Inspection on 01/12/05 for Maple Court Nursing Home

This inspection was carried out on 1st December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Maple Court Nursing Home 31/01/08

Maple Court Nursing Home 26/07/06

Maple Court Nursing Home 10/05/05

Maple Court Nursing Home 05/10/04

Maple Court Nursing Home 13/05/04

Maple Court Nursing Home 22/01/04

Maple Court Nursing Home 15/09/03

Maple Court Nursing Home 19/06/02

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Maple Court Nursing Home Rotherwood Drive Rowley Park Stafford Staffordshire ST17 9AF Lead Inspector Mrs Sue Mullin Unannounced Inspection 7th December 2005 2:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 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. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Maple Court Nursing Home Address Rotherwood Drive Rowley Park Stafford Staffordshire ST17 9AF 01785 245556 01785 244506 maplecourt@schealthcare.co.uk 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) Southern Cross Healthcare Services Limited Ms Patrica Heather Sault Care Home 81 Category(ies) of Dementia (25), Physical disability (35), Physical registration, with number disability over 65 years of age (21) of places Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 25 DE- Minimum age 60 years on admission 35 PD - Minimum age 60 years - 3 of whom may be 55 years on admission Date of last inspection Brief Description of the Service: Maple Court is a care home providing personal care including nursing care for up to 81 elderly service users. This includes care for up to 25 service users with Dementia and other related mental health needs. The home is owned by Southern Cross Healthcare Services Limited. The home is located in a quiet residential area on the outskirts of the town of Stafford in the South Staffordshire district. There are no amenities within the immediate vicinity but Stafford town centre is approximately a ten-minute walk away where there is a choice of shops, public houses, banks and churches. The home was purpose built several years ago and consists of two floors served by a passenger lift. The service users are accommodated on both floors within three separate units. The ground floor accommodates service users with nursing needs and the second floor is divided into two units caring for service users requiring personal care and mental healthcare needs. There are ample car-parking facilities at the entrance car park and around the side of the home. Gardens are located around the home including a forest walk. The accommodation provides for 81 single bedrooms, all of which have en-suite facilities. There is ample provision of communal and seating areas throughout the home. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspection officers made this statutory unannounced visit on the 7th December 2005. The inspection was undertaken using the National Minimum Standards for Older People as a reference. The total time spent for the inspection, including preparation amounted to 12.25 hrs. The inspection included the following elements; a tour of the building, inspection of records relating to provision of care, discussions with several residents and relatives and also staff members, observation and sampling of other services provided such as catering, housekeeping and laundry, and an inspection of the managerial aspects such as staffing and health & safety. Not all of the National Minimum standards were checked on each of the three units, as these have been verified previously during this inspection year. The registered care manager, who is a first level nurse, was on holiday at the time of the visit and the home was in the charge of two unit managers, both trained first level nurses. Care staffing levels were in line with those agreed prior to April 2002 by South Staffs Health Authority. However, there were concerns over the level of ancillary staff employed in the home. All areas were checked and duty rotas seen and it was determined that ancillary staff on duty at the time of the inspection included; 1 cook and 1 catering assistant, no domestic staff, 1 laundry worker, 1 maintenance/ gardener, and a business support worker. These staffing levels were not deemed adequate to meet the needs of current 67 residents in the home. Several parts of the home were not thought to be clean or hygienic enough. Some odours were evident on the EMI unit. The residential unit was more homely and the most part of the general units had a much nicer environment. Parts of the home were in need of refurbishment and upgrading these issues are detailed further in the report. The total of 67 residents included - 25 receiving nursing general nursing care and 22 receiving nursing care for residents suffering from dementia. 20 people were receiving personal care for needs associated with old age and physical disability. Catering services and facilities fell below acceptable national minimum standards. There was some evidence of choices being made in relation to the meals, albeit choice was limited. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 6 Quantities of meals was reported to be minimal at times and on the general unit residents were not offered choices in line with other units in the home. Residents requiring soft diets had a repetitive diet provided to them at teatime and this was discussed at length with the regional manager during feedback of the inspection. Confirmation was given that this would be reviewed with some urgency. Privacy, dignity and choice aspects for residents were being upheld. Health, personal and social care needs had been met and documented. A selection of care plans were examined at the time of the inspection and the care of the residents was tracked. It was identified that care plans on the residential unit had not been reviewed monthly. There was good evidence that risk assessments were in place pertaining to individual use of bedrails. Activities are being organised for the residents, at present the activity hours are limited to 27 hours per week. Following discussions with the activity organiser, this is to be increased to meet the needs of the whole residential occupancy and the home is actively recruiting. This will be followed up on the next inspection. Mandatory staff training was ongoing with induction training in place. However care staff on the residential unit had not received two monthly formal supervision sessions. The Commission are receiving monthly regulation 26 notices. 4 Immediate requirements were made following the visit and a further 7 requirements and 2 recommendations, against the regulations and the minimum standards, have been made as a result of this inspection. These are outlined at the end of the report. What the service does well: There was good interaction between staff and residents, and those residents asked (who were able to comment) were happy with their stay in the home. These aspects were established following discussions with residents, visitors, and staff and by direct observation of both inspectors. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 7 What has improved since the last inspection? What they could do better: The shower room on the first floor level on the EMI unit is extremely malodorous and has been out of use for some time. This must now be addressed and the shower room made functional for use by residents on the unit. The home was generally in need of a good clean throughout. All parts of the home must be kept clean and hygienic. There must be sufficient staff on duty to meet the needs of the residents in the home. There were shortfalls noted in the domestic, laundry and kitchens areas. This has had an impact on the care staff, in that they are expected to carry out some duties, normally undertaken by ancillary staff. On the general nursing unit residents requiring liquidised diets must be provided with more choice. A varied and more suitable and a more appealing menu, must be available to them at the teatime period. The home must ensure that all dietary requirements identified in the home are met. Menus should be displayed in the dining room so residents can be reminded of the choices on offer each day. This will be thoroughly checked on the next unannounced inspection. There no evidence of fresh fruits available on any unit in the home during the inspection. Liquid soap must be available at all times for all staff on duty. There was no liquid soap available on the EMI sluice room. This contravenes infection control measures. On the EMI unit some grab rails were coated in split paint and one area was splintered which could cause injury to a resident. Walls and doors and skirting boards were badly marked by wheelchairs. All grab rails; doors, walls must receive remedial attention. All care staff must receive a minimum of six formal supervisions per year and it is good practice to record such sessions, for the supervisor and supervisee to sign them and a copy kept by both. The issues which should be covered in supervision are listed in ‘Care Homes for Older People’, National Minimum Standard 36.3. Care staff must receive more structured supervision and the progress of this will be determined on the next inspection. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 8 The EMI large lounge and corridors were very malodorous and must be very unpleasant to reside or work in. Priority must be given to cleaning carpets in these areas. The flat linen was inspected by both inspectors on the general and EMI unit and those laundered and ready for use in the laundry. It was very disappointing to note that the vast majority was torn, stained and threadbare. These stocks must be replaced as soon as practicably possible and regular audits undertaken. Crockery and beakers were badly stained on the EMI unit and need cleaning properly or replaced. Tablecloths were torn and stained. On the EMI unit the flooring by the toilet in the bathroom next to room F10 is lifting and needs to be sealed down. The light in the linen cupboard is faulty and the entrance needs to be sealed. The main lighting in some resident’s bedrooms on the EMI and residential units were thought to be too low for each individual to see their surroundings comfortably. This area should be reviewed with input from residents (where possible) relatives and staff and remedial action undertaken where brighter lighting is required. 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. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 9 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 Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4 Information had been available for prospective service users, and they had been enabled to make an informed choice about residing in the home. Individual health, personal and social cares needs had been established prior to admission and were being met once a resident in the home. EVIDENCE: The statement of purpose and service users guide were not examined during this visit. However contracts of residency for private paying residents and those funded by social services were examined and had been agreed and signed by residents/representatives. The documentation seen, and a discussion with residents/representatives, evidenced that residents had been assessed, prior to admission and they had been enabled to make a choice about the home. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 11 The community care plans provided by the social worker, as part of the individual needs assessment process, were seen within the care planning documentation. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 General unit Resident’s health and social needs were meet appropriately; there was comprehensive information held within the care plans and consistency with reviewing plans on a monthly basis, which reflected the changing needs of the individual resident. Residential unit Monthly reviews had been undertaken on all residents and this could have a negative effect on their wellbeing. EVIDENCE: Care plans were in place for the individual resident providing information relating to their care needs and also identified the support and assistances required, to ensure that they live and fulfilled and active life style. The care plans have sections to record all health professional appointments, such as GP visits, District Nurse, chiropody, dental, ophthalmic etc. These were completed following visits. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 13 The daily contact sheets also recorded how each person was each day, and there was an audit trail to show if someone was not well that the GP had been contacted. Discussions with the residents evidenced that they consider that their health needs are well met by the home. The home has robust procedures in place for the receipt, storage, provision and recording of medication given. Only qualified nurses administer medication on the nursing units in line with NMC requirements. Medication was not inspected on the general units on this occasion. On the residential unit the medication system in operation appeared to be satisfactory, with staff having knowledge of the prescribed medicines for the individual resident. Residents spoken to on the general unit were complimentary about the home and the staff and the way that they are treated. Several residents have lived at the home for a number of years now, and each said that the staff continue to treat them well, that they are on hand if required but allow each person their privacy and opportunity to be as independent as they can. A staff member was asked about the care practices in the home, and it was clear that she had a good understanding of the needs of the residents and how to uphold their privacy and dignity. Residents had access to a telephone and receive their post unopened. Staff were observed throughout the course of the inspection to interact in a positive manner, promoting the rights and choice of the individual. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Service users had access to range of social activities, the necessary support and assistance was provided to enable them to maintain contact with their family and friends. Service users were able to exercise their rights and have an active involvement in areas affecting their lifestyle and wellbeing. Catering aspects were in need of reviewing on the general unit. EVIDENCE: Activities are being organised for the residents, at present the activity hours are limited to 27 hours per week. Following discussions with the activity organiser this is to be increased to meet the needs of the whole residential occupancy and the home are actively recruiting. This will be followed up on the next inspection. General discussions with both residents and the activity organiser on the day of the inspection identified that each individual had varying social interests. The inspector was informed that care plans identified resident’s interests and a record was maintained of social activities undertaken. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 15 The residents are encouraged to receive visitors and those spoken to say that they were made to feel welcome in the Home. Several of the residents engaged in conversation receive regular visitors to the home. The home provided an ethos of normal daily living and residents were encouraged to be involved in their plan of care and areas concerning their lifestyle. Residents’ bedrooms seen had been personalised and residents were encouraged to bring in personal effects from home. Residents had their rooms organised, as they preferred. Comments received from residents included “ I am alright here, they look after me well” and “ they always come when I call them’. Relatives explained that staff were ‘very kind but often very stretched and very busy’. The care staff commented that ‘this is the residents’ home and that their preferences must always be respected’. In relation to meals offered and provided, these need to be improved upon. There were some negative comments received from residents and relatives in relation to the choice of meals available on the general unit. Portion sizes of hot meal alternatives were observed as being very conservative in size on the day of the inspection. When staff were asked if there was food left over at teatime, they explained usually only sandwiches and not extra hot food alternatives. There was some evidence of choices being made in relation to the meals, albeit choice was limited. Menus provided at inspection were generally being followed but staff thought that most of the vegetables served in the home were frozen with the exception of mashed potatoes, which were served every day. On the general nursing unit residents requiring liquidised diets must be provided with more choice. A varied and more suitable and a more appealing menu, must be available to them at the teatime period. The home must ensure that all dietary requirements identified in the home are met. Menus should be displayed in the dining room so residents can be reminded of the choices on offer each day. This will be thoroughly checked on the next unannounced inspection. One relative spoken to stated that her mother’s dietary needs were not always met by the home. She had seen little evidence of fresh fruit or salad and had had some concerns regarding her mother’s nutritious intake. It became apparent that she did not know her mother should be provided with a menu the previous day, so she could make a choice of the food on offer for the next day. This was discussed with the regional manager during feedback and will now be put back into place in line with the other units in the home. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 16 This visitor explained to the inspector that she had had discussions with the care manager in the home previously and any matters of concern had always been dealt with professionally and positively. There no evidence of fresh fruits available on any unit in the home during the inspection. There were plentiful of general foodstuffs stocks and supplies in the kitchen and overall shortfalls seemed to be due to a lack of communication from the general unit to the catering staff. Crockery and beakers were badly stained on the EMI unit and need cleaning properly or replaced. Tablecloths were torn and stained. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The Home displays its complaints procedure in a format that is easily understood by residents/relatives and visiting professionals. Where residents/relatives have had areas of concern they are able to discuss these with the staff in the home, management, proprietors and ultimately the Commission. Appropriate systems were in place to ensure the protection of service users. EVIDENCE: The homes complaints procedure was located in the lobby area and within the service users guide; the documentation made reference to the Commission for Social Care inspection and also provided contact details. Following a discussion with two relatives it was determined that any complaints or concerns were listened to and dealt with via the homes procedures. The home was in receipt of a vulnerable adults policy and procedures. Records relating to staff working within the home that have regular contact with residents, identified that a Criminal Record Bureau checks had been undertaken. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,23,24,25,26 The standard of the environment within this home is in need of some improvement in order to ensure that residents are provided with an attractive, comfortable and safe place to live. Not all washing facilities were suitable for residents use. EVIDENCE: Décor was generally attractive but in need of attention in some areas. Some of the bedroom furniture was in need of repair or replacement and it is recommended that an audit of all furniture be undertaken. The home had been adapted with grab rails, ramps, a passenger lift, a stair lift, various mobile hoists, fixed bath hoists, moving and handling equipment and aids to help residents maintain mobility. On the EMI unit some grab rails were coated in split paint and one area was splintered which could cause injury to a resident. Walls and doors were badly marked by wheelchairs. All grab rails, doors, walls should be made good. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 19 The shower room on the first floor level on the EMI unit is extremely malodorous and has been out of use for some time. This must now be addressed and the shower room made functional for use by residents on the unit. On the EMI unit the flooring by the toilet in the bathroom next to room F10 is lifting and needs to be sealed down. The light in the linen cupboard is faulty and the entrance needs to be sealed. The main lighting in some resident’s bedrooms on the EMI unit and some of the residential unit was thought to be too low for each individual to see their surroundings comfortably. This area should be reviewed with input from residents (where possible) relatives and staff and remedial action undertaken where brighter lighting is required. The flat linen was examined by both inspectors on the general and EMI units and linen already laundered and ready for use in the laundry. It was very disappointing to note that the vast majority of sheets, duvet covers and pillowcases were torn, stained and threadbare. These stocks must be replaced as soon as practicably possible and regular audits undertaken. The home was generally in need of a good clean throughout. The inspector was not able to speak with any of the domestic staff, as there were none on duty. The organisation of the cleaning schedules could not be determined. (Staffing requirements has been referred to in the relevant section of the report). The EMI large lounge and corridors were very malodorous and must be very unpleasant to reside or work in. Priority must be given to cleaning carpets in these areas. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30 Although care staffing levels in the home were found to be sufficient in numbers and skill mix, care staff were trying hard to meet the needs of those in their care. However, as they had to undertake some ancillary duties this could have a negative impact on the care delivered EVIDENCE: This care home with nursing was previously registered under South Staffs Health Authority and the levels and mix of cae of staff required at 31st March 2002 are maintained. The care manager is fully supernumerary and the EMI Unit Manager and newly appointed deputy manager on the general unit also have some hours a week supernumerary. Daily there are three qualified nurses on duty during the early shift and two during the afternoon and night. Additionally there are on the ground floor nursing unit: • • • Early shift (8.00 – 2.00) there are four care staff Late shift (2.00 – 8.00) there are four care staff Night shift (8.00-8.00) there are two care staff Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 21 On the EMI Unit there are: • Early shift there are four care staff • Late shift there is three care staff • Night shift there is one care staff On the residential unit there are on the • Early shift three care staff • Late Shift three care staff • Night shift two care staff This level of care staff was found to be in line with minimum requirements on the day of the inspection. Maintenance/gardening hours are adequate and the home have full time administrator. However, there is not sufficient laundry, domestic or catering staff over a seven-day period. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36,38 Improvements need to be made in some areas to ensure full compliance with all national minimum standards. The majority of Health and safety issues had been met. EVIDENCE: A number of staff were spoken to at the time of the inspection. All of them confirmed that they had received regular updates in mandatory training. This included moving and handling training, fire safety food hygiene as required and COSHH. The records were examined and indicated that there were sufficient fire drill training sessions during the last twelve months. The maintenance person was reminded to ensure that all night staff receive fire training two times a year and day receive two sessions. This is well in hand. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 23 The registered care manager takes into account residents relatives and staff views at regular intervals. These meetings are documented and avaialble at inspection when required. Health and Safety records were checked and found to be in order and well maintained. These included the records for the bed rails, wheelchairs and manual handling maintenance, which demonstrated that they are regularly tested. The fire safety records were examined and fire alarm and emergency lighting testing is done at appropriate intervals. The Commission continue to receive monthly regulation 26 notices from the regional manager. Residential unit All care staff must receive a minimum of six formal supervisions per year and it is good practice to record such sessions, for the supervisor and supervisee to sign them and a copy kept by both. The issues which should be covered in supervision are listed in ‘Care Homes for Older People’, National Minimum Standard 36.3. Care staff must receive more structured supervision and the progress of this will be determined on the next inspection. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X 1 X 3 1 2 1 STAFFING Standard No Score 27 1 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 X 3 Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP21 Regulation 16(2)(k) • Requirement The shower room on the first floor level on the EMI unit is extremely malodorous and has been out of use for some time. This must now be addressed and the shower room made functional for use by residents on the unit. • On the EMI unit the flooring by the toilet in the bathroom next to room F10 is lifting and needs to be sealed down There must be sufficient staff on duty to meet the needs of the residents in the home. There were shortfalls noted in • Domestic • Laundry • Kitchen This has had an impact on the care staff, in that they are expected to carry out some duties, normally undertaken by ancillary staff. DS0000022352.V270312.R01.S.doc Timescale for action 07/12/05 23(2)(b) 2 OP27 18(1)(a) 07/12/05 Maple Court Nursing Home Version 5.0 Page 26 3 OP15 16(2)(i) (g) • On the general nursing 07/12/05 unit residents requiring liquidised diets must be provided with more choice. A varied and more suitable and a more appealing menu, must be available to them at the teatime period. Crockery and beakers were badly stained on the EMI unit and need cleaning properly or replaced. Menus should be displayed in the dining room so residents can be reminded of the choices on offer each day. 07/12/05 • • 4 OP26 13(3) 5 OP24 16(2)(c) Liquid soap must be available at all times for all staff on duty. There was no liquid soap available on the EMI sluice room. • All broken bedroom furniture should be repaired or replaced and regular audits undertaken Inadequate flat linen stocks must be replaced as soon as practicably possible and regular audits undertaken. All grab rails, doors; walls on the EMI unit should be repaired were they are chipped/marked. All care staff must receive a minimum of six formal supervisions per year. The EMI large lounge and corridors were very malodorous and the carpets must be deep cleaned as a matter of urgency. All parts of the home must be kept clean and hygienic. The dining room carpet on the DS0000022352.V270312.R01.S.doc 01/01/06 • 6 7 8 OP19 OP36 OP26 13(4)(a) 18(1)(2) 16(2)(k) 01/02/06 01/02/06 07/12/05 9 OP26 16(2)(j) 07/12/05 Maple Court Nursing Home Version 5.0 Page 27 10 11 OP19 OP25 23(2)(b) 23(2)(p) general unit is badly stained. This must be deep cleaned or replaced as soon as practicably possible The light in the linen cupboard is faulty and the entrance needs to be sealed. The main lighting in some resident’s bedrooms on the EMI and residential units were thought to be too low for each individual to see their surroundings comfortably. This area should be reviewed with input from residents (where possible) relatives and staff and remedial action undertaken where brighter lighting is required. 01/02/06 07/12/05 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. 2. Refer to Standard OP20 OP24 Good Practice Recommendations To relocate the staff desk on the residential unit to minimise noise from the telephone interrupting residents peace and quiet and for confidentiality. A review of bedroom furniture/ fittings/ flat linen should be undertaken regularly and based on the views of all parties concerned. Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 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 Maple Court Nursing Home DS0000022352.V270312.R01.S.doc Version 5.0 Page 29 - 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. 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