Inspection on 26/08/08 for Maitland House

This inspection was carried out on 26th August 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Maitland House 03/09/07

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Maitland House 33 Church Road Clacton On Sea Essex CO15 6AX Lead Inspector Helen Laker Unannounced Inspection 10:20 26 & 27 August 2008 th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Maitland House DS0000068186.V370585.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. Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maitland House Address 33 Church Road Clacton On Sea Essex CO15 6AX 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) 01255 421415 maitlandhouse@blackswan.co.uk www.blackswan.co.uk Black Swan International Limited Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Four named persons, over the age of 65 years, who require care by reason of dementia. 3rd September 2007 Date of last inspection Brief Description of the Service: Maitland House is an established care home situated in a residential area close to the town centre of Clacton on Sea. It is within walking distance of local shops, post office, library, churches, leisure facilities and the railway station. Fees were said to be £383.04.- £460.00 per week. Additional charges are newspapers, toiletries, chiropodist, dry cleaning and magazines at cost. Maitland House offers accommodation for twenty-three service users, on the ground and first floor, with fourteen single bedrooms and one double room having en-suite facilities (This is used as a single room currently). There is passenger lift access to all floors. The home has gardens to the front and rear. The front garden offers off road parking, with flowerbeds and borders. The rear garden has paved patio, shrubs and flowerbeds. Communal areas are found at the front and rear of the property. The rear lounge has patio doors to the garden. A second lounge and dining room are found at the front of the building. There are bathroom facilities on each floor, including a Parker bath. A call bell system is in place, with handrails, aids and hoists in the home. Maitland House DS0000068186.V370585.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 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out as part of the annual inspection programme for this home. The operation directors and manager were available on the day of the inspection. The inspection took part of a second day as the inspector required more time to talk to service users, staff and residents. The inspection focused on all of the key standards. A tour of the premises was undertaken. Evidence was also taken from the Annual Quality Assurance Assessment (AQAA) completed by the management of the home and submitted to CSCI. The AQAA provides an opportunity for the service to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that some improvement be noted as this contributes to the inspection process and indicates the home’s understanding of current requirements, legislation changes and own audited compliance. Eight residents and five staff were spoken with during the inspection. Three staff and six service user completed CSCI’s feedback survey sheets. All comments were taken into account when writing the report. Observations on the day of inspection showed residents’ looked happy, relaxed, well groomed and comfortable. Overall the comments within the returned surveys were positive and are reflected on in detail in this report. All were pleased with the service and happy about way they are supported and assisted by the staff. They considered the manager and staff to be kind and courteous. What the service does well: The home actively encourages residents to be involved in the running of the home, and making decisions about their daily lives (e.g. through involvement with care plans, key workers and residents’ meetings.). The home encourages contact with family and friends. Residents reported that they could receive visitors at any time. Relationships within the home are supported by staff, and one resident described the home as “It’s my home and I love it, I like being on my own sometimes but having someone close at hand is reassuring” Another stated “I like it here and have no complaints” The home provides a good range of activities, social, leisure and educational, both inside and outside of the home. The environment is homely and comfortable with ongoing improvements and maintenance implemented. Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 6 On the day of this inspection, the home was maintained in a good condition. Residents were receiving good care and support, and those spoken to enjoyed living at Maitland House and were positive about the staff team. It was clear that the people who live in the home have established friendships amongst themselves and during the inspection we were told of ways in which they support and help each other day by day. What has improved since the last inspection? What they could do better: Full and detailed pre admission assessments by the home must be undertaken prior to a service user moving in. Staff must ensure that where possible residents and/or their representatives have input into the care planning system. Staff need to ensure that residents care plans are a clearly documented daily record of the care delivered and be person centred to evidence that staff appreciate the diversity of individual residents. People who use the service must be assured that there are sufficient staff to meet their assessed needs, with particular regard to the provision of social and leisure activities in the home and getting people to bed in the evening. Staff rotas should be representative of the home staffing requirements showing contracted hours worked, names and designations, person in charge and staff complement must be in ration to dependency of current service user group. NVQ qualifications should continue to be encouraged amongst staff. The home should have a registered manager The home must ensure that ongoing quality audit systems are in place and that systems within the home protect and safeguard service users. This is also with reference to regular fire drills being undertaken and recorded. Maitland House DS0000068186.V370585.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. Maitland House DS0000068186.V370585.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 Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3. Standard 6 does not apply to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an assessment system in place that does not always ensure that they can meet the needs of people they admit to the home. Information is available to prospective residents to ensure they will receive accurate information about the service or facilities on offer when deciding to move to the service. EVIDENCE: Black Swan International Limited has redeveloped the Service User Guide, which includes the Statement of Purpose, which is provided in all service user rooms. A copy was seen at Maitland House and was dated as being reviewed in March 2008. Within this guide, detail as required by the National Minimum Standards – Standard 1 was seen with details of fees included. Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 10 The documentation of two new admissions was sampled, both had statement of terms and conditions documents as produced by Black Swan International Limited however signatures were missing in one case. On the day of the inspection there were seventeen people living at Maitland House. The primary care needs of these people related to their old age. The admission process was discussed and considered with the manager and sampled paperwork was not in all cases seen to support a comprehensive assessment and admission process. An initial assessment had not been conducted before admission to the home in one case, although supporting evidence of assessments completed by health professionals and social workers were present. This does not concur with the home’s AQAA which states “We complete a comprehensive pre-admission assessment of needs by way of visits to the potential service user, an invitation to visit the home, eat at the home, meet staff and other residents, free trial overnight stay at the home.” The manager said that family and relatives are encouraged and had been part of the admission processes for the two sampled admissions. This statement was also not supported by the documentation reviewed on the day of inspection. The AQAA acknowledges in response, “They could get more comprehensive feedback from all those involved in the admission process and then respond accordingly.” One relative survey received highlighted that although they felt the home met the care needs of their relative they could have been more involved with the admission process. No intermediate care is offered at Maitland House. Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning standards in the home do not always ensure that the care of residents is monitored carefully enough. The development of a more person centred approach would improve outcomes for residents further. People who use this care service can be assured that their health care needs are met through the management of medication and they are supported to access health professionals as needed. EVIDENCE: The admission procedures in the home did not in all cases provide sufficient introductory information. From this information the home would be able to determine whether they could meet the identified needs and commence an individualised plan of care. Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 12 The care plans of three people living at the home were sampled and inspected and they were used to case track care in the home. An assessment of needs identified, health, personal and social cares needs. Within one of the three care plans sampled, care plans had been created which covered topics such as Medical Care, Personal Needs, Mobility, Moving, Handling & Transferring, Behavioural & Emotional, Activities, Financial Management & Restrictions of Choice & Specific Risks. Of the other two sampled, one had not been developed at all and the other was only partially in process. The homes AQAA refers to “Each resident having an individual care plan based on assessed needs which is driven by the resident.” One service user spoken to stated “I haven’t seen my care plan” Another stated “I know I have one and they write in it but I haven’t read it”. Care plan detail was seen in one of the three care plans and goals/objectives and agreed action were noted. Monthly reviews combined with a formal six monthly one were evident but this had not been a consistent trend with the other care plans reviewed. The manager discussed the implementation of a key worker system whereby care plan reviews and updates would be their responsibility. This is yet to begin but is viewed as good practice to ensure consistency. Alongside the care plans, risk assessments were seen in place. Risk assessments for Self-Medication, Prevention of Falls, Diabetes, Smoking, Going out of the Home unaccompanied, Challenging Behaviour, Manual Handling and Nutrition & Health were considered. In addition to these identified risks, the home has developed a risk assessment around the use of bedside rails and this had been brought into operation as needed and was seen to be appropriate and reviewed. We were informed by the previous registered manager, that the practice of writing daily records had ceased following an instruction from the new registered providers. Weekly record keeping had commenced and this was found to either very brief i.e. ‘…had a good week’ , ‘ is fine’ or where the notes were more detailed it had been found impossible to follow through what action had been taken either in the notes made weekly or in medical notes. This practice had not changed at this inspection and in one service user’s file it was noted an entry had been made on the 25/06/2008 and there had been no more entries until the 6/07/2008. This was a gap of twelve days and is considered very poor practice. Additionally the space allowed on the AQAA for the home to be specific about what they could do better within health and social care section was just left blank and incomplete. Staff did not highlight any problems with care planning when spoken to. However it was noted that depending on who had completed the care plan determined how much time and detail was involved when documenting the entry. Training in care planning was discussed with the manager and gaps of up to 14 days with no daily entry is not deemed appropriate or good practice and must be addressed as the care plan is currently failing to reflect the current care required. Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 13 People living at Maitland House use the services of five GP practices in the area. Many have been able to remain with their previous GP as they moved into Maitland House. At the time of the inspection, the manager said that two people were having regular visits from the District Nursing Service. Staff and residents spoken to said that ‘Residents are looked after well’ and ‘staff are kind and caring’. The manager confirmed that the home has a variety of aids and equipment to assist with caring for the people living at the care home. They have pressure mattresses in use and the home has one stand-up hoist, three mobile hoists two electric and one manual available for use. A Monitored Dosage System is used. Medication records, storage and administration were sampled and inspected for people living at the home. Photographs were seen in the medication folder of each person on medication and records were found to be in general good order. MAR sheets were neat but there were some missing signatures and some hand written prescriptions without two signatures. A signature audit may be of value to keep this issue in check. Staff need to make better use of the omissions code. Items are checked into the home and a returns system is in place. No residents are presently selfadministering and controlled medications checked on the day of inspection were in order. A list of drug givers with their signatures and initials is used. During the inspection, staff were seen to treat all of the people living at Maitland House with respect and dignity. Within care planning notes there were the details of the preferred names, which some people wished to be called. It was also evident that the people living at Maitland House were also able to express their individuality in their accommodation, and there was evidence of personal possessions, small pieces of furniture and photographs in their rooms. During the inspection we were able to observe staff going about their duties and as they approached and spoke with the people living at Maitland House, it was pleasing to see that they were both respectful and sensitive to their needs and there was lots of friendly chatting and joking going on between staff and residents. Staff approach to privacy is good and relatives confirmed this on the day. Interaction between staff and residents was seen and heard to be friendly, caring and respectful. Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social care standards at the home generally ensure that residents’ individual and groups needs are met and their strengths optimised. The meal service at the home is satisfactory and the daily routine and activites in the home were flexible and optional, with people who live at Maitland House being encouraged to make choices with regard to their social, cultural, religious and leisure activities. EVIDENCE: Throughout the day of the inspection, the people who live at Maitland House were seen to come and go as they pleased. Some people choose to sit in the lounge areas, whilst others sat in their rooms listening to the radio, watching television or reading. Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 15 One person living at the home said that they ‘enjoyed sitting in the small lounge with the TV in the background as they found it comforting’. Another person said that they enjoyed doing word searches and quizzes, whilst a third person said that were happy to do craft activities. They also enjoyed the company of the caged bird in the lounge. A weekly programme of activities was on display in the hall of the home and on the day of the inspection. The manager confirmed that normal staffing levels in the afternoon are three care staff, a reduction from the morning staffing levels of four care staff. Care staff take part in activity provision and a discussion took place regarding the provision of extra staff if required to cover external activities. As the practice of writing daily reports had predominantly ceased it was not possible to evidence what activities had taken place and who was taking part in them. A file is kept but more one to one recordings would evidence clarity of choices. Residents and relatives told us that they have entertainment but sometimes there are not enough staff to put these activities on. One relative’s survey stated “ I do feel that the residents miss out on the outside activities due to short supply of staff sometimes, also at times in the afternoon the shift is run off it’s feet so the residents are in short supply of company and quality talking time” Within the home’s completed Annual Quality Assurance Assessment, it was previously acknowledged that the home did need to increase and improve their range of activities offered and in the home’s 2008 submission it states, “All activities and entertainment have been massively increased.” Activities now include Chairobics, Zoo lab, themed lunches, musical bingo, keep fit, quizzes, theatre visits, pottery ceramics, cake and sherry mornings and a recent trip to the sea life centre. One response from a person living at the home said that they enjoyed this visit and would like to go again. In addition two said they enjoyed the ‘armchair exercise lady who is friendly and kind’. When asked in the residents survey – ‘Are there activities arranged by the home that you can take part in?’ – Three said that there was always activities arranged, four said there were usually activities arranged and one said there were sometimes activities arranged by the home. Maitland House has a policy on visiting arrangements in the home. There was said to be no restriction on visiting, the choice being up to the resident. The manager said that family and friends are involved in assisting the people who live at Maitland House to manage their financial affairs. Should this not be possible then the home would assist the individual to find an independent financial advisor and/or advocate. Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 16 On the tour of the premises it was evident that there was a range of personal belongings in the home. People living in the home had items of furniture including chairs, storage units, bookcases and small tables. In addition there was evidence of pictures, photographs and ornaments on display in the bedrooms. The home accommodated this by hanging the pictures and putting up shelves, as needed. Lockable facilities are also available in all rooms. A three-week rotation menu is used to plan meals at Maitland House. At least two sometimes three choices were offered at both the lunch and teatime meal, with a choice of a cooked or cereal and toast for breakfast. At the last inspection the cook on duty said that the menu had recently been revised to take into account the likes and dislikes of the people living at Maitland House. They said that they are responsible for finding out what people would like to eat and they would go around the home asking the residents. Themed menus are used in the form of a round the world trip. Culinary delights already savoured include Indian, Moroccan and Australian food types. Record sheets were seen of the meals selected and food supplies were plentiful to ensure that choice was on offer. Fridge and freezer space was available inside the home and in the outside food storage area. The outside storage area is a metal shed and it was noted on the day of inspection that the temperature was quite warm and one freezer was showing minus 13 degrees Celsius, which is too warm. This was bought to the homes’ attention with a request to monitor the temperature of the external storage shed to ensure food is stored at safe temperatures. It was also noted that some cleaning products were stored in the same shed and although at opposite ends this is not considered general good practice. Residents spoken too stated “ the food is lovely you can’t fault it” and another stated what they had had for dinner and that having the menus on the table a day in advance helped. Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can generally feel confident about how to complain and can expect to be listened to and their complaints acted upon. Residents can also be assured that all carers are adequately trained to safeguard their welfare. EVIDENCE: The home has an appropriate complaints policy and procedure, which promotes complaints being taken seriously and responses to them handled efficiently. Residents spoken to felt able to raise concerns, and were clear that they would speak to the manager if they had any complaints. One service user stated, “I don’t have any complaints it is lovely here you couldn’t ask for better.” Another who had had some previous issues confirmed, “I can speak to the manager and they do sort it out”. The home maintained records of complaints received: these records showed that any complaints had generally been responded to. The provision of the complaints procedure in alternative formats i.e. large print was discussed on this visit. However service users spoken with did display an awareness and understanding of the current policy and it was seen to be displayed prominently on the notice board. Management of complaints was discussed with the acting manager and the home’s AQAA informs us that they “Have an open policy of welcoming suggestions and complaints which will be acted upon”. Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 18 At the inspection visit a potential Adult Protection issue from January 2008 was highlighted in discussion and was found to have some shortfalls with regard to reflecting current practice for making a referral to the Safeguarding Adults Unit. The AQAA highlights that there was one safeguarding referral made this year, however documentation was not available within the home to support this. The home has a policy relating to the protection of service users, which includes a statement on the protection of service users’ monies, referred to the home’s Whistle Blowing policy, and does identify social services as the lead agency to which any concerns would be referred. The AQAA does not outline any plans for improvement regarding complaints but seems to refer to the employment of staff in this section, which is confusing, however does state, “All staff read, sign and understand the Homes policy on Protection of Vulnerable Adults. All staff are trained in Safeguarding of Vulnerable Adults”. Conversations with staff both new and existing, confirmed they had an awareness of the whistle blowing policy and the actions required to safeguard residents. Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is homely, clean and safe. Individual rooms were personalised promoting service users independence. EVIDENCE: A tour of the home was conducted at the inspection. There was evidence of ongoing decoration, maintenance and repair, with maintenance records completed as a task is done. The dining room has been repainted and decorated. Ten to fourteen bedrooms have now been redecorated and new carpets have been laid. The doors and door guards have been repainted and new armchairs have been purchased for one of the lounges. The rear garden had been paved over to provide a good seating area. At the last inspection it was highlighted that the home needs to introduce some shade and shelter provision and an umbrella has now been purchased. Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 20 Whilst there was no evidence of a record of a programme of planned work, the AQAA acknowledges that the kitchen is to be completely refurbished. An Occupational Therapist assessment was completed in February and June 2007. Some recommendations had been made with regard to bathing facilities in the home and these were being given consideration. In addition some recommendations around the installation of handrails has been actioned. Since the last inspection the upstairs shower room has now been converted to a bathroom. Maitland House has an in-house laundry room. Two washers and two dryers were in place with care staff responsible for laundry both day and night. One dryer required fixing on the day on inspection and was awaiting repair. There were areas for hanging clothes to dry and air and individual baskets are used to ensure individual laundry items are returned to the people living at Maitland House. Service users spoken to commented “Oh yes it is very clean here” and another confirmed “My clothes don’t get lost generally but if they do they find them and return them” Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home overall provides staff that were appropriately trained and qualified; however they are not always in sufficient numbers to meet residents’ needs. Recruitment practices meet regulatory requirements set out to protect residents. EVIDENCE: The manager stated that staffing hours are reviewed and revised according to the assessed needs of the service users. Copies of the staff rotas for the weeks commencing 28th July 2008 and 9th June 2008 were inspected and staffing levels were seen to be three carers on duty 08:00 hours to 17:00 hours, two to three carers on duty from 09:00 to 13:00 hours, reducing to two to three carers 13:00 hours to 19:00 hours. After 19:00 hours the staffing levels reduce again to two carers, with two awake carers with a senior on call at night. The rota for the week commencing the 9th June 2008 had been left blank and the other one inspected was confusing and just highlighted surnames with no designations or indication of who was the person in charge. These need to be much more clearly defined. The manager was seen to be part of these calculations for the majority of the week, with only two days designated each week for management duties. A Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 22 discussion was held as to whether this was sufficient as the manager had not long been in post and was still getting used to changes being implemented. Some staff and relative surveys received commented that they thought staffing levels in the home were low. The AQAA refers to staffing levels being reduced accordingly. This is done in line with the home not having a full complement of service users. In the home’s Reg 26 reports it states this was being reviewed. Staff spoken to state, “Yes it is busy at times but we all help each other”. A service user commented that occasionally it took staff longer to answer their buzzer. The previous inspection report highlighted ‘some problems at weekend’ and they had commented that they felt the cleanliness of the home was ‘neglected at weekends.’ When asked in the Commission ‘s surveys whether they receive the care and support they needed, five had said that they always receive the care and support needed and two had said that they usually received the care and support needed. One carer said that it is noticeable when residents have higher dependency levels and they ‘sometimes feels stretched when trying to put residents to bed, hoisting etc. and then another resident calls’. Whilst staff did not seem noticeably stretched during the inspection although staffing levels were reduced due to sickness, the provider does need to ensure that staffing levels meet the dependency needs of the home’s current service users. It was confirmed at the last inspection that eight care staff have completed National Vocational Qualification training (NVQ) level 2 in care, two of whom are starting their NVQ level 3 in care and three staff are currently on NVQ level 2 in care. The home was therefore said to have met the minimum ratio of 50 trained members of staff with NVQ level 2 or equivalent. Two care staff spoken with at the inspection confirmed that there were training opportunities and one had completed their NVQ level 2 in care, whilst the other was planning to do it. Staff recruitment practices and paperwork were sampled and inspected for three care staff. Recruitment documentation inspected for two out of the three staff members included an application form, employment history, a criminal record declaration, evidence of identity and a photo, two written references, and a CRB and a POVA first check. One shortfall was noted in the paperwork of a one staff recruitment file, there was no photographic identification on the file. The manager demonstrated a responsible approach to recruitment issues discussed, and detailed some examples of when appropriate action was taken when alerted to a recruitment concern. This reflected a recruitment practice that aimed to protect service users. The AQAA also confirms that recruitment checks are now undertaken centrally by head office and no one starts work until all relevant checks have been completed. Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 23 Of the three staff files sampled, all had commenced employment since the last inspection and started or had completed induction training. The home was using a Skills for Care Induction training package.’ Staff files and a matrix sampled showed evidence of basic training courses attended. In 2007 to 2008 care staff had attended First Aid, Basic Food Hygiene, Moving and Handling, Fire Safety, Health & Safety, Medication, Infection Control and Dementia Awareness training. In addition in-house training provided by the local Primary Care Trust on Protection of Vulnerable Adults (POVA) had been completed by the majority of staff, the last course to be held was seen to be the 19th May 2008. Staff spoken with confirmed their attendance at relevant training courses and one staff survey returned stated, “My manager has been very helpful and she does discuss my work and how I am getting on, I have done all the courses required for my role”. Overall, the evidence seen at the inspection did confirm as stated in the Annual Quality Assurance Assessment that ‘improvements have been made in our staff recruitment, induction and training and no member of staff begins employment until all checks have been completed’. Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a generally well-run home. Systems were in place to ensure that residents’ views form part of the monitoring and review of the home. Health and safety practices overall promote the health, safety and welfare of residents. EVIDENCE: The home does not have a registered manager. The manager currently in post has held the post for just under a year and prior to that had worked at Maitland House for some years. An application for registration is still to be made to the CSCI and The AQAA informs us that there are plans for her undertake the Registered Managers’ Award (NVQ level 4 in management). She Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 25 stated that she did feel supported in her role and that staff had supported her appointment and that they all worked well together. The registered provider visits at least three times a week and this included one to one sessions. She demonstrated a generally good knowledge and understanding of the service and of care and management practices, and training records showed that she attended training to update her skills and knowledge. Residents and staff spoken with reported that the manager was supportive and approachable, and it was noted that she spent a lot of time working alongside staff in the home, and therefore provided a good level of support and was able to monitor practices. Survey work has been completed by the home using the ‘Living in the Home’ format. Service Users had completed surveys and the results of the survey work are shared with Service Users via residents meetings. In addition the outcome of the survey work had been published and placed on the home’s notice board. This took the form of a tick box analysis and some dialogue summary would have provided some clarity on any views shared. The AQAA states that improvements include “A more detailed company audit system and that a company auditor has been appointed”. Minutes of staff meetings were seen where reference had been made to implementing the key worker system. As detailed earlier in this report, it would appear that no action had been taken in this area yet. Records and monies held by the home were sampled and checked for two people living at the care home. They were all found to be in good order. Records required for the protection of service users and for the efficient and effective running of the care home were inspected and reviewed during this inspection. Schedule 2 records, Information and Documentation in Respect of Persons Carrying on, Managing or Working at a Care Home, were generally found to have improved and be in good order. – see National Minimum Standard - Standard 29 for detail. The home had systems in place to maintain the health and safety of the home, and a clear policy statement of the arrangements to maintain health and safety in the home, including employer and employee responsibilities. Staff training records showed that staff had received training in relevant health and safety topics, including the moving and handling of people. The home maintains records to show that equipment and utilities are regularly serviced, and that appropriate internal checks are carried out (e.g. routine testing of fire alarms and emergency lighting, checking of bath and shower hot tap temperatures, checks on central hot water temperatures re risk of legionella, etc.). The home has a range of risk assessments on safe working practices, including fire risk assessments and the use/storage of chemicals (with hazard sheets available for the chemicals used). Fire drills on a more regular basis need to be Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 26 implemented to safeguard residents and ensure staff are aware of the appropriate actions to take. Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 3 2 Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 OP3 Regulation Reg 14 (1) & (2) Reg 15 Requirement Full and detailed pre admission assessments by the home must be undertaken prior to a service user moving in. Staff must ensure that where possible residents and/or their representatives have input into the care planning system. Staff need to ensure that residents care plans are a clearly documented daily record of the care delivered and be person centred to evidence that staff appreciate the diversity of individual residents. People who use the service must be assured that there are sufficient staff to meet their assessed needs, with particular regard to the provision of social and leisure activities in the home and getting people to bed in the evening. Staff rotas should be representative of the home staffing requirements showing contracted hours worked, names and designations, person in charge and staff complement must be in ration to dependency of current service user group. DS0000068186.V370585.R01.S.doc Timescale for action 30/11/08 2. OP7 30/11/08 3. OP27 18(1)(a) 30/11/08 Maitland House Version 5.2 Page 29 4. OP38 Reg 24 & 26 NVQ qualifications should continue to be encouraged amongst staff. The home must ensure that 30/11/08 ongoing quality audit systems are in place and that systems within the home protect and safeguard service users. This also with reference to regular fire drills being undertaken and recorded 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 OP9 Good Practice Recommendations Any transcribed medications must be clearly documented with evidence of two signatures to ensure the risk of medication errors being made are reduced. The home should have a registered manager. 2. OP31 Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Maitland House DS0000068186.V370585.R01.S.doc Version 5.2 Page 31 - 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!