the following policies relating to Equality & diversity in place, Equal opportunities & race equality, Recruitment, Gender Specific care and Racial Harassment. The service ensures that staff interviews include questions around social inclusion, equality and diversity, to ensure the candidate has an understanding of these, prior to employment. Service users are able to take part in interview if they wish to. Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: Service users have the opportunity during the interview process to ask a question or give an opinion. Potential employees are taken to meet the service users and the interaction is observed as part of the recruitment process. Staff do not commence employment until a fully enhanced CRB check has been carried out, and two written references obtained. Human resources at head office oversee the recruitment process and all documents are checked before commencement of employment. Terms and conditions of employment are given to new employees by the human resources department and are kept on file. Staff files are held at Head Office and are audited regularly by an independent auditor. All posts are subject to a 6 month probationary period. All staff are given comprehensive job descriptions and Social Care Council code of practice terms and conditions. All staff carry out an induction which is the skills for care common induction standards. Staff are offered mandatory training and a range of specialist training. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The unregistered Manager ensures that the home is run effectively and in the best interests of the service users placed. Staff work with service users with person centred care plans, and service users are protected by the homes policies and procedures, staff recruitment, supervision and training practises. However the Manager must ensure they submit an application for registration to the CSCI. Evidence: As part of the inspection the inspector case tracked three service users in the home and spent time in the company of four of them. As part of the case tracking the inspector examined the person centred care plans and the associated documents such as risk assessments and activities plans for these individuals, also evidenced were the external reviews from the community learning disability team. Other documents examined were copies of notifications, and accidents and appointments, evidence of external reviews, the record of complaints and the complaints procedure. The staff recruitment files of new staff within the service were examined and the list of staff Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: training. The inspector spent time with the unregistered Manager and three members of staff, two of these were senior carers. Comments are included in the report from relatives evidenced from cards seen in the home. Customer service surveys are sent out to family, friends and associated professionals this information has been collated by the home and showed positive feedback. Regulation 26 visits are carried out on a monthly basis and six monthly quality audits are also carried out. Discussions are held with the service users to ascertain their views. The unregistered Manager has ensured that care plans are person centred, risk assessments are comprehensive and up to date, providing clear documents to work from. Staff promote independence and choice for service users and activities are on offer and geared to individuals. The AQAA was returned within the correct timescales and was comprehensively filled in. The home is well maintained and reasonable decorated. Service users are protected by the homes staff recruitment procedures and the process which ensure that the unregistered Manager notifies the CSCI and social services of any significant incidents. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 37 9 The Registered Manager is qualified, competent and experienced to run the home. To ensure that the unregistered Manager submits an application for registration to the CSCI 01/09/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!