CARE HOMES FOR OLDER PEOPLE
Maple Lodge Rotherwood Drive Rowley Park Stafford Staffordshire ST17 9AF Lead Inspector
Sue Mullin Unannounced 1 August 2005 9:30 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 Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Maple Lodge Address Rotherwood Drive Rowley Park Stafford Staffordshire ST17 9AF 01785 255259 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) Southern Cross Healthcare Services Limited Mrs Julie Ann Anderson CRH 40 Category(ies) of DE(E) 40 registration, with number OP 40 of places PD(E) 20 Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 14 January 2005 Brief Description of the Service: Maple Lodge is a purpose built detached residential home, which stands in its own grounds. The home is registered to admit (40) service users above the age of 65. Dementia - over 65 years of age (40), Old age, not falling within any other category (40), Physical disability over 65 years of age (20).There are 40 single bedrooms all with en suite facilities. There is a passenger lift available. Two bright and spacious lounges are available with two lounge/dining areas. There is a hobbies room which doubles up as a hairdressing salon on the first floor.The home has patio doors that open onto attractive grounds with established trees; seating has been provided some with pergola cover. This is an enclosed area. A bus service runs from the end of the road half a mile from where the home is situated into the centre of Stafford, where all local services and shops are to be found.There are ample car parking facilities. Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place on 1st August 2005. Discussions took place with the care manager and the staff on duty. Several residents were spoken to and staff were observed interacting and undertaking tasks with residents. A range of documentation relating to both the care of the residents and environmental issues was examined. A sample of medication and financial records were inspected. The home had received no complaints since the last inspection and none had been submitted directly to the CSCI. Staff spoken to reported that ‘the team of staff have been here for some time and we all work well together’. Another member of staff stated the residents ‘get what they want – when they want it’. Clearly, the staff were very fond of the residents in their care and nothing seemed too much trouble for them. The care staff themselves looked very smart and presentable and set a good example to others and this was reflected in the high standards of personal hygiene and grooming of the residents. All residents looked well cared for in clothes of their own choice, ladies with make up on and items of jewellery and gentleman smartly shaved and appropriately dressed. A happy friendly atmosphere was felt throughout. During lunch one resident informed the inspector ‘ it is lovely to waited on hand and foot’. Happy banter was exchanged during lunch and formed part of a real social occasion. What the service does well:
The home has a competent and experienced manager who was providing good leadership. The home was well supported by the regional manager of the home who visited regularly. The home had a friendly, relaxed atmosphere and was described by staff as ‘home from home’. Residents spoken to (who were able to comment) appeared very happy with the quality of the service feeling that the staff were friendly and caring and went out of their way to improve their quality of life. The home had undertaken assessments of all prospective residents and the home was able to meet the current residents’ assessed needs. External health professionals visiting residents provided a seamless service. The home responded appropriately to the health care needs of the residents. Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 6 Residents were provided with choice over how and where they spent their time and whether they joined in with activities. The home provided a weekly schedule of activities. The home provided the number of staff needed to meet the identified needs of the residents. Staff received the training required to undertake their duties and appeared well motivated and were promoting residents’ choice, privacy and individuality. What has improved since the last inspection? What they could do better:
The home provided an 8 weekly menu which was examined on the day of the inspection and it was determined that this was not always followed. Although the catering staff provided choices at all meals the Cumberland pie served on the day of the visit was runny, unappetising with no shape or form. The vegetables served were swede, carrots and peas, it could not be determined if any of these were fresh. Almost all of the 38 residents could eat well with a knife and fork; but the Cumberland pie was more suitable for residents requiring a very soft diet. Staff stated that there had been some improvements in the food recently, particularly with gravy but felt that meals could still be improved upon. However, they felt that mince was served too frequently and that the residents were fully able to enjoy a more solid meal. The home must provide meals that are presented in a manner which is attractive in terms of texture, flavour and appearance. A requirement has been made to this effect. The home was clean and tidy and procedures were in place for the control of infections. Even though the downstairs lounge appeared clean and was seen to be tidy, it was quite malodorous with a strong smell of urine. This was discussed with the care manager who had identified this problem and had ordered some specialised cleaning agents to deep clean the carpet. These
Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 7 cleaning products were seen in her office during the visit. The carpet had been deep cleaned daily but the member of staff undertaking this duty had just commenced annual leave and the carpet had not been cleaned the day before. This was high on the agenda for addressing. All areas of the home must be kept free from offensive odours. A requirement has been made to this effect. 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 Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,4,5 The home provided an admissions procedure that enabled residents and their representatives to retain choice and control over their lives. The home’s quality of staffing and the involvement of a range of health care professionals enabled residents to have the confidence that the home was able to meet their needs. EVIDENCE: The admissions procedure included an assessment by the home completed before admission and provided the opportunity for the prospective residents and/ or their relatives to visit the home. Staff spoken to confirmed that residents or their relatives could visited the home to look round before they committed themselves to residency. Records showed that assessments had been completed and this provided the necessary information for the home to be able to provide the care needed. Staff spoken to were aware of individual resident’s needs as well as their likes and dislikes. Staff spoken to were aware of good practice principles. Records showed that the home involved the necessary health care professionals to respond to the health care needs of the residents including CPN, and the
Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 10 District nurse. Records and discussions with staff confirmed that they had received the training required to meet the residents’ needs. Files showed each resident had a plan of care for daily living. Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The home was actively identifying the health needs of the residents and residents could expect that all aspects of their care requirements were fully met. The medication at this home is well managed promoting good health. Resident’s could be assured that they are treated with respect and their privacy and dignity were promoted enhancing their wellbeing and self esteem. EVIDENCE: The home had developed individual plans of care identifying the health, personal and social care needs. The home was also undertaking practices to prevent falls and improve supervision. Care plans were up to date and had been evaluated. All entries were legible and signed and dated. Staff confirmed that resident’s health care needs were being met and all NHS entitlements were accessed. Residents received dental, chiropody care and saw the optician where required. The home supported residents to attend outpatient appointments. District Nurses visiting responded appropriately to residents’ health care needs.
Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 12 The risk of pressure sores was assessed and the necessary equipment was provided. Nutritional issues were identified and a nutritional plan was in place. The home promoted the privacy, dignity and independence of the residents. Staff were observed responding to residents in a sensitive manner and were able to describe how they undertook tasks in a manner that promoted residents’ privacy and supported them to make choices over their lives. The clinical room was inspected and found to be very clean and all medicines were stored appropriately. The staff followed the homes medication procedure and all medication was checked on arrival. The MAR sheets were examined and there were no errors identified in the recording of the administration of medication. Training was provided for those administering medication. Controlled drugs were checked and the inspector noted that two staff prior to the inspection that morning had checked them. Temperatures were recorded for the drug fridge and clinical room and found to be within normal limits. During the hot summer months a fan was used in the room to keep the temperature below 25.C. No resident was self-medicating or receiving oxygen at the time of the inspection. Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 13 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) 12,15 The flexible routines, the social activities provided the residents with a lifestyle that respected their individuality and provided them with choice and variation. However, meals served on the day of the inspection were not all presented in an appetising manner and this may result in resident’s nutritional requirements not being met. EVIDENCE: Residents (who could comment) stated that they were happy living in the home, which had a weekly schedule of activities in place. Visitors could visit at any reasonable time and they were made to feel welcome. The home provided flexible routines whereby residents could get up and go to bed when they wished, could spend time in the communal rooms or in their bedrooms and could choose where to have meals and snacks. The home provided an 8 weekly menu which was examined on the day of the inspection and it was determined that this was not always followed. Although the catering staff provided choices at all meals the Cumberland pie served on the day of the visit was runny, unappetising with no shape or form. The vegetables served were swede, carrots and peas, it could not be determined if any of these were fresh. Almost all of the 38 residents could eat well with a knife and fork; the Cumberland pie was more suitable for residents
Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 14 requiring a very soft diet. Staff stated that there had been some improvements in the food recently, particularly with gravy but felt that meals could still be improved upon. The home must provide meals that are presented in a manner which is attractive in terms of texture, flavour and appearance. A requirement has been made to this effect. Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 15 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) 16,18 Complaints were responded to appropriately ensuring that residents and relatives concerns were addressed. All care staff had received training in adult protection and were confident that to any concerns were appropriately addressed. EVIDENCE: The home had a complaints procedure and responded to concerns raised by residents and relatives. The CSCI had received no complaints. The home had adult protection procedures and all care staff had received adult protection training. Further training from the Community mental health team was ongoing and well received. Training had also been identified and planned for relatives to receive awareness of dementia and its management. Staff are carefully selected to work in the home and had undergone CRB and POVA checks before being offered employment. Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 16 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) 19,20,21,22,23,24,25,26 Bedroom accommodation provided a homely and domestic environment for the residents that respected their privacy. The home had suitable procedures in place to minimise the risk of infection. The home’s communal areas were spacious and bright, however the downstairs lounge was malodorous and could be unpleasant for residents/relatives to sit in. EVIDENCE: The home is suitable for its purpose and was domestic and homely in style. Bedrooms were lockable, suitably decorated and furnished and were personalised. The home was clean and tidy and procedures were in place for the control of infections. Even though the downstairs lounge appeared clean and was seen to be tidy, it was quite malodorous with a strong smell of urine. This was discussed with the care manager who had identified this problem and had
Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 17 ordered some specialised cleaning agents to deep clean the carpet. These cleaning products were seen in her office during the visit. The carpet had been deep cleaned daily but the member of staff undertaking this duty had just commenced annual leave and the carpet had not been cleaned the day before. This was high on the agenda for addressing. All areas of the home must be kept free from offensive odours. A requirement has been made to this effect. There were adequate hand washing facilities and the laundry service was provided by the sister home Maple Court next door. Staff reported that the laundry services had improved somewhat since the last inspection. Various aids and adaptations were in place, including chair lifts in the bath, mobile hoists and other equipment for moving and handling. The nurse call facility was fully operational. There was a documented programme of redecoration and refurbishment. Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 18 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) 27,28,29,30 The level of staffing and the quality of the staff was providing the residents with a good standard of care. The home’s recruitment procedure was providing the residents with the necessary protection. The arrangements for the induction of staff are good with the staff demonstrating a clear understanding of their roles. Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 19 EVIDENCE: The home provides personal care only all nursing care is provided by district nursing services. At the time of the inspection there were 38 residents in the home, one in hospital and one vacancy. The care manager works fully supernumerary five days a week and this has enabled her to meet the national minimum standards. However, Mrs Anderson prefers to undertake some shifts in the home to ensure she is kept up to date with current needs of residents and the demands made upon staff. This is very good practice. Additionally on the early and late shift there 7 care staff. Night shift there are 4 care staff. Staffing levels are based on the dependency levels of residents in the home and these are reviewed on a regular basis. On the day of the inspection staffing levels and skill mix were found to be acceptable. The home use agency cover where required. 5 care staff hold First Aid certificates and 50 of care staff have either got NVQ level 2 or are in the process of undertaking the course. There is a part time administrator (24 hours) and an activity coordinator (30hours). There are changes determined in the near future for a change around of staff duties and this will be assessed on the next inspection. The handyman/gardener (30hours) keeps very good accurate and clear records of maintenance throughout the home. Which includes emergency lighting, fire and electrical equipment testing. There is adequate domestic staff the home and the sister home (Maple Court) provides laundry cover. Maple Court catering staff supplies the Lodge with all meals, which is served by a kitchen assistant based at Maple Lodge. Recruitment procedures were determined and meet all the national minimum standards. Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 20 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) 31,32,33,34,35,36,37,38 The home is well managed providing residents with continuity in standards of care. The systems for residents/relatives/staff views to be taken into consideration and acted upon are robust and residents can be assured that the management of the home will maximise their quality of life. EVIDENCE: The home is well managed. The manager has the necessary experience, knowledge and is undertaking qualifications in care and management. The home had some methods of reviewing the service through informal discussions with residents and relatives as well as a formal method of reviewing the environment. Residents and relatives views were sought and they were provided with copies of the inspection reports and were made aware of announced inspections. Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 21 The home was fully insured and there were no concerns as to the home’s financial viability. The home’s maintained the required records including those for residents’ monies, accidents, and for visitors to the home. The home had procedures in place and staff had received training to maintain a safe environment. Fire testing and fire training had taken place. Fire drills were up to date for day and night staff. All mandatory training had been undertaken and clearly documented. Procedures were in place to ensure water was at a safe temperature, radiators were covered and the necessary testing of mobile equipment had taken place. All records seen were very well organised and in order, and all were kept safe and secure in line with national requirements. Supervision of care staff was well met with clear accurate records and a matrix formulated, so that the care manager can organise these sessions well in advance. Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 22 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 2
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 4 4 3 3 3 4 3 3 Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 23 NA 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 15.4 Regulation 16(2)(i) Requirement The home must provide meals that are presented in a manner which is attractive in terms of texture, flavour and appearance. All areas of the home must be kept free from offensive odours Timescale for action with immediate effect with immediate effect 2. 26.1 16(2)(j) 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 Good Practice Recommendations Maple Lodge E51-E09 s. 5120 Maple Lodge UI v.238721 19.07.05 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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