CARE HOMES FOR OLDER PEOPLE
Maple Lodge Rotherwood Drive Rowley Park Stafford Staffordshire ST17 9AF Lead Inspector
Mrs Sue Mullin Unannounced Inspection 11:20a 30 January 2006
th 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 DS0000005120.V272889.R01.S.doc Version 5.0 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 DS0000005120.V272889.R01.S.doc Version 5.0 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 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) Southern Cross Healthcare Services Limited Mrs Julie Ann Anderson Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (20) Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th July 2005 Brief Description of the Service: Maple Lodge is a purpose built detached care home, which stands in its own grounds. The home is registered to admit 40 residents above the age of 65, who require personal care only. There are 40 single bedrooms all with en suite facilities and a passenger lift is 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 enclosed grounds with established trees; seating has been provided some with pergola cover. 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 DS0000005120.V272889.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over on 30th January 2006 and was completed by one inspector. The home is currently full, with 40 people being in residence. A tour of the home and grounds was undertaken and the care manager was present during the visit. Discussions were held with the care manager and other members of staff that were on duty. There were no visitors to the home during this visit. Staff records regarding recruitment and induction were seen as were records relating to medication and maintenance. A care plan was examined in detail and some of the information contained was cross-referenced with the resident to further confirm this evidence. Further clarification about life in the home was sought in varying degrees from the other residents and staff. In this way a fuller picture of what it is like living at Maple Lodge was built up. Staff practice was observed throughout the inspection. What the service does well:
Some of the residents living at Maple Lodge were very happy to speak to the inspector, and while the majority of people were engaged in conversation most discussion was held with three ladies who were sitting at the dining table. Despite all three suffering from varying degrees of dementia they were full of praise for the home, the care that they receive, and the staff. Staff confirmed that full attention was paid to meeting all identified health needs and that should residents require a GP there was no hesitation towards them receiving the care that they needed. The inspector saw three GP’s in the home during the inspection. Staff confirmed that family and friends were always made very welcome at the home. There were no complaints from any of the residents at Maple Lodge during the visit, and no complaints had been received by the home or the Commission since the last visit. Considerable effort is made by the home to provide a range of activities for the residents that will meet their varied tastes and interests. Various musical sessions are organised, there is bingo at least once a week. There is a wide range of table pastimes available. Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 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 Lodge DS0000005120.V272889.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 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 the following standard(s): 3,4 Residents receive a thorough assessment of their needs prior to them moving into the home and the home confirms it can meet those needs prior to residency. EVIDENCE: The individual file of a resident was seen who had been admitted since the last inspection visit. The care plan showed that there had been a thorough pre admission assessment of needs undertaken. This followed on from the Community Care Assessment undertaken by the Social Services Department prior to the referral being made to Maple Lodge. A lengthy discussion was held in general with three residents who were sitting together in one of the dining rooms. The group included the residents who had most recently been admitted. Unfortunately due to their confused state they were unable to confirm that their needs had been appropriately assessed prior to residency or that they had been advised that the home could meet their needs.
Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 Page 9 However, the most recently admitted resident chatted to the inspector about her family and illnesses and these were satisfactorily recorded in the main body of the care documentation. Discussion with the care staff at this visit, and previous visits confirmed that an assessment of need was always completed prior to any resident moving into the home. Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9,10 The home has the individual needs of each resident at heart, and appropriate care is provided to meet those needs in a way that residents appear to like. Residents can feel safe living at Maple Lodge and confident in the staff meeting their needs EVIDENCE: The individual file of the most newly admitted resident was looked at in depth and clearly showed that their care needs relating to health, personal and social care had been appropriately recorded. The care plans have individual sheets for addressing the various aspects of need, with areas to be completed for the aspect of care required by the individual resident, and these were completed in every case. Records showed that the care plans are reviewed on a monthly basis. The care plans have sections to record all health professional appointments, such as GP visits, District Nurse, chiropody, dental, ophthalmic etc. These were complete in every instance. The daily contact sheets also recorded how each person was each day, and there was an audit trail to show if someone was not well that the GP had been contacted.
Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 Page 11 The home has sound procedures in place for the receipt, storage, provision and recording of medication given. Part of the medication round was seen, and the staff member followed good practice in checking records the MAR sheets prior to giving the medication, and noting that the resident had taken the medication before recording the same on the chart. Residents generally had some marked degree of confusion and not all conversation was meaningful. However, those who could comment were complimentary about the home and the staff and the way that they are treated. Several staff members were asked about the care practices in the home, and it was clear that she had a good understanding of the needs of the residents and how to uphold their privacy and dignity. Several residents have lived at the home for a number of years now, and it was obvious upon observation that the staff know them very well and encourage each person to be as independent as possible. Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 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 the following standard(s): Residents choose the lifestyle that they prefer, having a range of activities provided that they choose according to their own tastes. They are encouraged to retain control over their lives and to accept visitors as they please. Residents can expect promotion of individual choice. Meals served on the day of the inspection were not all considered flavoursome and appealing and this may result in resident’s nutritional requirements not being met. EVIDENCE: The home is to be commended on the programme of therapeutic activities and entertainment it provides for the residents. The hobby room itself contained a variety of art and craft materials. There were many examples of individual resident participation and records had been maintained to support this. Assessments of individual needs, preferences and abilities had been taken into account when planning activities, especially in relation to the needs of residents with dementia. The activity coordinator assesses residents when they come into the home, with the help of families, and this helps to find out what individual residents are interested in and are able to participate in, as well as any particular hobbies they might have.
Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 Page 13 There is a range of activities provided, including fun mobility exercise sessions, bingo, and several types of musical sessions such as a sing along. The activity coordinator is to put daily information of activities up in the dining room where residents can view it regularly. This will help with residents suffering from short-term memory loss. Staff confirmed that residents could receive visitors at any time and they could chose to sit in the lounge with others, or go the bedroom of the resident for some privacy. All of the residents spoken appeared to enjoy their lifestyle in the home and were actively encouraged to make their own choices about how they conducted their day. Financial arrangements were not inspected at this visit. Residents were encouraged to bring their own possessions into the home, and evidence was seen in each care plan of an inventory of residents’ personal property. The dining room is very pleasant and the dining tables were well set out, with a small floral arrangement on each table, condiments and napkins etc. There is a flexible breakfast time and staff reported that residents tended to sit down together for all most meals, but should they not feel like eating at a particular meal they would be free to choose something later in the day. Staff stated that there had been some improvements in the food recently, but felt that meals could still be improved upon. The inspector sampled the food at lunch and found the meal a little bland. The lamb stew consisted only of lamb and watery gravy with no onion or vegetables in it. Fresh sprouts and swede were served but the mashed potato was very watery and could not keep its shape when served on to the plate. It had no real taste and was grainy in texture. The home must provide meals which are acceptable in terms of texture and flavour. A requirement has been made to this effect. This will be followed up by further inspections. Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 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): 16,17,18 The home has sound procedures in place to respond to complaints or to any allegation of abuse. Residents can be confidant knowing any concerns raised would be dealt with appropriately. EVIDENCE: There have been no complaints received by the home or the Commission since the last inspection. Residents generally were unable to comment on how they would go about raising any concerns but the inspector felt the care manager would identify any issues and deal with them in line with the complaints procedures in the home. The home has an appropriate complaints procedure on display, which is also available in the service users guide, and provided to all residents or their representatives. The home have a whistle-blowing policy that would be followed should any other member of staff feel that they needed to alert the manager to any poor practice, but fortunately this had never arisen. Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 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): 19,20,21,23,24,25,26 The home is very clean, pleasantly decorated and well equipped. This means that residents are not exposed to any hazards and can take pleasure in their surroundings. EVIDENCE: Maple Lodge always presents, as a very comfortable, pleasant and safe home in which to live and at this inspection there was no exception. A tour of the home was made, including communal areas, kitchen, bathrooms and toilets and several resident’s bedrooms. The general décor was very pleasant as were the fixtures and fittings, with comfortable lounge chairs that met the needs of the residents, and a well-equipped and pleasant dining room. The bedrooms seen were very homely and personalised with private possessions. All carpets and floor coverings were appropriate, and no tripping hazards were seen. The maintenance record book was examined and this showed that all routine maintenance was up to date. The building complies with the requirements of the fire service and environmental health department.
Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 Page 16 If a member of the staff team notices any defects with any equipment they report it and the maintenance man then takes prompt remedial action. Externally there are well-maintained grounds, with adequate space for car parking and areas for the residents to sit out in the warmer weather. It was observed during the tour of the accommodation and throughout the visit that all parts of the home were clean and hygienic. The ground floor lounge area was in the process of being deep cleaned. Following a discussion with staff it was determined that bed linen from the sister home is not delivered in sufficient quantities on a regular basis. Some of the bed linen is old and worn and needs to be replaced. Management confirmed that they have had to send some items back as they were not fit to be put on resident’s beds. The home must ensure that they have adequate good quality bed linen in suitable quantities, available at all times. A requirement has been made to this effect. Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 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 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): 27,28,29,30 The home has sufficient numbers of motivated and caring staff to meet the needs of the residents. All staff were found to be competent and suitably trained to carry out their duties. Residents can be assured that they are being cared for by staff who ensure that they reside in a safe environment at all times. EVIDENCE: The home provides personal care only all nursing care is provided by district nursing services. At the time of the inspection there were 40 residents in the home. 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 are 6 sometimes 7-care staff, one of which is a senior carer. 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 would use agency cover if their own staff could not cover shifts.
Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 Page 18 There is a part time administrator and an activity coordinator. The handyman/gardener 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. A newly recruited domestic member of staff stated ‘ I was made to feel welcome by the others when I started working here’. Staff stated to the inspector ‘ we provided a good range of activities to the residents which they really enjoy’ ‘ this is a happy place to be in’. Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 Page 19 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): 31,32,33,38 The management team have a clear development plan and vision for the home, this is effectively communicated to the residents, staff, relatives and significant others. The health, safety and welfare of staff and residents are protected. EVIDENCE: The home is well run and all parties are always made aware of any announced inspections. The care manager always welcomes the inspector into the home, and give access to all of the residents on a private basis. Both the registered manager and her staff are committed to ensuring that the best quality of care is offered to each individual. Resident’s daily lives were varied and they were empowered to live the lifestyle they prefer as far as practicably possible. Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 Page 20 Elements of practice in the home relating to health, safety and welfare were inspected. Fire alarm tests are held weekly and emergency lighting is tested monthly in accordance with the fire authorities requirements. Regular fire drills take place and are rotated to ensure that all of the staff undertakes the required fire drills in every 12-month period. The home had appropriate lift servicing and maintenance, and bi annual examination of the mobile and bath hoists. There was appropriate testing of water temperatures all were maintained in line with requirements. Bed rails check (when in use) The appropriate insurance certificate is in place alongside the homes registration certificate. Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 Page 21 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 X X 4 4 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 X 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X X X X 3 Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard 15 24 Regulation 16(2)(i) 16(2)(c) Requirement The home must provide meals which are acceptable in terms of texture and flavour. The home must ensure that they have adequate good quality bed linen in suitable quantities, available at all times. Timescale for action 30/01/06 30/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Maple Lodge DS0000005120.V272889.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Stafford Office 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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