Care Home: The Martlets

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What the care home does well There are good arrangements in place for people living in the home and their relatives or advocates to influence what is provided in the home. The employment of activities staff is helping to ensure that people`s social needs and need for stimulation are being met. The premises are purpose built and decorated and furnished to a high standard. Efforts are made to make the environment as homely as possible for the people living there. Arrangements are in place for staff to receive the training and support which assists them in meeting the needs of the people living in the home. What has improved since the last inspection? Care plans are now including more detailed information on how the person wishes their care to be provided, and arrangements are in place for the person or their relative or advocate to be involved in the review of the care plan if they wish to. There is an improved level of interaction between staff and people living in the home, and more understanding of the needs of people who suffer from memory loss. Where people are prescribed medication to be taken `as required` guidance is now in place for staff as part of the individual`s medication records. Improvements to the garden areas have included developing water features, a vegetable garden, sitting areas, pathways and covered areas such as a summer house. A number of features such as nesting boxes, a telephone kiosk and a post box have all added interest to the gardens for people living there. All previous requirements were found to have been met. What the care home could do better: No requirements were made at this visit. Key inspection report Care homes for older people Name: Address: The Martlets The Martlets Fairlands East Preston West Sussex BN16 1LJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Edward McLeod     Date: 1 1 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Martlets The Martlets Fairlands East Preston West Sussex BN16 1LJ TBC TBC Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Shaw Healthcare Ltd Name of registered manager (if applicable) Mrs Marian Eileen Drake Type of registration: Number of places registered: care home 80 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1. 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: Old age, not falling within any other category (OP) Dementia (DE) 2. The maximum number of service users to be accommodated is 80. Date of last inspection Brief description of the care home The Martlets is a new and purpose built property situated in the village of East Preston, West Sussex, close to local shops and transport links. The accommodation is arranged on the ground floor, first floor and second floor. The first and second floors can be reached by stairs or a lift. The registered provider for the service is Shaw Healthcare Limited, and the Care Homes for Older People Page 4 of 26 Over 65 0 80 80 0 2 8 0 7 2 0 0 9 Brief description of the care home Responsible Individual registered for the service is Mr Peter John Jeremy Nixey. The registered manager for the service is Mrs Marion Eileen Drake. Fees range from 420 pounds per week to 700 pounds per week. Care Homes for Older People 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was arranged to review the services compliance with requirements made at our previous visit, and to assess compliance with the key national minimum standards for care homes for older people. In preparing for the visit we looked at all the information that we have received or asked for since the last key inspection or annual service review. This included the the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self assessment that focuses on how well outcomes are being met for people living in the home. It also gave us some numerical information about the service. We also recieved surveys returned to us by four people using the service and from four staff working for the service. Care Homes for Older People Page 6 of 26 In preparation for this visit we took into account what the service has told us about things that have happened in the service - these are called notifications and are a legal requirement, and the previous key inspection. The site visit was attended by a regulatory inspector and was conducted over a period of five hours on the 11th May 2010. During our visit we spoke with the manager Mrs Drake, with four people living in the home, a visiting relative, and five members of staff. As we had concerns from our previous visit about the care provided for people with dementia, we therefore focussed our visit on the units in the home which care for people with dementia - Wren, Nightingale, and Dove units. We sampled care and support records for four people living in the home. We sampled recruitment and training records for three permanent and three temporary staff working in the home. Other records sampled included records relating to pre-admission assessments, staff supervision, complaints, and health and safety. We visited the main communal areas of the home, including outdoor areas. Care Homes for Older People Page 7 of 26 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. 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 and the support they need. Evidence: At our visit we sampled the pre-admission assessments for two people admitted to the home since our previous visit. We found that people were being visited and their needs assessed before admission was being agreed. The manager Mrs Drake advised us that where it was not possible to gather full information during these visits, the information would be gathered after the visit and included in the risk assessments that were subsequently carried out. Risk assessments sampled confirmed this. Care Homes for Older People Page 10 of 26 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Peoples health, personal and social care needs are met. The home has a plan of care that the person or someone close to them has been involved in making. If they take medicine they manage it themselves if they can. If they cannot manage their medicine the home supports them with it in a safe way. Peoples right to privacy is respected and the support they get from staff is given in a way that respects their dignity. Evidence: At our previous visit we found that care plans were not fully setting out how the person wished their care to be provided, and were not setting out in detail the care to be provided by staff. At this visit we found that care plans sampled included records of the persons preferences, for example with regard to the handling of their money, and health care services such as chiropody they wished arranged for them. Care Homes for Older People Page 11 of 26 Evidence: At our visit we found that care plans were including information on how the person wished their care to be provided, for example care plans seen included how the person wished to be supported with taking their medicines, and how they preferred to be assisted with eating if they needed this support. We found that where the care plan was indicating there was a need for an aspect of their care to be monitored, for example their continence care, that records for this were being regularly maintained. We are told in the AQAA that as a result of listening to peoples views the service now routinely communicate with relatives, inviting them to each review. Care plans sampled indicated where the person or their relatives wished to be involved in the review of their care plan. Letters to relatives advising them of a care plan review were included on the care records sampled, and administrative staff showed us records to indicate how this was being monitored. The AQAA tells us that managers are monitoring the care plan training undertaken by staff. Training records sampled indicated that staff are accessing training in managing challenging behaviour and in dementia care. We talked with staff who gave examples of how they support one person with their personal care and with remaining as independent as possible. Staff we talked to seemed very aware of the persons likes and dislikes, and this helps them provide the care the person needs. The four people living in the home who responded to our Care Quality Commission (CQC) survey told us that they received the care and support they needed always or usually, and that staff always or usually acted on what they said. We discussed with staff how they are monitoring continence care. Staff told us that if they ask someone if they wish assistance and they decline, they will ask them again a little while later or perhaps another member of staff will approach them. One person living in the home told us in their survey form that it is like home from home, warm, friendly. Staff are all kind and helpful and do their best to make us happy whilst here. Interactions we observed indicated that staff are respecting each persons dignity, and staff provided examples of how each persons privacy is being respected. Care Homes for Older People Page 12 of 26 Evidence: The four people living in the home who responded to our CQC survey told us that they always receive the medical support they are in need of. Care plans we sampled indicated the health care support being provided for the person. We attended the team leader handover on one unit, and discussions in the handover indicated that peoples health care needs are being monitored and action taken, such as arranging G.P. visits and obtaining equipment needed. Staff we spoke to told us that district nurses and a local hospice become involved in supporting end of life care in the home, and staff are undertaking some distance learning training in end of life care. At our previous visit we found that medication records were not sufficiently providing guidance for staff on the administration of the individuals as required medicines. We sampled medication records for six people during this visit. We found that where people were prescribed medication to be taken as required guidance is now in place for staff on its administration on the individuals medication records. The previous requirement was found to have been met. Medication administration records sampled were found to have been completed consistently, and there is a system in place for records to be checked and audited. Medication records sampled included a description of how the person prefers their medicines to be administered. Medication records sampled included completed forms where the person had been assessed for administering their own medicines. The home has suitable facilities for the storage of medication. Training records seen indicated that staff responsible for administering medicines have recently completed a modular training entitled Care of Medicines. Care Homes for Older People Page 13 of 26 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. Each person is treated as an individual and the care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks at a time and place to suit them. Evidence: At this visit we talked to an activity coordinator who told us that they have received recent training in the care of people with dementia. We were told that the planned outings for the present week were a visit to Brighton pier for a fish and chips lunch and a visit to a park which is having an event. There were posters in the sitting rooms to tell people about future events, such as a musical entertainer and a movement to music session. On the day of our visit a number of activities took place, such as ball games, skittles, and painting. Staff were also doing spontaneous things such as singing and dancing Care Homes for Older People Page 14 of 26 Evidence: with people. Although people needed encouragement and support with the activities, it was our observation that they were really enjoying themselves. A relative we spoke to told us that staff look after her hair and paint her nails which she enjoys, and that staff keep the relatives informed about her care. On the day of our visit several people were being visited by friends or relatives, and we noted that staff welcomed them, talked to them and offered them a hot drink. People living in the home have been helping with the vegetable garden and planting bedding plants, and people less able have been able to help by planting seeds and potting seedlings. One person living in the home told us in their CQC survey form that they felt at home and that staff do their best to meet my needs and do activities. At our previous visit we found that people were not always receiving the support they needed with eating, and a requirement was made concerning this. The four people living in the home who responded to our CQC survey told us that they always or usually like the meals provided. One person we spoke to said it was lovely food here, and said they had a choice of cooked breakfasts such as bacon sandwiches or porage or toast. The main choices for lunch on the day of our visit were beef hot pot, vegetable hot pot, or liver. We observed arrangements for lunch on Nightingale and Wren units, where people accomodated have a diagnosis of dementia. People are asked which choice they would prefer or shown plates of the dishes to help them choose. There were enough staff available to ensure that people who needed assistance with prompting or eating were receiving this. The lunch was unhurried, and there was a calm and relaxed atmosphere. The previous requirement concerning people receiving the support they need with eating was found to have been met. Care Homes for Older People Page 15 of 26 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. If people have concerns with their care they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. Evidence: We are told in the AQAA that each person receives a copy of the homes complaints procedure in their pre-admission pack. The four people living in the home who responded to our CQC survey told us that there was someone they could talk to if they felt they had concerns, and three of the people said they knew how to make a complaint. The four staff working in the home who responded to our CQC survey told us that they know what to do if someone has concerns about the home. At our visit we sampled the records of three complaints which had been recorded and investigated by the home. Each of the complainants had been advised in writing of the outcome of the complaint in a timely manner. We discussed some safeguarding incidents with the manager and Mrs Drake advised Care Homes for Older People Page 16 of 26 Evidence: us of the actions which have been taken to change one of the units around to minimise incidents where people living there become agitated with others - for example, people having their meals in smaller groups. Five staff have recently undertaken training in managing challenging behaviour, and training records sampled indicated that staff receive regular updating training in safeguarding vulnerable adults. Care Homes for Older People Page 17 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, 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. 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. People stay in a safe and well-maintained home that is homely, clean, 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. Evidence: Since our previous visit key locks for lifts have been provided to increase the security of the building. There are four seperate garden areas, all of which have been developed since our previous visit. Improvements to the garden areas have included developing water features, a vegetable garden, sitting areas, pathways and covered areas such as a summer house. A number of features such as nesting boxes, a telephone kiosk and a post box have all added interest to the gardens for people living there. There is good access to the gardens for people with poor mobility or who use wheelchairs. We found that the premises are being well maintained, and that the furnishings, decoration and furniture in the home provided are of a high standard. Care Homes for Older People Page 18 of 26 Evidence: The building is new and had been operating for about seventeen months at the time of our visit. A lot has been done to make the environment homely and comfortable, and the home has re-arranged some of the communal areas to better meet peoples needs. Maintenance records seen indicated that health and safety checks for the building are being regularly carried out. All areas of the home visited were found to be clean, pleasant and odour-free. The four people living in the home who responded to our CQC survey told us that the home is kept fresh and clean always or usually. Care Homes for Older People 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. People have safe and appropriate support as there are enough competent 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. Evidence: At our previous visit we found that there were shortfalls in the support provided for people with dementia. A requirement was made that the provider ensure that sufficient numbers of suitably qualified, competent and experienced staff were employed to meet the needs of the people accomodated. The four staff working in the home who responded to our CQC survey told us that there were usually enough staff to meet the needs of all the people in the home, and three of the people living in the home told us in their survey forms that there were usually enough staff. The four staff working in the home who responded to our CQC survey told us that they were receiving training which helped them understand and meet peoples needs, keep up to date with new ways of working, and gives them enough knowledge about health Care Homes for Older People Page 20 of 26 Evidence: care and medication. We sampled staff training records and found that staff who are caring for people with a dementia, including activities staff, are accessing training in the care of dementia and managing challenging behaviour. At this visit we found that staff were more alert to peoples needs, and that staff were engaging more with people and were better meeting their needs. The previous requirement concerning staffing was found to have been met. We are told in the AQAA that 43 of the 65 care staff employed in the home have achieved the National Vocational Qualification (NVQ) in care at level 2 or above. At our previous visit we found that the home had not obtained the necessary checks and references for some of the temporary or agency staff working in the home. A requirement was made concerning this. The AQAA tells us that all staff employed in the home in the past 12 months have had satisfactory pre-employment checks before commencing work. At this visit we sampled the recruitment records for three permanent staff and three staff employed by an agency who had worked recent shifts in the home. We found that the required checks and references had been obtained before staff were employed in the home, and that training records were available for both temporary and permanent staff. The previous requirement was found to have been met. Care Homes for Older People Page 21 of 26 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. People have confidence in the care home because it is led and managed appropriately. The environment is safe for people and staff because appropriate health and safety practices are carried out. Evidence: The registered manager has obtained qualifications in the Registered Managers Award and NVQ in care at level 4. She has continued to update her skills and knowledge, for example by attending a training course for managers which the company has made available. We found at this visit that the management team have taken the measures to address the shortfalls identified at our previous visit, and all previous requirements were found to have been met. At this visit we found that managers and staff have continued to make improvements Care Homes for Older People Page 22 of 26 Evidence: to the service, for example by providing more activities and opportunities for outings, and by changes to the environment to decrease friction between people living there. A member of staff told us in their survey form that there was a homely, welcoming feel in the home and that staff and managers were friendly. People we spoke to and their relatives agreed that there was a good atmosphere in the home. A relative we spoke to said that the home had a cheery bunch of carers. The service has provided questionnaires for people living in the home and their relatives, and has received responses from them on the service provided. There are also regular relatives meetings. We are told in the AQAA that as a result of listening to peoples views the service now routinely communicate with relatives, inviting them to each review, and that they are now extending the activities programme to seven days a week. At our visit other examples of the service responding to suggestions made were improvements to passenger lift and gate security, and the use of door guards on bedroom doors. We sampled two of the monthly reports of visits which the provider carries out on the service. These show us that the provider is monitoring the performance of the service and that action is being taken on shortfalls identified. The AQAA tells us of the most recent services, checks and tests as recommended by the manufacturer or regulatory body which have been carried out in the home. At our visit we found that weekly fire testing and regular fire drills are carried out. We talked with the maintenance staff, and sampled records for ongoing maintenance and safety checks such as fire safety and hot water temperature checks. Training records sampled indicated that staff are receiving training in the required health and safety topics such as food hygiene, lifting and handling, and health and safety. Care Homes for Older People 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 Older People 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 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 Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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. 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