CARE HOMES FOR OLDER PEOPLE
Maple Lodge Arncliffe Road Halewood Liverpool Merseyside L25 9PA Lead Inspector
Mrs Elaine White Unannounced Inspection 21st March 2006 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Maple Lodge Address Arncliffe Road Halewood Liverpool Merseyside L25 9PA 0151 448 1621 0151 448 0713 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) the.willows@ashbourne.co.uk Exceler Healthcare Services Limited Ms Eileen Geraghty Care Home 45 Category(ies) of Dementia (24), Dementia - over 65 years of age registration, with number (20), Old age, not falling within any other of places category (25) Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. Service users to include up to 25 OP, and up to 24 DE and up to 20 DE(E). Service Users in the DE category only can be in the age range 55 years and over. The manager to provide the inspector with 3 monthly accident evaluations for the DE Unit whilst evaluating staffing levels The manager must provide all staff working on this unit with dementia care training within 3 months A maximum of 45 service users may be accommodated. The Service should, at all times, employ a suitably qualified and experienced manager who is registered with the CSCI. 7th September 2005 Date of last inspection Brief Description of the Service: Maple Lodge is a large, single storey building located in the Halewood area of Liverpool. It is close to local shops and has good links to motorways and buses. The home is approximately 3 miles from the city centre. The home is registered for 24 people with dementia and 25 people who are elderly. Within the home, there are two units, each looking after people with different care needs. The units have security locks to ensure the safety of those who live there. The home is easily accessible from the front and back of the building and has plenty of car parking spaces. There is suitable access for people using wheelchairs. Garden areas are located to the front and rear of the home and a small communal garden in a central courtyard and accessed from the main building. Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was carried out over a period of one day. It was an unannounced visit and was carried out as part of the regulatory requirement for care homes to be inspected at least twice a year. 11 standards were assessed during this inspection. There has been no cause to visit the home since the last inspection in September 2005. For this inspection a tour of the home was conducted and care records and other home records were viewed. Discussion took place with the newly appointed manager, care manager, care and domestic staff, cook, relatives and residents. There were 45 residents at the time of the inspection. What the service does well:
The staff team working at the home work well together and receive strong leadership from the care managers. Residents were complimentary about staff stating they are helpful and enthusiastic. Staff have good in house training in all key areas of care and the home runs a good monitoring system to ensure all training remains up to date. Staff were observed interacting well with residents and visitors on both units and a homely atmosphere was evident throughout the home. Residents interviewed said, “I am very happy here”. “The staff are very good”. Relatives commented, “The staff care for everyone, even those without relatives to speak for them”. “The staff are always very obliging”. “Always polite”. The home has two large lounge areas with interlocking doors, which enables activities to be attended by residents on both units. The home has ample communal area for those who wish to smoke and for those who don’t. Visitors are welcome at any time and were observed to pop in at all times during the inspection. There are gardens to the rear and centre of the home with easy access for residents. Décor in the home is tasteful and of a good standard. A tour of the building showed that private and communal areas were tidy and clean. An activity coordinator provides an entertainments programme, which includes bingo; sing a long, reflexology, baking and card games. Residents were Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 Page 6 observed having aromatherapy and nail care in the lounge. Residents spoken to said, “I feel lovely”. “It’s nice to have a bit of pampering”. Monthly quality monitoring takes place by the company’s operations manager, who was visiting the home during the inspection. These visits ensure regular assessment of the services provided, identifies improvements required and provides support and direction to the manager. A full time maintenance person is on site to undertake repairs needed. Care plans are detailed and are reviewed monthly involving residents, relatives, staff and other interested parties. There are extensive life biographies showing the past lives and hobbies that residents had. These enable staff to have a basic knowledge of residents’ likes and dislikes. Any risks that are taken by residents such as smoking and moving about the home are clearly recorded and updated in their files. The entrance provides a welcome approach to the home and information is available for visitors on the services provided i.e. activities, menus, complaints procedure, and inspection reports. What has improved since the last inspection?
A new registered manager is now in post and has been approved by the Commission for Social Care Inspection. The registered manager has ensured that all the requirements and recommendations made at the last inspection have been met and is progressing towards making further improvements in the care and support provided, environment and recording systems in place. Staff spoken to provided positive comments regarding the support, direction and training provided. “It gives me the confidence to do my job”. The recent training programme, which has taken place, includes fire training, manual handling, welfare and abuse. Other courses planned are dementia care, pressure care and diabetes. Staff are encouraged to take National Vocational Qualifications and one care manager spoken to is taking NVQ Level 3 and commented, “The new manager is brilliant. The seniors are taking part in a series of workshops, which are really good”. The manager has introduced new admission, assessment and care planning system for both short term and long term residents. Records seen were detailed and easy to follow. Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 Page 7 Relatives spoken with said, “The home is improving all the time”. “It is much cleaner”. “I call in here every day and they always make me feel welcome”. The home now provides a more varied, weekly activity programme, which includes reflexology, aromatherapy and sing a longs. Relatives commented, “The activities are more stimulating”. A new activity room with strobe lighting and a ‘touchy feely wall’ provides a quiet area for residents to sit, listen to music, talk to visitors and take part in activities. Since the last inspection menu surveys have taken place to ensure the meals are to the liking of the residents. Surveys viewed showed the following comments from residents, “I would like to be offered horlicks, ovaltine and grapefruit”. “I enjoy all the meals prepared”. Menus have been revised from the information received. Redecoration has taken place in a number of private rooms, corridors and hairdressing room and new carpets have been fitted were required to improve the standard and create a homely, comfortable home. The improvement programme is ongoing by the full time maintenance man. The manager using a checklist system, which highlights action needed, now audits medication monthly. What they could do better:
The home is making progress to eliminate odours within the dementia unit. New carpets have been fitted and other flooring alternatives are being looked at. Training in medication should be provided for care staff. Information leaflets should be made available on the medication in place to enable staff to have the knowledge of allergies and reactions to medication. At the time of the inspection there were 13 vacancies. Discussion with the manager confirmed that occupancy levels are being addressed and the company is marketing the service using the new statement of purpose and improved information leaflets in place. Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 Page 8 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 DS0000005463.V279443.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3. A statement of purpose and service user guide is in place and available in residents’ rooms. Assessments of need are completed prior to admission. EVIDENCE: A new statement of purpose and service user guide is in place and is continually being updated to provide information for the residents. New pre admission assessments and short stay assessments were seen and the manager confirmed that this documentation is to be introduced in April 2006. Training is in place for staff to enable them to transfer existing information onto the new system. The documentation provides detailed information on the individual care needs required to enable the home to make a decision if these can be met by Maple lodge. Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 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 the following standard(s): 7,9,10. Residents’ health and personal care needs are identified within their plan of care. Medication policies and procedures have improved and are audited monthly by the manager. Residents are treated with respect and their privacy is upheld. EVIDENCE: Care files viewed contained detailed information on the care needs of each resident. A life history is completed, likes and dislikes recorded, communication and mobility assessments completed. These are reviewed monthly to assess changing needs and action taken. The manager is reviewing all care files over the next three months and a new recording system introduced. Staff confirmed they are receiving training to assist them in this process. Policies and procedures are in place for the administration of medication and the manager conducts a monthly audit check to monitor this. Medication training for staff is recommended and information on the medication in place i.e. side effects, should be made available to raise staff awareness. Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 Page 12 Residents and relatives spoken to confirmed that they are treated with dignity and respect at all times and positive comments were received regarding the staff and management. “The staff are very obliging”. “Always polite”, (Relatives). “I am very happy with the service”, (Resident). There are many areas in the home were the residents can sit privately or interact with other residents. The home has two communal rooms, smoking lounge, activity ‘chill out’ room, garden areas and their own private rooms for this purpose. Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 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 the following standard(s): 15. A wholesome, varied menu provides a balanced diet to the residents. EVIDENCE: A recent food survey conducted has resulted in the provision of new and varied menus. Surveys viewed showed comments from residents and these have been addressed to provide more choice to meet the needs of the residents accommodated. Comments include – “I prefer an evening meal”, “I would like more fruit”. New menus in place showed that choices are available for breakfast i.e. porridge, toast and marmalade or black pudding and beans. Two choices are also available for the lunch and evening meals. Morning coffee, afternoon tea and supper is also provided. The main meal of the day is now served at teatime as a result of the resident’s survey. Meals are served in the dining areas or within the residents own rooms. Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 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 the following standard(s): 16.18. The home has a clear complaints procedure. Abuse policies, procedures and training are in place. EVIDENCE: Complaints are dealt with in accordance with their policies and procedures. Staff confirmed that abuse training has recently been provided within the home’s internal welfare training programme. A copy of the new procedures issued by Liverpool and Sefton Social Services is to be obtained by the home for staff reference. Residents and relatives spoken with during the inspection stated that they are aware of the homes complaints procedure and commented, “I wouldn’t hesitate to report anything”. Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 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 the following standard(s): 19. The layout, facilities and location of the home are suitable for the residents who live there. The home is safe and clean. EVIDENCE: All communal areas and a number of resident’s rooms were viewed and were found to be comfortably furnished and clean. Redecoration has taken place in a number of private rooms, corridors and hairdressing room and new carpets have been fitted were required to improve the standard and create a homely, comfortable home. The improvement programme is ongoing by the full time maintenance man. The home is making progress to eliminate odours within the dementia unit. New carpets have been fitted and other flooring alternatives are being looked at. Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28. Sufficient numbers of staff are employed by the home to meet the needs of the residents who live there. A training plan ensures that staff are equipped to meet the needs of the residents. EVIDENCE: Since the last inspection the new manager has developed a computerised ‘tracker’ training programme, which highlights training needs, training received and those in need of review. The main statutory training is provided and in includes manual handling, fire safety, food hygiene and health and safety. However the home provides additional training i.e. dementia care, abuse, welfare and diabetes to enable the staff to care for their residents effectively. A series of workshops are conducted for the senior care staff who commented, “They are very good and address the job we do”. NVQ qualifications are also encouraged for all care staff and records were seen for staff working towards NVQ Levels 2 and 3. Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31. The home has a registered manager who is approved by Commission for Social Care Inspection. EVIDENCE: Since the last inspection the home has appointed a registered manager who is approved by Commission for Social Care Inspection. The registered manager has ensured that all the requirements and recommendations made at the last inspection have been met and is progressing towards making further improvements in the care and support provided, environment and recording systems in place. Staff spoken to provided positive comments regarding the support, direction and training provided. One relative spoken to said, “I haven’t met the new manager yet”. This was discussed with the manager during the inspection who informed that a coffee morning has been arranged and all relatives, visitors and residents are invited to meet the new manager.
Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 Page 18 Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X X Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 3 Refer to Standard OP1 OP7 OP9 Good Practice Recommendations The home to continue to review the statement of purpose and service user guide to provide up to date information on the services and staff in place. The review of care plans taking place in April should involve all interested parties, residents and relatives. The home to provide medication training for staff who administer. The home to maintain information the medication in place and this must be made available to staff. The home to obtain a copy of the new procedures on adult protection from Liverpool and Sefton. This must be provided to all staff so they are aware of the new procedures. The home to continue to make progress to eliminate odours within the dementia unit. 4 OP18 5 OP26 Maple Lodge DS0000005463.V279443.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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