Inspection on 07/02/07 for Maple House

This inspection was carried out on 7th February 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Maple House 23/02/06

Maple House 24/10/05

Maple House 22/03/05

Maple House 03/02/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Maple House 78 Aldborough Road South Seven Kings Ilford Essex IG3 8EX Lead Inspector Stanley Phipps Unannounced Inspection 7 to 23 February 2007 03:45 th rd DS0000025909.V330051.R01.S.doc Version 5.2 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 DS0000025909.V330051.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 Adults 18-65. 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. DS0000025909.V330051.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maple House Address 78 Aldborough Road South Seven Kings Ilford Essex IG3 8EX 020 8590 7082 020 8550 0666 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) Mr Alan Philp Mrs Pamela Philp Mr Brad Holloway Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (1) of places DS0000025909.V330051.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Moderate to high level of disability. To include named people as they reach 65 years of age, subject to the home being able to demonstrate that they are still able to meet their needs. One Service User with a Learning Disability over the age of 65 can be accommodated within the home 23rd February 2006 Date of last inspection Brief Description of the Service: Maple Lodge is a residential home for Adults with a Learning Disability, which is staffed on a twenty-four hour basis to ensure that service users needs are met as and when required. The home is situated in a residential road in Seven Kings in the London Borough of Redbridge, with easy access to the local park, shops, places of worship and transport. The nearest shopping facilities are Seven Kings High Road, Ilford Shopping Centre and Newbury Park. Each service user has a single bedroom, individually decorated to a high standard, with personal items that reflects their individual character and interests. Toilets and bathrooms are available on both floors of the building. The home is generally decorated, furnished and maintained to a good standard including the garden, which is accessible to all service users. The home is part of the Alpam Homes organisation, which operates two other similar residential care homes in the London Borough of Redbridge and also has its own day centre (Highview), which service users attend daily. Fees range from £950.00 to £1300.00 and may vary dependent on individual levels of need. They do not cover personal effects. A statement of purpose is made available to all service users in the home and is kept in the main office. This document is also made available to relatives and stakeholders, who may be involved in referring service users to the home. A service user guide is also given to each service user upon admission to the home. DS0000025909.V330051.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and a key inspection of the service for the inspection year 2006/2007. This meant that all key standards were covered as well as some of the non-key standards. The visit was done over two days beginning at 15.45 p.m. on the 07/02/07 and ended on the 23/02/07, which was the last day of the inspection. It was spread over this period to ensure meeting with as much of the staff, service users and their relatives, as possible. As part of the inspection, informal discussions were held with four service users, detailed discussions held with the manager and a formal interview with two of the staff on duty. Informal discussions were held with other staff and as well as an interview with one service user. Several records were assessed including: menus, risk assessments, staff training records, service user plans, policies and procedures and records pertaining to health and safety. A tour of the environment was also undertaken. The inspection also considered written feedback from service users and staff. The inspection found that service users continue to receive a good standard of care in the home. Progress had been made since the last inspection in meeting most of the requirements made. However, further improvements are required to enhance the overall quality of life for service users, as well as ensuring, full compliance with the National Minimum Standards for Younger Adults. For any requirement that has been repeated – this would be highlighted at the back of the report and must be acted upon without undue delay. This would ensure that the Commission does not pursue enforcement action to achieve compliance. It is imperative that the registered persons act with in earnest in complying with repeated requirements along with any requirement made from this inspection. What the service does well: The service user plans remained comprehensive and regularly reviewed. The service users continue to have choices about their chosen lifestyles and have the option to attend day centres if they wish. All service users have access to all health care services and are supported by the staff team with personal care and to take a pride in their appearance. Service users can challenge the service and risk assessments were available in the service user files with details of how to minimise risks to themselves, other service users and staff. The environment was well maintained and personalised. DS0000025909.V330051.R01.S.doc Version 5.2 Page 6 There is a positive commitment from the management and staff towards the service provision as a whole. A high percentage of staff by virtue of achieving an NVQ Level 2 in Care have, a good understanding of the principles underpinning good basic care. Service users would therefore stand to benefit from this mix. What has improved since the last inspection? An updated service user guide was in place at the home for the benefit of service users. Fire closures are now in place on fire doors, making it safer in the home for all concerned. The views and requests of service users are now followed up to ensure that the service is more reflective their wishes. Medication is now provided as prescribed and an adequate system is now in place to ensure that instructions to changes in medication from the GP are pertinently recorded. The recording of complaints now outlines both the process and views of the complainant on the handling of their complaint. Training has been provided for staff in key areas identified such as managing challenging behaviour and food hygiene. The adult protection protocols for placing authorities were available to staff in the home, to ensure that they are clear about the processes involved in handling issues around adult protection. A record of violent incidents is kept in the home and staff are proactive in reporting such incidents. References are now more robustly screened to ensure that signatures are, provided by the referees. The staffing deployment ensures that staff involvement with service users is not affected by their involvement in domestic chores. Risk assessments have been carried out in relation to the community and external based activities to ensure greater service user safety. DS0000025909.V330051.R01.S.doc Version 5.2 Page 7 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. DS0000025909.V330051.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000025909.V330051.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (1,2,5) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users continue to have most of the information about the home in the relevant documents. For some it remains outstanding for their fees to be included in their contracts. All service users benefit from having a detailed assessment carried out on them prior to coming to live in the home. They also have the benefit of a statement of their terms and conditions, which must have detail their fees. EVIDENCE: An updated statement of purpose and service user guide is in place and available to all service users. In general the documents contain most of the information to enable service users and or their relatives to make a decision about the suitability of Maple House in providing for their needs. However, the service user guide does detail the fees for the service for each individual, which must be included in the individual statement of terms and conditions. There were but two cases in which this was satisfied as the registered manager included the information on their fees, having had it from the local authority. Discussions were held individually with both the registered manager and the registered provider about the failure to meet this requirement. From the provider’s point of view he was concerned about the confidentiality of the information. While this was acknowledged, it was explained that the information could not be kept away from the service user/s it concerned, which he or she is required to have privy to, by law. DS0000025909.V330051.R01.S.doc Version 5.2 Page 10 In enabling the registered provider to meet his statutory obligations towards the service users, it was agreed to send the most recent regulatory guidance regarding fees to him. In the conversation, it was made clear that the Commission would embark upon statutory enforcement action to achieve compliance of this requirement. It is therefore imperative that all service users are provided with this information without undue delay. A revised timescale has been given in this report by which full compliance must be achieved. From a random sample of three service user files assessed, there was evidence that detailed assessments were carried out in each case as part of the admissions process of the home. Assessments carried out also included the risks associated with living in the home. The registered persons also had arrangements in place to involve service users and their relatives in the assessment process. This is consolidated with comprehensive information that is provided by the placement authorities. Service users therefore would not be admitted if the home could not provide for their needs. This is good practice. DS0000025909.V330051.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (6,7,9) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service user plans reflect their changing needs and service users are given appropriate support to enable them to live in the community. Their independence is promoted and enhanced through assessing individual risks within the risk management framework of the service. EVIDENCE: From case the case tracking of three service users, individualised service user plans were in place for each person. They were detailed and covered key areas such as personal care, health care, communication, activities and nutrition amongst others. Satisfactory arrangements were in place to involve service users in setting up their personal goals and this is enhanced by the use of a key worker system in the home. These plans were monitored on a monthly basis and reviews were held involving the relatives of service users, where possible. Annual reviews were also held and this involved the input of external professionals and relatives. It was clear that the systems in place ensured that service users needs were not only monitored, but kept up to date and in line with their wishes. DS0000025909.V330051.R01.S.doc Version 5.2 Page 12 Feedback received from service users indicated that most times staff listened to what they say. Most of the service users also informed that they could do what they wanted to do in the home. One service user said; ‘I did not wish to go to a club, but prefer to knit’. Another stated; ’I enjoy going on day trips to the coast and do get to go’. Service users do get opportunities to determine their experiences at Maple House and this is positive. The organisation is embarking upon person centred planning which once implemented should enhance the range of opportunities in promoting their involvement. It must be stated that there are a range of forums that enables service users to make choices. They included: regular service user meetings, reviews, key work sessions and where possible involving relatives in matters affecting their welfare. During the course of the visits service users were observed doing different things. Some were watching television; one was reading in her room, another was knitting, while one person was relaxing in her room. It was clear that service users did not feel under pressure to be involved in things that they did not enjoy. Service users do get support to manage their finances from the registered providers and records were in place to evidence this. There was an improvement in this standard in that risk assessments were in place for activities undertaken outside the home. From the case tracking of three, service users risk assessments were carried out with them. They were updated and developed within the risk management framework of the home. Despite their varying levels of disability, service users were getting out and about in the community quite regularly and were doing so, safely. One of the real positives is that as far as possible, service users’ independence is promoted. The risk assessments seen were individually undertaken and took taking into consideration the aspirations, skills and abilities of each service user. They were used in a positive manner in minimising risks and although there are incidents involving service users, it was clear that they served a valuable purpose in promoting the safety and welfare of the individuals concerned. Staff spoken to, had a good knowledge of the safety issues that impacted on individuals and were aware of the strategies in making it safer for them. There is a missing persons procedure in place to guide staff in promptly dealing with unexplained absence from the home. DS0000025909.V330051.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (12,13,15,16,17) Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are appropriately engaged in activities they choose and generally enjoy. They are actively involved with their community and enjoy positive relationships with their relatives. The management and staff continue to promote both the individuality and, rights of all service users. Meals are provided in line with the choices and nutritional requirements of service users living there. EVIDENCE: Service users were involved in a number of activities aimed at learning and developing various skills. In the main they regularly attended day centres e.g. Highview and the Chadwell in achieving their individual goals. At the day centres they also enjoy meeting friends, which adds value to their experiences. Apart from learning and development there are opportunities for relaxation. One of the service users that attend five days per week enjoys puzzles, art and craft work. Another service user who attends the Chadwell Day centre on a Tuesday enjoys music and board games and really enjoys it. One individual enjoys pottery on a Friday at the day centre and is supported to do this. Each service user had a programme of activity based on choice, ability, interest and cultural preferences. This is a strong area of the homes operations. DS0000025909.V330051.R01.S.doc Version 5.2 Page 14 From viewing records and speaking with service users it was clear that they used the community on a regular basis. Good support is, provided by the staff to ensure that service users get to the bank, local shops and leisure facilities as a part of their normal daily life. Most service users attend evening clubs up to three evenings per week and additional staff is brought in to facilitate this. One service user from a minority ethnic grouping went to the theatre up to three times in January2007, as he loves the theatre and particular plays. This is positive. What was really interesting is that staff, had a good understanding of the service users interests and so were well placed to identify resources in the community for them to enjoy. This is a strong area of the home’s operations. There were seven service users in the home at the time of the inspection and there was evidence to confirm that they were all in touch with their relatives. In speaking with a couple of service users, they described their meetings and times visiting their loved ones as something they looked forward to. Two of the relatives spoken to indicated, that the home was very good at involving and keeping them informed about the welfare of the respective service users. During the course of the inspection one individual was going to spend some time with her brother and was extremely excited about this, despite this being a regular occurrence. One individual enjoyed a week away over last Christmas with relatives and reportedly enjoyed the experience. Another individual meets with his mum every weekend and at the Thursday evening club. Relatives are also welcome to visit the home and they have been doing so. Records viewed indicated that relatives were invited to service users reviews and kept informed on matters, affecting their (SU) welfare. This is a strong area of the home’s operations. At the time of the visit none of the service users were using advocacy services, although information was made widely available to them. In discussions held with staff, they were aware of promoting the rights of service users and had an understanding of the GSCC code of conduct. They had a good understanding of service user’s needs including that of their methods of communication. From observation service users were generally treated with respect and had access to all areas of the home. Service users’ obligations are detailed in their contracts and rules regarding smoking and alcohol are outlined in the service user guide. Menus were observed in the home and generally reflected the needs and wishes of service users. Some service users were able to verbally communicate what they wanted to eat, while others were less able to so do. Some pictures of food were available to service users, however, the registered manager was planning to develop a picture menu book to encourage more active choices and greater participation in menu planning. Plans were also in place to encourage service users to participate in the food shopping, which is a regular agenda DS0000025909.V330051.R01.S.doc Version 5.2 Page 15 item at service users meetings. Some service users are also encouraged to help in food preparation e.g. cutting up vegetables, which they enjoy. During the course of the inspection service users were observed having their evening meal, which was well presented. Individuals spoken to indicated that they were happy with the meal on the day and, meals in general. One relative stated: ’We are pleased with the meals provided by the home and more importantly ‘B’ is happy with it’. The home was adequately stocked with food including fresh fruit and vegetables, which were appropriately stored. Staff were reminded that a record needs to be maintained of what service users have for breakfast. Service users do have the benefit of a takeaway meal occasionally and this adds to the variety of food they enjoy. Sound arrangements were in place for monitoring the dietary intake of service users with eating problems to ensure that their nutritional requirements are adequately provided for. DS0000025909.V330051.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (18,19,20) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy personal support in line with their wishes. Staffing interventions ensure that both their physical and emotional needs are met. Generally, the management of medication is in the service users’ best interests, which is crucial, as they are unable to independently manage their medication. However, some improvement is required to enhance the safe handling of drugs used in the home. EVIDENCE: At Maple House staff worked closely with service users and their agreed service user plans in providing personal support to them. This is important as the range of special needs of the service user group is quite varied and as such, would be best provided in line with the preferences of each individual. A number of service users were unable to independently manage their personal care and for those individuals the staffing input was much more intense. In many respects they needed guiding and prompting in carrying some bodily functions of which staff were well aware. A key worker system ensures that staff gather important information about individual likes/dislikes and preferences upon which they engage with the service users. This also included their style of clothes, methods of communication and indeed, how they prefer being called. In observing DS0000025909.V330051.R01.S.doc Version 5.2 Page 17 interactions between staff and service users, good quality interactions and interventions were observed when staff supported service users. There was evidence available to indicate that service users receive good healthcare support. A record was in place for each individual with regard to their healthcare provision e.g. with the; GP, chiropodist, dentist, opticians, psychiatrist, the continence nurse and at times the community learning disability nurse. One relative indicated that he found the staff very much on the ball with regards to picking up the health care matters with his relative. It is true to say that from an interview held with one of the staff, there was an in-depth and thorough understanding of the healthcare needs of most of the service users in the home. Importantly there was evidence to support the actions planned in meeting the needs of the service users under discussion. This meant that staff were in touch with the detail and the approaches to providing quality healthcare. Staff were observed supporting a service user to have regular blood tests and worked well with external health care professionals e.g. the GP in ensuring that service users received the healthcare that they are entitled to. Service users are therefore in receipt of good healthcare support at Maple House. A medication procedure was in place to guide staff with regard to the safe handling of drugs in the home. The inspector left a copy of the Commission’s most updated guidance on ‘the administration of medicines in care homes’ for the benefit of staff. Just prior to the inspection staff had training in the handling of medication and in speaking with some of the staff, they felt that it was very useful in refreshing their knowledge and skills in this area. None of the service users were independently able to manage their medication and hence relied on staff to support them in it. Generally staff were carrying this function in a safe manner and service users benefited from the support they received. However, an audit trail of medication was carried out and there was evidence that in some cases, handwritten entries on the medication administration record did not have a start date for them. This meant that an audit trail could not be effectively carried out from the stock held in the home. This needs to improve. It was also noted that discontinued drugs for one service user was found stored in container with a new stock of medication. This could lead to confusion and increases the risk of errors occurring. Discontinued drugs must be stored appropriately. Finally, it was staff were observed leaving the keys to the medication cupboard lying around several places in the home. From talking to staff, it became clear that they felt that the risk to service users accessing the medication cupboard without their knowledge was low. Whilst, their view may be valid, there was no recorded evidence of how they came to this conclusion e.g. carrying out a risk assessment. The medication keys allow entry to the cupboard in which drugs could be accessed from the container with the new stock and discontinued DS0000025909.V330051.R01.S.doc Version 5.2 Page 18 drugs. Interestingly and at one point during the inspection staff were looking for the bunch of keys and could not locate them for a short while. This did cause some anxiety amongst them, which could have been avoided. Medication keys must be kept safely at all times by staff in the home. DS0000025909.V330051.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (22,23) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of complaints in the home now ensures that outcomes are recorded. Service users, relatives and prospective complainants are therefore, assured that their concerns would be thoroughly addressed. Whilst satisfactory procedures are in place for protecting service users from abuse, the lack of adult protection training for staff, does not ensure that they (SU) are adequately protected from abuse, neglect and self-harm. EVIDENCE: A complaints policy/procedure is in place at the home and available to service users, relatives and staff. Staff interviewed understood their role in supporting service users to raise concerns, when they are unhappy. Key to this is the staff’s understanding of the wishes and communications methods of service users. Service users are encouraged to raise their concerns at forums such as residents meetings, on a one to one basis and through their relatives. Interviews held with two service users informed that they were confident in raising a complaint, if they were unhappy in the home. The complaints record was assessed and it was noted that very few complain. What has improved from the previous inspection is that the outcomes of complaints’ investigations were recorded. As such, an audit trail of complaints could be carried out. The impact of this on service users is that complaints would not be lost and at any given point in time, the stage of a complaint and actions could be determined. This improvement is positive and needs to continue. A satisfactory adult protection procedure was in place. There were also policies on managing aggression, grievance and whistle-blowing. Staff spoken to DS0000025909.V330051.R01.S.doc Version 5.2 Page 20 demonstrated an understanding of safeguarding adults. However, there was no evidence that adult protection training had been provided as required by the previous report. The registered persons must ensure that staff are provided with this training to enhance their understanding of safeguarding vulnerable service users. One example that this is needed could be drawn from a record dated 29/3/06, in which a service user fell out of a chair and should have been handled safer by the staff. The staff member concerned reacted, rather than using her knowledge and skills to protect the service user in managing the situation. Whilst there was little evidence that the individual came to harm there was good evidence that he was put at risk of harm. It was also noted from this incident that staff were in need of refresher training in moving and handling. The previous requirement is therefore repeated in this report along with the inclusion of, the refresher training referred to above. DS0000025909.V330051.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (24,26,28,30) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a home that is well maintained and suitably designed to meet their needs. They enjoy using their facilities, which are homely and personal, particularly in relation to their bedrooms. The home is generally fit for its purpose, however alternative arrangements need to be made for the staffing storage of personal belongings. EVIDENCE: The home was clean, bright and airy with furnishings and fittings that were homely and maintained in a good state of repair. On the first day of the inspection a number of floor tiles were damaged and they had been swiftly replaced to promote a safer environment. Feedback received from service users and relatives was quite positive about the quality of the accommodation at Maple House. Service users were quite familiar with their surroundings and were observed accessing all areas both internally and externally, with some ease. Sound arrangements are in place to identify and carry out repairs to ensure that the standard of the environment is adequately maintained. The inspector had the benefit of viewing four bedrooms, which were personalised to individual taste and interest. One service indicated that she wanted to move to a smaller bedroom and plans were in place to facilitate this. DS0000025909.V330051.R01.S.doc Version 5.2 Page 22 She also indicated that she chose the colours she wanted and was quite happy doing so. Her current bedroom defined her personal comforts with evidence of craftwork, hung on her bedroom walls. In speaking with another service user she stated; ‘my room is very cosy and comfortable, when I want to relax I just go up there’. It was clear that service users were happy with their private spaces at Maple Lodge. More importantly, they get to choose what and how they want their space decorated. This is a strong area of the homes operations. Service users have access to a number of shared spaces in the home, which includes; the kitchen, main lounge, dining room, laundry toilets and baths and the external grounds. The communal spaces meet the minimum requirements in relation to the number of service users in the home. Service users can meet privately with their visitors in the staff office or in the privacy of their bedrooms. It was noted that some service users were more independently accessing various parts of the communal areas, whilst others needed support. In all cases they were doing so in a safe manner. During the course of the inspection, it was observed that staff were storing their personal belongings in kitchen cupboards. This practice is unsafe and an inappropriate use of the cupboards, which were designed for kitchen utensils. Staff felt spoken to felt that their personal belongings were safer in an unlocked kitchen cupboard, which they stated, is hardly accessed by service users. Whilst this may be true staff, still have a responsibility to encourage service users to increase their independence as far as possible in relation to all aspects of the home – including the kitchen. The practice of storing handbags with personal belongings in the kitchen cupboards needs to be reviewed to ensure that a safer and more appropriate arrangement is made. Staff were observed supporting service users with their laundry and this was carried out satisfactorily. The laundry area was assessed and found in a good condition. The floor surfaces were also impermeable and the laundry equipment is suitable for safely cleaning soiled linen in the home. Hand washing facilities were placed throughout the home and this is useful in promoting good hygiene. Policies and procedures are in place to ensure the safe management of spillages, dealing with soiled laundry and generally guiding staff in relation to infection control. DS0000025909.V330051.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (32,34,35,36) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive care and support from staff that are qualified to carry out their roles. Robust recruitment practices acts as a safeguard for protecting vulnerable service users. Training and development is provided to ensure a good standard of service delivery, although the staff would benefit from having Learning Disability Award Framework accredited training. The system of supervision and appraisals ensure that staff are supported to effectively carry out their duties at Maple House. EVIDENCE: Interviews held with staff indicated that they were akin to the needs of service users including their various methods of communication. They were also observed interacting with service users in a positive manner throughout the course of the visit. At the time of the visit over seventy percent of the staff team had achieved at least an NVQ Level 2 Award in Care. This meant that a significant number of staff had a good basic understanding in principles of care provision. Service users were therefore, supported by a staff team that was capable of meeting most of their basic needs. Written feedback received from the service users confirmed that they were satisfied with the quality of support that had been provided to them. DS0000025909.V330051.R01.S.doc Version 5.2 Page 24 The recruitment files of the two most recently employed staff, were looked at and were generally found in good order. Criminal Reference Bureau checks were carried out for both individuals as required by regulation. Two references were taken up in each case and the registered manager was aware of the need to explore gaps in employment histories. As an improvement the references seen were, signed off by the person writing them. All staff have a probationary period that meets the minimum requirement set by standard NMS 34.7 for Younger Adults. The recruitment practices were also in line with the General Social Care Council’s code of conduct and as such, the processes ensure that staff are robustly screened prior to working with the service user group. A training and development plan was in place for staff working in the home, although this should include the dates that identified training is proposed. From the training records viewed, a number of training had been accessed for staff. They included; Person Centred Planning, First Aid, Food Hygiene, Dementia, End of Life, Managing Challenging Behaviour and NVQ Level 2 in Care. The registered persons may wish to consider the provision of equality and diversity training to ensure that the staff develop a greater understanding of both the needs and issues, which may affect the diverse service user group at the Maple House. There is also a need to provide Learning Disability Award Framework accredited training to ensure that staff have underpinning knowledge that would enhance their understanding of the work they carry out with the service user group. In discussion with staff they described an experience of feeling supported by the management of the home. From a sample of records viewed, staff were in receipt of regular supervision. There was also evidence that staffing appraisals were carried out and a copy of the homes grievance and disciplinary procedures were available to all staff. Service users are, therefore supported by a staff team that was generally motivated in providing care and support to them. DS0000025909.V330051.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (37,39.42) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users generally benefit from a home that is managed and run in their best interests. This is complimented by having sound systems in place to provide good quality care. Systems for the promotion of health and safety are good, but an internal audit is required as part of improving the quality assurance monitoring of the service. EVIDENCE: The registered manager has been in charge of the service for some time now and has a good understanding of his roles and responsibilities for ensuring that the service is run in line with its aims and objectives. He has also achieved his NVQ Level 4 in Management and Care qualification and has been on further training such as; person centred planning and challenging behaviour. Staff, service users and some relatives spoken to, expressed their satisfaction with the way in which the home is run. Staff were also of the view that he provided a clear sense of leadership and guidance in his role as manager. There is DS0000025909.V330051.R01.S.doc Version 5.2 Page 26 evidence of teamwork in the home, which is guided by the manager. This ensures consistency and is positive as an outcome for service users. There was evidence that actions have been taken by the registered persons in relation to monitoring the quality of the service provided at Maple House. Quality assurance surveys for service users have been carried out as well as surveys for external professionals. The manager reported that only the GP had responded and so from an external point of view – the input was somewhat limited. However, an annual development plan was in place for the service and monthly provider monitoring visits are taking place regularly. The reports from these visits remain brief and could be more effective with a bit more detail. This has been discussed with the registered providers previously. At the time of the visit policies and procedures were under review to ensure that they are kept updated. While there are adequate systems in place for quality assuring the service, there was no evidence of an annual audit, or review of the service. This was discussed with the registered manager as one of the key ways of monitoring the service objectives against what has been delivered. This needs to improve. Good evidence was provided to show that actions have been taken in relation to negative responses made by service users. In essence service users are encouraged to shape and have an impact on the operations of their home. Health and safety practices throughout the home have improved in that risk assessments were carried out in relation to service users going on trips out or on holiday. Other key risk assessments were in place and updated to ensure that service users and staff are safe. Staff received health and safety training and, demonstrated an understanding of the principles in maintaining a safe environment. Health and safety records were assessed and found to be in order. Some of the records assessed included; fire, gas, electrics, electrical testing, and Legionella. A health and safety inspection was carried out on the 14/1/07, which reported good management systems and a satisfactory standard of health and safety in the home. Accidents and incidents were duly recorded and arrangements for the storage of hazardous substances were adequate. At the time of the visit, maintenance works were being carried out to the exterior of the home and adequate arrangements were in place to ensure the safety of service users and staff. DS0000025909.V330051.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 Adults 18-65 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 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 4 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 2 X X 3 x DS0000025909.V330051.R01.S.doc Version 5.2 Page 28 YES Are there any outstanding requirements from the last inspection? 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 YA5 Regulation Requirement Timescale for action 22/05/07 2. YA20 3. YA23 5A(2)(a)(i)(iii)(b) The Service Users’ Guide must include fees charged in the contracts. This is repeated from previous inspections with the last timescale being 24/06/06. 22/05/07 13 The registered persons are required to ensure the safe handling of medication in the home by: 1) recording the start date on handwritten entries of all drugs prescribed in the home, 2) storing discontinued drugs together as a group and 3) ensuring that keys to the medication cupboard are safely held by staff at all times. 18(1)(c)(i) All staff must have specific 15/06/07 training to meet the needs of service users. This includes adult protection and moving and handling refresher training. The provision of Adult protection training forms part of a previously DS0000025909.V330051.R01.S.doc Version 5.2 Page 29 4. YA28 23(3)(a)(ii) 5. YA35 18(1)(c)(i) 6. YA39 24(1) made requirement with a timescale – 24/06/06. The registered persons are required to provide appropriate storage facilities for staff, other than the kitchen cupboards currently used. The registered persons are required to provide Learning Disability Award Framework accredited training for staff. The registered persons are required to carry out an annual internal audit of the service. 24/05/07 24/07/07 30/06/07 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 YA35 Good Practice Recommendations The registered persons should include equality and diversity training in their training and development plan as well as timelines for the training identified. DS0000025909.V330051.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 DS0000025909.V330051.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. 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