CARE HOMES FOR OLDER PEOPLE
Maple Lodge Care Centre (Scotton Gardens) Scotton Richmond North Yorkshire DL9 4LZ Lead Inspector
John McGarva Unannounced Inspection 14th February 2006 10:00a 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 Care Centre DS0000066447.V283488.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 Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Maple Lodge Care Centre Address (Scotton Gardens) Scotton Richmond North Yorkshire DL9 4LZ 01748 834029 01748 831008 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) Four Seasons (DFK) Limited Mrs Susan Margaret Alderson Care Home 60 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10), Old age, not falling within any other category (50) Maple Lodge Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service Users to include up to 50 (OP), up to 10 (DE(E)) and up to 10 (MD(E)) up to a maximum of 60 Service Users 22/09/05 Date of last inspection Brief Description of the Service: Maple Lodge is a large care home providing nursing and Social care for up to 60 elderly people.. There is a separate 10-bedded unit providing nursing care for people suffering from dementia. The home was purpose built in 1991 and comprises three single storey wings with level access by wheelchair users throughout. It is located near the Garrison base of Catterick and has extensive grounds to the rear with car parking at the front. Maple Lodge Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report relates to an unannounced inspection, which took place on Tuesday 14th February 2006, and Mrs Sue Alderson the manager was available to assist throughout. The inspection commenced at 10.00hrs and finished at 15.30hrs. There were 47 residents in total, 37 of that are in receipt of nursing care and 10 requiring social care only. The inspection focused on issues raised at the last inspection and the general management of the home. An inspection of the medication room and lounges took place. Discussions took place with the Manager as well as nursing, care staff and residents. The care staff were open and readily answered questions about the home The atmosphere among the staff is very good and there appears to be good accord between them and the manager. One stated that they “provided a good service, staff were stable and sufficient management support was available for her work”. The providers are considering providing additional EMI residential beds in the future and this will require discussion with the staff as well as the CSCI in due course. What the service does well:
The home provides a good quality of care in a homely and professional manner. There is a strong commitment to training in addition to the NVQ programme for the care staff. The residents seen appeared well cared for and content. Maple Lodge Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 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 Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 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 Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 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): These standards were not inspected on this occasion. EVIDENCE: Maple Lodge Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 Page 9 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): 9. The medications are stored in appropriate conditions. EVIDENCE: The storage and administration of medications is managed in accordance with good practice and a 28-day blister pack system is in use and appears to be working well. The supply of the medicines has now been transferred from Richmond to Darlington. The first metre of both full height windows in the medication room has been boxed in and has helped reduce the temperature of the room. Roller blinds have also been provided. Security and privacy would be aided by the provision of an opaque film to the windows and the manager said this would be considered. Maple Lodge Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 Page 10 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): These standards were not inspected on this occasion. EVIDENCE: Maple Lodge Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 Page 11 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): These standards were not inspected on this occasion. EVIDENCE: Maple Lodge Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 Page 12 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): 19,21 and 24. Refurbishment, as well as improved hoisting equipment is required in one bathroom. Easily accessible hoisting equipment is required in all appropriate locations. EVIDENCE: Decoration of the corridor areas has taken place and has improved the general light in these areas. Decoration has also taken place in the EMI dining room. The lounge has been provided with a new window as well as new chairs and new windows are soon to be fitted in the main dining room. A new fire alarm system has been installed and all residents’ room doors are fitted with magnetic catches that ensures that whenever the alarms are actuated, the doors close automatically. Maple Lodge Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 Page 13 The bathroom in Laurel Wing is not satisfactory with poor lighting and a low set enamelled domestic type bath fixed against the wall. Due to the misplacement of the ‘D plate’ fixed bath hoist, the surface of the bath has been damaged and in consequence it now constitutes an infection risk. The domestic type ‘ wind up ‘ hoist is inadequate for the heavy residents and therefore represents a hazard for the staff that operates it. There are plans to relocate this bathroom later on this year. A shower room is to be refurbished. The hairdressing room is to be provided with a more satisfactory air extractor in the near future. In conversation with staff, it emerged that the EMI unit does not have a hoist of their own to transfer the residents onto the bath chair or bed. The manager said there was insufficient storage space for them to have one located in the unit. This is not entirely satisfactory as the lack of easily available equipment can result in staff attempting transfers without the aids required. Eighteen rooms now have benefit of lockable space for the residents to store their private things or medications and there will be a rolling programme of refurbishment, which will include this facility for all rooms. Maple Lodge Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 Page 14 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 and 30. The numbers of staff provided are sufficient to meet the present needs of the residents. The lack of the provision of specialist nurses inhibits the homes ability to fully meet the needs of the EMI category resident’s. EVIDENCE: The staffing levels in the home meet the staffing letter issued by the previous regulatory authority. The manager’s hours are wholly supernumerary enabling her to focus on the management and supporting the staff. Eleven of the care staff has NVQ Level 2 qualifications and six have achieved NVQ Level 3 standard. An additional three staff are soon to commence this training. As 68 of the care staff have NVQ qualifications, the CSCI 50 minimum standard in this regard has been exceeded. Staff confirmed that statutory training in Fire Safety, First Aid, Health & Safety, Infection control and Abuse issues takes place at the recommended intervals and feel well supported in their work in this respect. Only one Registered Mental Nurse (RMN) was employed and she has now left the home.
Maple Lodge Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 Page 15 Although some support is provided by the Community psychiatric nursing service (CPN) the residents need to have support on a continuous basis in order to justify the provision of this specialist service. A general nurse (RN) is shortly to commence RMN training but this will not be completed before sixteen months from start. Maple Lodge Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 Page 16 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 and 38. There are policies and procedures designed to protect the residents and staff. EVIDENCE: The manager is a first level nurse with many years of experience in caring for the elderly. She has commenced the NVQ Level 4 Management Award course and has completed four units, with two more to complete the course. The staffing numbers are fairly stable despite the regular turn-round of military families in the garrison town of Catterick. Staff meetings are held two monthly and the staff would appreciate meetings on a monthly basis. Regular meetings with the staff will be important in the future with the provider considering changing the provision of services on the site.
Maple Lodge Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 Page 17 A new bathing policy has been written which includes all the pertinent issues to help ensure safety of the staff and residents alike. There is also a system of obtaining the signatures of the staff to evidence that they have seen the policies in the home. Maple Lodge Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 Page 18 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 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 3 x 1 x x 1 x x STAFFING Standard No Score 27 1 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 x x x x x 3 Maple Lodge Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 Page 19 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 Standard OP24 Regulation 23(1)(m) Requirement Lockable space must be provided in each resident’s room for the safe storage of money, valuables or medications. The bathroom in Laurel Wing should be refurbished with the aim of providing a safer environment for the residents and staff. RMN qualified nurses must be provided for the EMI unit. Timescale for action 01/04/06 2 OP21 23(2)(j) 01/04/06 3 OP27 18 (1) 01/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP9 OP22 OP32 Good Practice Recommendations The provision of an opaque film on the medication room windows would help ensure privacy and security. A suitable hoist and storage facilities for it should be provided for the EMI unit. Monthly meetings should be convened with the staff. Maple Lodge Care Centre DS0000066447.V283488.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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