CARE HOMES FOR OLDER PEOPLE
Maple Leaf House Kirk Close Ripley Derbyshire DE5 3RY Lead Inspector
Brian Marks Unannounced 22 June 2005 9.00 am 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 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 Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Maple Leaf House Address Kirk Close Ripley Derbyshire DE5 3RY 01773 513361 01773 513501 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Methodist Homes for the Aged Michelle Whitmill Care Home with Nursing 45 Category(ies) of Dementia - Over 65 registration, with number of places Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 16 February 2005 Brief Description of the Service: Maple Leaf House is a 45-bedded care home with nursing for older people with dementia, operated by Methodist Homes, and which opened in August 2003. The home is situated on the outskirts of Ripley and is one storey and purpose built with all facilities having level access. The home is divided into three wings, each accommodating fifteen people, with their own lounge, kitchenette and dining area. Décor, furnishings and fittings are of a high standard. All bedrooms are single and have en-suite facilities. There is an enclosed garden with outdoor seating. Support services are in place with a choice of GP, optician and dentist, and community psychiatric nurses, occupational therapists, physiotherapists and dietician are accessed as required. Staff training has been prioritised to take place to inform and enable staff to care for service users appropriately. The home has two activities coordinators who have responsibility for ensuring that a good range of entertainment and inhouse activities are arranged Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced visit that took place at the home over a morning. Additionally, time was spent in preparation for the visit, looking at previous reports and other documents. At the home, apart from examining the home’s documents, care files and records, time was spent looking around the building and speaking to visitors in one of the units. Because of the nature of their medical condition, the majority of the residents were not able to give a clear opinion of their life at the home. However one was spoken to and she did so in a limited way. Staff of the same unit were also spoken to, and they were observed throughout the visit, looking after and dealing with residents and visitors. The manager was present throughout the inspection visit. What the service does well:
This home was built to a high specification and provides a quality environment for staff and residents. It is spacious, light and airy yet, as it is split into 3 units, the residents live in smaller living environments that are more homely in scale. All bedrooms are large and single and have en-suite facilities, and give levels of comfort and equipment for those people who have specialist nursing needs. There is a variety of communal space; this includes pleasantly arranged garden areas that will be enjoyed by residents during the summer months. Staffing levels at the home have been set well above the minimum standard for this type of home and although the staff group is large, successful recruitment has offered a team with a variety of skills, knowledge and experience. Standards of induction of new staff to the home are good; staff are able to quickly get to know the individual needs of the people who live at the home and what is expected of them. The work of the staff group is guided by good quality documentation, particularly the personal care plans, and these cover a wide range of needs and activities that ensure they properly understand the individuals who live at the home. They are written in a clear style that helps them work consistently and safely, and communication within the home between different staff groups and those on different shifts makes sure that everybody is aware of the important things that need to be done. Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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.
Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 People do not come to live at the home without their needs being assessed and the services they need from the home being identified. This makes sure that the care provided is right when they move in. EVIDENCE: From the files looked at, all the people who had come to live at the home had had there needs looked at the time they came to the home; this identified the type of care required and was included within the ‘Assessment of Daily Living’ document. All of the assessment records had been completed to the same comprehensive standard and included some formal assessment documents that looked at quality of skin health (Waterlow) and any wounds, nutrition, mobility, mental health and whether the person was suffering pain. From these a detailed care plan had been developed (see next section) that indicated how staff would provide help consistently and safely on a day-to-day basis. This is written in an easy-to-follow style that ensures all areas of care needed by each individual are described, and the staff spoken to commented how the documentation was easy to use and an improvement on the care plans that had been in use at the home last year.
Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 9 The home does not provide an intermediate care service so Standard 6 does not apply. Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 The care of all residents, including health care, was planned and given in a way that respected individuality and privacy. EVIDENCE: The records of 3 residents were looked at closely and staff caring for these people were also spoken to during the inspection. The care plans included a comprehensive description about how staff care for individuals divided into a number of important areas to reflect personal and health needs. Additionally, some of the assessments referred to previously identified areas of risk affecting the residents’ lives, and these created a practical guide for staff to care for residents consistently and safely. Generally all the care plans examined were looked at and evaluated regularly, and revised where necessary, except for one that did not contain any documentation to indicate this occurring. This could lead to actions being taken which are based on outof-date information. A resident, who was able to express herself, confirmed that she had a good relationship with the home’s staff, and this was further confirmed by the relatives present during the inspection. They said they worked very hard and treated the residents with respect and with care – ‘When you come in in the
Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 11 morning everybody’s really friendly’, ‘Nothing is missed. I wouldn’t want my mother anywhere else’ Good contact with local health care services was indicated in the records and a relative spoken to stated that the doctor was due to visit on the morning of the visit. The records examined indicated that none of the residents looked after their own medicines and this was managed by the home on their behalf. This area had been a major cause for concern at previous inspections and the pharmacy inspector had previously made a number of requirements for the home to act on with some urgency. Examination of records held on the ‘wing’ and in the central clinic room, and discussions with the manager and an assistant manager indicated that these had been attended to and a substantial degree of organisation and safety had been introduced. A minor issue in relation to the training of care staff remains outstanding, but the manager had organised an activity to deal with this. Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 14 Visitors speaking on behalf of their relatives were very happy with life at the home, which has been steadily improving in recent months. Residents are able to arrange their lives to suit themselves and are supported by staff to maintain independence and individuality. EVIDENCE: The relatives spoken to talked about the home in glowing terms and about the life enjoyed by the residents. In particular they reported how this has been improved in recent months. Although most residents stay in the unit on which they live, they are free to use all of the building without any restrictions and some were observed to be doing so. Visitors are free to come to the home throughout the day and a good number were seen during the visit. The bedrooms are big enough to accommodate visitors but there is also a small sitting room on each wing for their use, which increases the options for privacy and bigger family groups. Those spoken to reported that routines at the home were very flexible and, for example, some late risers were seen having breakfast in the middle of the morning, which was their choice. The home also has the involvement of the Methodist Church network and there are photographs in the entrance hall showing some of their activities. This is done to increase community involvement of the home and allow residents a greater range of social contact.
Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 13 The home now employs a full-time and a part-time activities organiser and one was spoken to during the visit. As she is newly appointed, following a vacancy, services in this area are still underdeveloped. This was commented on by the relatives spoken. However she talked about a number of ideas she planned to put into operation and reported that resources of time and money were made available to her. A religious service has been a feature of the home since it opened, although a Christian commitment is not required by people coming to live at the home. Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The home makes sure that all of its residents are protected from harm by having robust policies and procedures in place and by a programme of staff training and awareness. The level of protection is impaired by the latter not being completed. EVIDENCE: The home had a comprehensive policy on the protection of vulnerable people that had been developed by Methodist Homes; this also that includes reference to the procedures required by law and operated by the key public agencies, such as Social Services and the Police. A programme of staff training, organised by Social Services had been commenced but not all staff had attended this. Since this was about the identification and reporting of possible abuse and the general principles of the adult protection procedures, all staff being aware of their responsibilities will enhance resident safety. An investigation was carried out under these procedures in 2004 concerning the nursing practices and medicines administration at the home and these have been changed to ensure that the situation does not happen again Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The home is clean, hygienic and offers good standards of comfort to residents in the bedrooms, garden and communal areas, and this had led to high levels of satisfaction. EVIDENCE: Observations made during the visit and comments by relatives indicated that the home had been well maintained, decorated and equipped. ‘The bedroom is very good and all we hope for – like a hotel’. ‘Everything is provided’. All residents are accommodated in single rooms with en-suite facilities. The courtyard garden area is maturing steadily and is well maintained and offers additional safe facilities for residents to enjoy. Some were doing so with their visitors during the visit. The design of the home had been made to a high standard, and specialist consultants had been employed who had advised on colour schemes and detailed features that made the home suitable for people with dementia and who may be liable to be confused by their environment. The home was very clean and tidy, and free from odours at the time of this inspection. Relatives commented very favourably about the laundry service of
Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 16 the home and all residents observed in the home wore clean and wellpresented clothing. Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28 and 30 The home is staffed by people who still require training in key skills in order to make sure that care to residents is given safely and properly. EVIDENCE: Progress has been made since the last inspection with the number of care staff passing a National Vocational Qualification (NVQ) at level 2, but the target is not yet achieved. The manager indicated that the target of 50 of care staff passing will be met on September of this year. The requirements made at the last inspection in relation to the standard 30 were discussed with the manager although the outcome described above was not fully tested at this visit. There are still some staff who have not received training in relation to basic food hygiene and emergency first aid and a programme of fire safety training is due for completion within 3 months. This will make sure that the care provided to residents is done so safely and by properly trained staff. Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36 and 38 The home’s new manager has made a positive impact on the home and has established orderly processes to make sure that staff deliver care to residents safely and consistently. Work still needs to be done to ensure that staff are fully supported and their work properly monitored. EVIDENCE: The manager’s appointment was confirmed in December 2004 and her application to register with the CSCI is nearing completion. She is currently completing a Registered Manager’s course, which meets the standard of achievement of NVQ level 4 and has continued to update herself with training to meet the requirements of being a registered nurse. She reported that she continues to be well supported by her line manager from Methodist Homes, who visits the home regularly. Staff and relatives spoken to commented very favourably about the positive impact the manager has had on the home since she started, and this was reflected in the improvements reported elsewhere in this report.
Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 19 The manager and other representatives from Methodist Homes regularly check the health and safety standards of the home. The requirements from the last such check, made before the last inspection, have now been fully carried out and this included the completion of a full risk assessment for the whole building, which is required by law. This makes sure that all areas of the building are made safe for both staff and residents. As mentioned above, some of the key areas of staff training require completion in order for care to be delivered as safely as possible. The manager has re-introduced a system of 1-to-1 staff supervision so that they receive individual and confidential support from the assistant managers and so that work can be monitored as well. From discussion with one of the assistant mangers and staff, this system has not been fully established and the required frequency of meetings is not being achieved for all staff. Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 4 x x x x x x 4 STAFFING Standard No Score 27 x 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 2 x x x x 2 x 2 Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 21 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 7 Regulation 15(2) Requirement All care plans and their differing elements must be reviewed on a monthly basis. (Previous timescale of 31.05.05 not met). The registered person must provide training in the use of creams and fluid-thickening agents to all care staff, who are not qualified nurses, who are required to administer these preparations as part of their duties. This must include an assessment of carer competence. (Previous timescale of 30.06.05 not met). The manager must support the activities organisers, through the provison of appropriate resources, a range of activities within the home that suits the needs of residents. records of any activities taking place must be retained. Staff must undertake training in adult protection. (Previous timescale of 30.06.04 not met). The registered person must ensure that 50 of care staff achieve NVQ level 2 by 31.12.05. (Previous timescale of 30.06.05 not met). Timescale for action 30.09.05 2. 9 13(2), 18(1) 30.09.05 3. 12 16(2) 30.09.05 4. 5. 18 28 13(6), 18(1) 18(1) 30.09.05 31.12.05 Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 22 6. 30, 38 18(1) 7. 30, 38 18(1) 8. 31 9(2), 10(3) 9. 36 18(2) All staff must receive training (instruction) in the core skills of food hygiene and emergency first aid.(Previous timescale of 30.06.05 not met). All staff must receive training in fire safety at least annually.(Previous timescale of 30.04.06 not met). The manager should achieve a qualification at NVQ level 4 (or equivalent) in management. Completion of the Registered Manager’s course will meet this recommendation. Staff must receive regular, formal supervision on an individual basis. (Previous timescale of 30.06.05 not met). 30.09.05 31.08.05 31.12.05 31.09.05 10. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 17 2 Good Practice Recommendations The registered person should make arrangements for service users to vote where appropriate. All service users should be issued with an individual contract that contains key terms and conditions of residence and identifies rights and responsibilities between home and service user. Staff should receive formal planned supervision on an individual basis six times per year. 3. 36 Maple Leaf House C02 C52 S42716 Maple Leaf House V234508 220605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Souht Point, Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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