Inspection on 14/08/07 for Maple Dene

This inspection was carried out on 14th August 2007.

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

Other inspections for this house

Maple Dene 06/09/06

Maple Dene 15/12/05

Maple Dene 27/06/05

Maple Dene 10/03/05

Maple Dene 28/09/04

Maple Dene 13/01/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Maple Dene 10-14 St Agnes Road Moseley Birmingham West Midlands B13 9PW Lead Inspector Amanda Lyndon Key Unannounced Inspection 14th August 2007 09:00 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 Dene DS0000016913.V348016.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. Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maple Dene Address 10-14 St Agnes Road Moseley Birmingham West Midlands B13 9PW 0121 449 7677 0121 449 6155 leisha.cooper@anchor.org.uk www.anchor.org.uk Anchor Trust 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) Leisha Cooper Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (40) of places Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: currently under review 1. The home is registered to accommodate 40 adults over the age of 65 who are in need of care for reasons of old age, not falling within any other category (40 OP) and Physical Disability over 65 years of age (40 PD(E)) The home can accommodate up to six service users who are in need of care for reasons of dementia. 6 DE(E) In addition to the manager and ancillary staff minimum staffing levels must be maintained to at least 4 care staff at all times during the waking day 6th September 2006 2. 3. Date of last inspection Brief Description of the Service: Maple Dene is a large detached three-storey property that is situated in a quiet residential area of Moseley, within easy reach of public transport and other amenities. The Home is owned and managed by Anchor Trust. The building has been adapted and extended to provide residential accommodation for 40 people for reason of old age. Six older people with dementia care needs can live at the Home. Accommodation is provided in 38 flats offering single accommodation and one flat offers double accommodation. Each flat has a small kitchen area suitable for the preparation of snacks and this includes a fridge. A number of flats have a separate lounge area. There is a call bell facility in each flat for residents to use in order to summons assistance or urgent help in the event of an emergency. Residents are able to smoke in their flats if deemed to be safe to do so however smoking is not permitted elsewhere in the building. Each flat has an en-suite facility that consists of a toilet and low-level bath or shower. There are assisted communal bathing facilities on each floor as the low level baths may not be suitable for all residents. Staff are available to provide assistance with bathing as required. Communal facilities consist of a lounge and dining room situated on the ground floor. A spacious conservatory offers an alternative sitting area for residents. The internal environment of the Home and external secure garden areas are suitable for wheelchair users. Two passenger lifts give access to all areas of the Home and there are aids and adaptations available to meet the needs of residents with disabilities. There is adequate parking to the front of the building. There are notice boards located throughout the Home displaying forthcoming events and other information of interest to residents and their visitors. The most recent CSCI inspection report and newsletters are accessible to any interested parties. Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 5 The weekly fee to live at Maple Dene is between £441 and £481 depending on the type of accommodation chosen. Items not covered by the fee include hairdressing, chiropody and telephone calls. Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents who live in the Home and their views of the service provided. This process considers the Care Home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Information obtained and used in the planning of this field work visit included Regulation 37 notification reports of any accidents or incidents involving residents. The Registered Manager had completed a self- assessment document, giving some information about the Home, residents and staff which was also taken into consideration. Prior to the visit four completed questionnaires were returned to CSCI from residents, their families and Doctors and these included positive comments about the service provided at Maple Dene including: “Staff are caring and kind and have a good attitude. They have a calm approach and are courteous”. “This is one of the best places we work with”. “I came to the Home to see it before moving in”. “On the whole I am happy and content”. A negative comment was received about the lack of group outings arranged for residents. The field work visit referred to in this report was undertaken over one day by one Inspector when there were thirty eight residents living there. The Home was not aware that we were visiting. Information was gathered by speaking with seven residents, three visitors, the management team and two staff members. An additional method of obtaining information was “case tracking” three residents in order to establish their individual experiences of living in the Care Home. This involved meeting and observing them, discussing their care with staff, looking at care files and focussing on their outcomes. A partial tour of the Home relevant for these people was also undertaken. Tracking residents’ care helps us understand the experiences of people who use the service. No immediate requirements were made on the day of the visit Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 7 What the service does well: Prior to coming to stay at the Home prospective residents are encouraged to visit in order to sample what life would be like to live there. One resident said “I chose this Home to come to”. Residents have access to a range of Health and Social Care Professionals and staff provide support to ensure that any instructions are carried out ensuring that any health care needs are met. Residents are cared for in a respectful manner by staff working at the Home and this ensures that their self- esteem and dignity are maintained. The staff team have a good knowledge about residents’ individual care needs so that they should receive the care and support that they require. Residents are able to exercise control over their daily lives and this promotes their independence and individuality. One resident said “I am very lucky, I can choose what I want to do”. There is a variety of activities for residents to take part in should they choose to do so and these meet the needs and expectations of the majority of residents. One resident said “I enjoy the theatre company and going to the pub for a meal”. Residents are supported to form friendships with each other so that they can share their experiences. One resident said “I like to go down for breakfast and say hello to everyone”. A social event is held at the Home every afternoon so that residents have the opportunity to meet with each other. Residents are supported to continue to practice their chosen religions and this ensures that their beliefs and individuality are respected. Visitors are made to feel welcome and a good rapport had built up between residents, staff and their visitors. This ensures that communications between these people are good. There is a choice of wholesome meals which meet any dietary needs for reasons of health, taste, culture or religion. Complaints are investigated in an appropriate and timely manner so that people are confident that their views are listened to. One visitor said “I can’t fault the place. The staff are very kind people. I have never had to raise any concerns”. Staff have a good knowledge of their roles and responsibilities regarding the protection of vulnerable adults so that residents should be safeguarded. Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 8 Residents are provided with a clean and homely living environment in which they are safe and secure and their privacy is respected. Residents are encouraged to personalise their flats to reflect their individual tastes, age, gender and culture so that they feel comfortable in their surroundings. Aids and adaptations are provided so that the independence, choice and dignity of residents are promoted whilst maintaining their safety. Regular maintenance checks of this equipment ensure that they are safe to use. Residents and staff are satisfied with the staffing levels so that there is an adequate number of staff on duty to support residents. One resident said “The carers are very kind”. Staff have a good understanding of residents’ individual care and support needs. Comprehensive training is provided so that staff should have the appropriate skills and knowledge to work safely and effectively and provide a good standard of care to residents. Residents and relatives are invited to regular group meetings so that they can discuss any suggestions that they may have about the services provided at the Home. Copies of the minutes of these are available for anyone unable to attend the meeting. One resident said “ I support the residents’ meetings, they are good but some people can’t hear very well during the meetings. We have a copy of the minutes though”. Service satisfaction questionnaires have been distributed to residents in order to obtain their views about the service provided. This is in order to monitor the quality of services provided and make improvements as necessary. Residents have the option of using the Home’s facility for the safekeeping of small amounts of money. Positive comments were received about the management team so that a friendly and supportive environment was created for residents and staff alike within the Home. One staff member said “The management team are absolutely supportive”. What has improved since the last inspection? Comprehensive pre admission assessments are undertaken for all prospective residents in order to determine whether their care needs could be met at Maple Dene. Care plans are written with the involvement of the resident and/or their representative so that any preferred routines can be maintained whilst living at the Home. Menus identified the alternatives to the main meal options so that residents could choose what they would like to eat. A chilled water cooler has been Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 9 installed in the dining room so that residents can help themselves to a drink when they wish. Improvements had been made regarding fire safety precautions so that residents should be safeguarded in the event of a fire. What they could do better: 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. Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 10 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 Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 11 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, 3 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission processes are thorough and residents have adequate information in order to make an informed decision about whether they would like to live at the Home. EVIDENCE: Comprehensive statement of purpose and service user guides had been produced in order to provide prospective residents with information about the services provided at Maple Dene. The Registered Manager stated that these could be made available in a large print format so that people with poor sight had access to the information included within these. A DVD about the Organisation was available if residents or their families wished to obtain further information. Prospective residents are encouraged to visit the Home in order to sample what it would be like to live there. During this time comprehensive Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 12 assessments of their individual care needs are undertaken in order to determine whether these could be met at the Home. One resident said “I chose this Home to come to”. Residents come to live at the Home on a four week trial period and this can be extended to six weeks if required. Following this time a care review is held involving the resident, their family, care home staff and social worker (if not privately funded), in order to provide opportunities for discussion about whether the resident is happy living at Maple Dene and to ensure that their care needs are being met. Staff are proactive and arrange social worker reviews during the trial period if it appears that residents are not settling in to the Home in order to seek the best possible outcomes for all residents at the Home. Intermediate care is not provided at Maple Dene Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 13 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 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are generally well met however inconsistencies regarding the content of care plans may prevent residents from receiving person centred care. Some improvements are required to ensure that residents receive their medication in a safe manner. Residents are cared for in a respectful manner and this ensures that their dignity and self esteem are maintained. EVIDENCE: Residents and visitors met during the visit stated that they were satisfied with the care and support provided at the Home regarding their health and personal care needs. Staff met during the visit appeared to have a good understanding of residents’ individual care needs, however this was not reflected within the care plans sampled. One staff member said “We promote the independence and choice of residents”. Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 14 The management team are in the process of transferring all care plans on to a new care planning format and the majority of senior staff have had training in this area. This system is designed to promote person centred care and identify the support required by staff to promote the independence and individuality of residents. Despite the training it was evident that there was some confusion regarding staff’s understanding of what was to be recorded within these. Three care files were sampled, two of these were of the new style format. The care file of the most recent person who had come to live at the Home (three and a half weeks ago) was sampled and it was disappointing that apart from a comprehensive pre admission assessment, no further assessments, care plans or risk assessments had been written for this person. The “Lifestyle Choices” record for this person was incomplete and stated that the person had no food preferences despite the pre admission assessment identifying otherwise. The resident had been weighed on admission and a dietary assessment had been undertaken. There was evidence that residents are involved in the writing of their care plans however the dates that residents’ signatures had been obtained regarding this were not always recorded. There was evidence that residents’ wishes regarding the support they receive during night time hours are respected to ensure that their privacy and safety during this time is maintained. One care plan of an old format style did not identify the support required by staff regarding a resident who was recently bereaved. This may prevent the resident from receiving the support required in this area. This is despite a recent care review identifying that the resident had stated that she feels lonely at times. Moving and handling risk assessments of the old style format did not always identify the type of hoist or sling size assessed for individual residents. Moving and handling risk assessments of the new style format were comprehensive however were considered to be confusing in parts as it was unclear as to when “alternative” techniques identified within the assessments were to be used. There were inconsistencies regarding the content of recording of daily records. A number of entries gave good detail of how residents had spent their time, however others were found to be non descriptive, repetitive and had not been signed by staff. It was evident that the care staff seek advice from Health and Social Care Professionals as required to ensure that residents’ health and well being are maintained. Residents have access to a range of Health and Social Care Professionals including district nurses, community psychiatric nurses, dieticians and chiropodists. The Registered Manager stated that she had experienced difficulties in obtaining a dentist to undertake routine dental checks for residents however dental care was provided on request for individual residents. Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 15 Residents are able to retain their own General Practitioner on admission to the Home (if the GP is in agreement). Staff accompany residents on hospital appointments so that they are supported at this time. Multi disciplinary care reviews are arranged by the Home if required in order to determine whether residents’ individual care needs were being met whilst living at Maple Dene and to establish if any additional care input was required. Care reviews are undertaken every six months and at any time should a residents’ care needs change. Residents are reassessed prior to returning to the Home following hospital admissions in order to ensure that their care needs could continue to be met at Maple Dene. On the day of the visit the relatives of a resident who had recently moved to an alternative care home as her care needs had increased, had returned to Maple Dene to thank the staff for their support during this time. Residents met during the visit appeared to be well supported to meet their personal hygiene needs and choose clothing, make up and jewellery that reflected their age, gender and culture. Residents’ hairstyles and nails were neat and clothing was clean. An extra staff member had been employed in order to ensure that residents had the opportunity to have a bath or shower as often as they wished. The management of medication was generally good and the systems for the ordering, storage and disposal of medication was robust, safeguarding residents. Comprehensive medication audits are undertaken regularly in order to ensure that residents receive their medication as prescribed. Stock balances of medication audited on the day of the visit were correct with the exception of one tablet which appeared to have become stuck within it’s packaging and had not been administered as prescribed. A number of residents had chosen to self administer their own medication and this promotes their independence. Risk assessments are undertaken in order to ensure that the correct medication is administered at the correct time and compliance checks are undertaken every six months. During the visit it was noted that one resident had recently moved into a new flat and a lockable facility for the safekeeping of her medication had not been provided. The Registered Manager stated that she would rectify this straight away. There were however a small number of improvements required in order to verify that residents had received their medication as prescribed. • One medication administration chart did not identify that a medication was being administered by a resident and another stated “take daily as directed”. This may prevent the correct dose of medication from being administered at the correct time of day. • A controlled drug had not been signed as administered within the controlled drug record book. This is considered to be poor practice as there was no evidence that the resident has received this medicine in a safe manner. Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 16 • The actual dosage administered in respect of a variable dosage medication had not been recorded preventing accurate auditing and monitoring of the effectiveness of the treatment. Most residents had a private telephone line in their flats and in addition to this the Home provides a pay phone which has been relocated to a private area. All residents are offered the key for their flat door and these could be overridden in the event of an emergency. This ensures that residents’ privacy is respected whilst maintaining their safety. Post is delivered to residents unopened so that their privacy is maintained and the preferred names of residents were recorded within the care plans. Staff were observed greeting residents by these names. Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 17 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to lead fulfilling lives and activities provided meet the needs and expectations of the majority of residents living at the Home. Residents have control over their daily lives and are provided with a choice of healthy meals that meet any special dietary requirements. EVIDENCE: The Home employs an activities organiser for twenty hours per week and in addition to this, all of the staff team are responsible for arranging activities at other times. The management team were currently recruiting an additional activities organiser for a further ten hours per week. There was a range of activities that residents could choose to participate in including entertainers, food tasting, reminiscence, gardening, quizzes, large print library books and manicures. Residents were recently involved in the planning of a garden fete. Residents confirmed that they could choose which activities they wished to participate in. One resident said “I enjoy the theatre company and going to the pub for a meal”. A record of activities arranged and the success of each of Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 18 these was maintained in order to plan forthcoming events to meet the interests of residents living at the Home. The activities organiser spends time with residents who either choose or are not able to participate in group activities, ensuring that they are socially and mentally stimulated. Prior to the visit a negative comment was received about the lack of group outings arranged for residents. During the visit another resident stated that he also would like to participate in group outings. One resident said “The staff try to arrange things for us but sometimes not many residents turn up”. It was evident that friendships had formed between residents and this promotes a friendly atmosphere at the Home. One resident said “I like to go down for breakfast and say hello to everyone”. A social hour has been introduced each afternoon and this is an opportunity for residents and staff to talk together. One visitor said “My Mom has built up a good rapport with the staff”. Residents are able to exercise their control over their daily lives and how they choose to spend their time. A number of residents are registered with the “Ring and Ride” and choose to go outside of the Home on their own, for example to the shops, pubs and to visit their families and friends. A number of residents visit an over 50’s club so that they have the opportunity to meet with people of similar ages and interests outside of the Home. A number of residents take holidays and this is important so that their interests are maintained. Residents can choose the time that they get up in the morning and the time that they go to bed at night. One resident said “I am very lucky, I can choose what I want to do”. One staff member said “Lots of residents have their own social lives, they are very independent”. Residents are encouraged to continue to undertake their own light household duties if they wish to do this so that their independence is promoted. There were opportunities for religious worship both within and outside of the Home. A church service is held at Maple Dene every month and Holy Communion is also held. A number of residents choose to visit their local church in order to maintain their independence and links with the community. There were currently no residents of non Christian faiths living at the Home, however the management team stated that they would provide support in this area as and when required. There is an open visiting policy at the Home and visitors are welcome to have a meal at the Home for a small charge. This ensures that residents are supported to maintain links with the people important to them. One visitor said “We would recommend this Home to anyone”. Residents have a choice of where they wish to meet with their visitors so that they their privacy is maintained. Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 19 Special diets can be arranged for reasons of taste, health, religious or cultural preferences. Diabetic and soft diets are currently being prepared. In consultation with residents a new system for the serving of food at lunchtime had recently been introduced. This involved staff presenting residents with the menu choices of the day at lunchtime instead of residents choosing what they would like to eat the day before. Residents were able to smell and see the menu choices thus be able to make an informed choice about what they would like to eat. As a result of this change in work practice, written records of food provided for individual residents were not kept. These records should be reintroduced so that a nutritional analysis of individual residents’ diets can be undertaken. Menus were available on the dining tables and in the reception area of the Home and these identified the main meal choices of the day, lamb hotpot or cheesy baked cod. Vegetables were served at the dining tables and residents were encouraged to serve their own gravy, sauces and other condiments in order to control portion sizes. Soup was served prior to the main meal. Residents generally expressed their satisfaction about the new system however a comment was made that at times the most popular meal option had “run out” before all residents had been served. One resident said “The lamb hotpot is very tasty”. Staff were assisting residents as required in a respectful manner during their lunch. Following a request made by residents, a chilled water cooler had recently been installed in the dining room for residents to help themselves to a drink. Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 20 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident that any concerns raised will be acted upon in a timely and appropriate manner. Systems are in place that should protect residents from harm. EVIDENCE: Since the last visit CSCI have not received any complaints about the service provided at Maple Dene. One visitor said “I can’t fault the place. The staff are very kind people. I have never had to raise any concerns”. A comprehensive complaints procedure was on display in a prominent place of the Home in order for residents or their visitors to refer to should they need to raise any concerns. This was also available in a large print format. A copy of this procedure was included within the service user guides distributed to all residents on arrival to the Home. One resident said “We can tell the staff anything that we want”. It was evident on the day of the visit that residents feel confident to approach the management team and raise any concerns that they may have. A number of compliments had been received by the Home about the standard of care and services provided there. Since the last visit the Home had received six complaints about the services provided there. These included issues regarding staff attitude and the standard Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 21 of cleaning within the flats. There was a written record of actions taken in response to these, for example a staff disciplinary meeting and work practices have been reviewed for the benefit of residents living at the Home. Staff had undertaken recent training about the protection of vulnerable adults and “whistle blowing” and staff met during the visit had a good knowledge of their role and responsibilities regarding this. This should ensure that residents are protected. The management team had recently made an adult protection referral for a resident who had exhibited aggressive behaviour towards another resident in order to safeguard all residents. Inventories of residents’ personal belongings had not always been completed and these did not include clothing items that may be of value to residents. The management team stated that they would address this. Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 22 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, 20, 21, 22, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a homely and clean living environment in which they are safe and secure and their privacy is maintained. Aids and adaptations provided promote residents’ independence and choice whilst maintaining their safety. EVIDENCE: The internal environment of the Home is homely, well maintained and suitable for wheelchair users. There was a rolling programme of refurbishment and redecoration in place in order to ensure that residents had a safe and comfortable environment in which to live. There was ramped access in to the well maintained and secure garden ensuring that this area was suitable for wheelchair users and residents with physical disabilities. There was an attractive fish pond which was securely Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 23 positioned behind railings and good quality garden furniture for residents to use whilst enjoying this facility. There is a raised flower bed and residents are encouraged to help with this if they are interested. Residents had a choice of communal sitting areas, a spacious lounge and conservatory. There were small seating areas located throughout the Home providing residents with a choice of areas in which to relax. Residents had been involved in the purchasing of new dining tables and chairs. These were due to be delivered and were of a circular design in order to promote social interactions between residents. In addition to en suite bathing facilities there were two assisted baths and two assisted shower facilities that met the needs of residents living at the Home. The majority of residents required the support of staff during bathing, however, if deemed safe to do so residents may bath or shower on their own in order to maintain their independence and dignity. Call bells were in easy reach of the bathing facilities in order for residents to summon assistance in an emergency. Pressure relieving mattresses and cushions were provided by the district nursing team for all residents deemed to be at risk of developing sore skin. There were three hoists available for residents with physical disabilities in order to safeguard both residents and staff. Raised toilet seats and hand rails were provided near to toilets and in corridors in order to promote the independence of residents and maintain their dignity and safety. The Home is suitable for wheelchair users. Residents are encouraged to bring their own furniture in to the Home and decorate their flats to reflect their individual interests and tastes in order to feel comfortable in their surroundings. Residents’ flats contained many personal belongings. There is a call bell facility in each flat for residents to use in order to summons assistance or urgent help in the event of an emergency. Since the last visit a shared flat had been converted into two single occupancy flats. These were furnished to a high standard and one resident met expressed her satisfaction about her new flat saying “It is state of the art”. The Home was clean and fresh on the day of the inspection and hygienic hand washing facilities were provided. Residents have the option of using a commode in their bedroom, however only a few have chosen to do this. Used commode pots are manually cleaned by staff and a risk assessment is yet to be undertaken and practical procedure written regarding this in order to safeguard staff and prevent the spread of infection. The Registered Manager confirmed that the staff team had received training about this in order to prevent the spread of infection at the Home. Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 24 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by an adequate number of appropriately recruited and trained staff so that they are safeguarded and should receive a good standard of care. EVIDENCE: All staff met during the visit appeared to be enthusiastic within their job roles. One resident said “The carers are very kind”. Staffing rotas identified that there is one team leader with a minimum of four care assistants on duty during day time hours and two care assistants on duty overnight. The management team stated that they are satisfied with current staffing levels provided. Management, housekeeping and kitchen staff are in addition to the care staff provided so that residents are supported in all aspects of their daily lives. The Management team and senior staff provide on call support to the person in charge of the shift and this ensures that the staff on duty feel supported at all times. Following a request made by residents, agency staff are no longer used, the Home’s staff cover periods of staff holidays and sickness and this ensures continuity of care for residents. Comments were received that staff moral was a little lower than normal at the current time due to increased paperwork and Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 25 covering the busy staff holiday period. In order to address this, the management team had recently distributed questionnaires to the staff team in order to obtain their views about what it was like to work at Maple Dene. Actions will be taken in response to the findings of these in order to improve staff moral and ensure that residents continue to receive a good standard of care. The cultural mix of staff reflected the cultural mix of residents so that support could be provided in an understanding manner. Only one male staff member is employed at the Home and there are currently eight male residents living there. The management team stated that there had not been any negative impacts on the care provided for the male residents as a result of this. Staff recruitment files sampled contained all information required by regulations and all prospective staff were deemed to be safe to work with vulnerable people, thus safeguarding residents. New staff undertake comprehensive “Skills For Care” induction training and this should ensure that they have the appropriate knowledge to support residents in a competent manner. One new staff member said “Staff have made sure that I am really settled here and have supported me well”. Staff had undertaken recent training relevant to their job roles including safe management of medication, dementia care, how to undertake appraisals, fire safety, food hygiene, health and safety and back care. A schedule of planned statutory training was available in order to ensure that all staff received training in these areas when refresher sessions were due. 58 of care staff had achieved an NVQ Level 2 and other staff members were currently working towards this ensuring that residents receive a good standard of care. Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 26 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, 32, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This Home is run in the best interests of residents living there and systems in place for resident consultation are very good. Arrangements for health and safety are good so that residents are safeguarded. EVIDENCE: The Registered Manager has been in post for two years and holds a number of appropriate qualifications relevant for her job role. She has recently completed the Registered Manager’s Award, in order to acquire the necessary skills to lead the staff team. The Registered Manager is supported by a Deputy Manager and Administrator and it was apparent that this team works well together in the best interests of Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 27 the residents living at the Home. Positive comments were received about the management style of this team. One staff member said “The management team are absolutely supportive”. Quality monitoring visits are undertaken regularly by Senior External Managers to ensure that the Home provides a good standard of service. Group meetings are held regularly in order for residents to put forward their views about the service provide at Maple Dene. Copies of the minutes of these are distributed in a large print format for residents who were unable to attend in order to keep them informed about any changes in the service provided or forthcoming events. A copy of the minutes of the last meeting was on display and this included discussions about fundraising, social events, menu requests and a new resident was welcomed. One resident said “ I support the residents’ meetings, they are good but some people can’t hear very well during the meetings. We have a copy of the minutes though”. The dates of forthcoming meetings were on display so that residents could choose whether they wanted to attend. Additional resident/relative meetings had been reintroduced recently so that relatives have the opportunity to put forward their views about the services provided. The Registered Manager stated that the most recent meeting was well attended. Staff meetings are also held regularly in order to ensure that staff are informed about any relevant changes in the services provided and to enable staff to put forward their suggestions in respect of the running of the Home. Service satisfaction questionnaires had been distributed to residents earlier this year in order to obtain their views about living at Maple Dene. The management team are currently working on a report based on the findings of these. In addition any issues raised as a result of these had been addressed for the benefit of residents living at the Home. An internal auditing system was in place in order to monitor the services provided. As previously agreed with us, residents’ personal allowances are paid into one general bank account and individual electronic and paper records of this were well maintained safeguarding residents who choose to use this facility. Residents are able to access small amounts of money at short notice. Receipts of items purchased out of residents’ money were available and two signatures were obtained for all money in and out of the account. Residents or their families are able to have a “print out” of their account balance at any time on request. Health and safety checks and servicing of equipment and facilities used at the Home were undertaken regularly in order to safeguard residents. A positive health and safety audit had recently been undertaken by the Organisation so Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 28 that any shortfalls could be identified. Arrangements for fire safety were good so that residents should be safeguarded in the event of a fire. There had been an increase in the number of falls involving residents during recent months. The management team stated that this was partly due to one person experiencing multiple falls due to medical reasons. Accident records were well maintained and identified that the appropriate actions had been taken following accidents so that medical advice was sought. These are audited each month in order to identify any trends/patterns regarding these and minimise the risk of further incidences of the same nature. Action had been taken to reduce the risk of residents falling, for example, referrals to the “falls clinic” had been made. Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 29 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 x 3 x 3 x 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 3 3 3 x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 x x 3 Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15 Requirement Timescale for action 31/10/07 2 OP9 13(2)(4) Each resident must have a care plan that identifies the specific support required by staff so that they receive support in a way that they prefer at the times that they require. All medication must be stored 15/09/07 securely at all times. Timescale of 06/09/06 not met Suitable arrangements must be made for the accurate recording of all medicines onto medication administration charts. Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 31 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 OP7 Good Practice Recommendations Care records should identify the care and support provided for residents and the activities that they have engaged in during that day so that a review of care can be undertaken. A written record detailing the food provided for individual residents should be kept so that a nutritional analysis of individual diets can be undertaken. A written record of all personal and valuable items brought into and taken out of the Home should be kept in respect of each resident so that all items are accounted for. A policy should be introduced so that staff are aware of the risks involved in manually cleaning commode pots and how to do this in a hygienic manner to reduce the risk of infection spreading in the Home. 2 3 4 OP15 OP18 OP26 Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Local Office 1st Floor, Ladywood House Stephenson Street Birmingham West Midlands B2 4UZ 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 Maple Dene DS0000016913.V348016.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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