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Inspection on 22/02/06 for Maple Lodge Nursing Home

Also see our care home review for Maple Lodge Nursing Home for more information

This inspection was carried out on 22nd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users spoke very highly about the opportunities available to them for regular bus trips to local places of interest. Staff have nice attitude and conduct themselves in a professional manner. Staff interaction with service users was friendly but professional and service users commented positively on the staff approach to them. The home had taken appropriate steps to ensure that temporary workmen who are involved in the re-decoration of the home have had CRB checks done, thus further promoting the welfare of the service users. A programme of re-decoration work is ongoing and the service users were pleased with the work that is going on in the home. A number of bedrooms have been re-decorated and new carpets provided. It is intended to extend this to all the other bedrooms in the home. All staff receive regular one-to-one supervision on two monthly basis. Staff who were interviewed confirmed this arrangements and commented that this further enhanced their professional development for the benefit of the service users.The nursing staff indicated that recently there had been good training programme for the staff in all areas relating to nursing and personal care. The home carries out six monthly review for each service user and a letter goes to the families, inviting them to be part of the review. This allows the service user and the family to have an input into the future care needs of the service user concerned.

What has improved since the last inspection?

Since the last inspection, suitable arrangements have been made to ensure that the cutleries are properly cleaned. The current arrangements have improved the standard of cleanliness regarding the cutleries. The home continues to find ways of dealing effectively with odour control. However, this remains an unresolved problem and other ways should be explored in dealing with odour control. All service users have now been issued with terms and conditions of residence. This sets out the rights and obligations of both the company and the service users.

What the care home could do better:

The service users` plastic teacups were not in good hygienic condition. Some of these were heavily stained with tea and looks very unsightly. These should be replaced with more modern and attractive cups to enhance the dignity of the service users. Personal details about the service users and in some cases families, are kept in the reception area and should be removed to a more appropriate location. The practice is not in line with the company`s policy on data protection.

CARE HOMES FOR OLDER PEOPLE Maple Lodge Nursing Home Woolwich Road Witherwack Sunderland SR5 5SF Lead Inspector Sam Doku Unannounced Inspection 22nd February 2006 10:40 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 Nursing Home DS0000018201.V285720.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 Nursing Home DS0000018201.V285720.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Maple Lodge Nursing Home Address Woolwich Road Witherwack Sunderland SR5 5SF 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) 0191 549 3672 0191 549 3687 www.fshc.co.uk Tamaris (South East) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mr Anthony Duggan Care Home 54 Category(ies) of Dementia (30), Dementia - over 65 years of age registration, with number (30), Mental disorder, excluding learning of places disability or dementia (15), Mental Disorder, excluding learning disability or dementia - over 65 years of age (15), Old age, not falling within any other category (24) Maple Lodge Nursing Home DS0000018201.V285720.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users within the category of MD/MD(E) may only be accommodated on the first floor 7th September 2005 Date of last inspection Brief Description of the Service: Maple Lodge is a two storey care home which was purpose built in 1995 and offers accommodation to a maximum of 54 older people. The home provides both personal and nursing care to those living there, some of whom may have dementia, mental health needs or general nursing care needs. The service users who require general nursing are accommodated on the ground floor and those with dementia and mental health needs are accommodated on the first floor. The property is located in a residential area of Witherwack and is within walking distance of a small range of local amenities, including shops, a post office, and a pub and bus station to the city centre of Sunderland. Local churches are accessible by car or public transport. A mini-bus is available to the home for use by service users but this must be pre-booked. Accommodation is provided on two floors, each with self-contained facilities including lounges, dining areas, WCs and bathrooms. All bedrooms are single rooms, of good size and are provided with en-suite WC facilities. Entry to the home is accessible with lift access to the first floor. Externally, generous car parking space is provided to the front of the building, and extensive grounds surround the home. This area is enclosed with fencing for security but would benefit from landscaping. Maple Lodge Nursing Home DS0000018201.V285720.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 on 14 February 2006. This inspection, although an unannounced inspection the manager was advice of this three days before because the inspector wanted to be sure that the manager would be present at this inspection. The last inspection was also an unannounced inspection but in that case the manager was not given prior warning. The inspection process involved observations of staff practices and procedures, examination of documents and records and discussions with staff and management also contributed to the inspection findings. The general atmosphere within the Home was friendly, relaxed and comfortable throughout the time of the inspection. A number of service users and a visiting relative were spoken with. All were very complimentary about the Home and the staff. Service users appeared cared for and comfortable with the staff. Staff were professional in their manner and care practices. What the service does well: Service users spoke very highly about the opportunities available to them for regular bus trips to local places of interest. Staff have nice attitude and conduct themselves in a professional manner. Staff interaction with service users was friendly but professional and service users commented positively on the staff approach to them. The home had taken appropriate steps to ensure that temporary workmen who are involved in the re-decoration of the home have had CRB checks done, thus further promoting the welfare of the service users. A programme of re-decoration work is ongoing and the service users were pleased with the work that is going on in the home. A number of bedrooms have been re-decorated and new carpets provided. It is intended to extend this to all the other bedrooms in the home. All staff receive regular one-to-one supervision on two monthly basis. Staff who were interviewed confirmed this arrangements and commented that this further enhanced their professional development for the benefit of the service users. Maple Lodge Nursing Home DS0000018201.V285720.R01.S.doc Version 5.1 Page 6 The nursing staff indicated that recently there had been good training programme for the staff in all areas relating to nursing and personal care. The home carries out six monthly review for each service user and a letter goes to the families, inviting them to be part of the review. This allows the service user and the family to have an input into the future care needs of the service user concerned. 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 Nursing Home DS0000018201.V285720.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 Nursing Home DS0000018201.V285720.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): 2, 3, 4. The company has introduced new contracts with all service users setting out the responsibilities and obligations on both sides. The service user guide is available to all service users and the document provides details about contracts and also about the home’s policy on preadmission visits to the home, including the arrangements for pre-admission visits. EVIDENCE: The manager confirmed that the company had recently produced new terms of conditions of service and these have been issued to all the service users. He emphasised that it is the company’s policy to regard the first six weeks of residency as a trial period. This is stated in the statement of terms and conditions and in the Service User Guide. In discussion with one visiting relative, she confirmed that she is aware of the contract between the company and the service users. This ensured that both parties know what their roles and responsibilities are. Maple Lodge Nursing Home DS0000018201.V285720.R01.S.doc Version 5.1 Page 9 The manager confirmed that it is the policy of the company for all prospective service users to have their needs assessed before they are admitted to the home. Health and social work assessments have been provided to the home in line with the company’s policy of receiving social work assessment before the service commences. The files that were examined provided evidence of such policy being adhered to by the home. All the files belonging to the service users who are funded by the local authority contained copies of the social work assessments. The home had also carried out their own assessment, which together with the social work assessment form the basis of the care plans. The manager confirmed that where necessary the families are involved in the assessment process thus ensuring that they are aware of the methods being used to determine whether the individuals care needs can be met in the home. One relative who was spoken with confirmed that the family was confident about the home’s ability to care for her mother long before she was admitted into the home. She also stated that she and her mother visited the home before deciding on whether or not to choose the home as their preferred choice. Maple Lodge Nursing Home DS0000018201.V285720.R01.S.doc Version 5.1 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, 11. The individual care plans set out the health, social and personal care needs of each service user and plans are formulated to meet those care needs. This has ensured that the care needs of the individuals are met. The home has clear medication policies that are followed by the staff who are responsible for the day to day administration of medicines in the home. EVIDENCE: In establishing the arrangements for meeting the healthcare needs of the service users, a number of care plans were examined and were found to provide details of service user’s nursing and personal care needs and details of how those needs were to be met. The staff had carried out risk assessments for those service users for whom it is thought necessary. These included prevention of fall, moving and handling, nutrition, pressure area care and skin condition. The care plans also provided details of visits by GPs, consultants, chiropody treatment, opticians, dentists and other healthcare professionals. In Maple Lodge Nursing Home DS0000018201.V285720.R01.S.doc Version 5.1 Page 11 discussions with staff and one relative, they all confirmed that the service users’ healthcare needs are met within the home and feel that the staff take active role in promoting this. Two service users who were spoke with at length confirmed that their healthcare needs are adequately met in the home and that the arrangements for their care are good. There was also evidence in the service user’s files relating to their mental health care needs. Visits by the consultant psychiatrist were recorded in individual files. This promoted the psychological wellbeing of the service users. Recording on the Medicine Administration Record charts were seen and found to be satisfactory. Drugs were safely and securely stored. There are training and written policies on safe handling of medication are in place. This ensured that the service users’ healthcare needs regarding the management of their medication is safeguarded. Two care staff were specifically spoken with about the death and dying and their understanding of the care to be provided at a time death is expected. They described the general policy on caring for the dying. Staff described the care routines and the general support given to the family and the wishes of the service user at such times. They spoke about the wishes of the family and how the nursing staff provide the necessary support to the family at such times. This provides reassurance to families that their loved one would be properly care for when a service user is approaching death. The deputy manager confirmed that the Palliative nurse from the local healthcare TRUST is providing training to the care staff on the care of the dying. Maple Lodge Nursing Home DS0000018201.V285720.R01.S.doc Version 5.1 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): 15. The dietary needs of the service users are met, thus promoting their health and wellbeing. EVIDENCE: Service users complimented the catering staff and quality of the meals provided in the home. Nutritional assessments have been carried out for those service users who require their diet intake to be monitored to ensure they receive adequate diet. The manner in which assistance was offered in one case was unsatisfactory and should be reviewed. The staff member who was assisting the service was also engaged in other activities at the same time. This meant that the service user did not receive the carer’s full attention. Consequently, the service user was having to wait long periods of time to be assist with his meals. The four weeks rotating menus provided evidence of varied and nutritious meals, including alternatives for the service to choose from. Maple Lodge Nursing Home DS0000018201.V285720.R01.S.doc Version 5.1 Page 13 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: The standards relating to this part of the section had not been assessed on this occasion. These standards were examined at the last announced inspection of the 7 September 2005. All the standards were met and at this inspection it was observed that the standards have been maintained and remain satisfactory. Readers wishing to read about these standards should refer to the last inspection report of 7 September 2005. Maple Lodge Nursing Home DS0000018201.V285720.R01.S.doc Version 5.1 Page 14 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): 20, 22, 25, 26. The service users life in safe, clean well maintained environment that meets their individual needs and promotes their safety and well-being. However, the lack of adequate shower facility on the ground compromise the safety and welfare of the service users who needed to use the facility. EVIDENCE: All rooms are single rooms and service users are able to entertain visitors in their rooms. There are a number of communal areas throughout the home for service users to use. The dining rooms are spacious and appropriately furnished with suitable seating arrangements. Lighting in general is good but the lighting on the entrance hall is poor and must be addressed. The access into and within the home is considered good. The corridors are of sufficient width to allow people with wheelchairs or walking aids to access all parts of the home without much problem. There are also grab rails along the corridors to assist with mobility. This ensured that those service users with mobility problems are able to access all parts of the home. Maple Lodge Nursing Home DS0000018201.V285720.R01.S.doc Version 5.1 Page 15 Heating and lighting in individual bedrooms was adequate at the time of the inspection. Individual rooms have good ventilation and natural lighting. These ensured comfortable surroundings for the service users. At the time of the inspection the home was noted to be clean and generally free from offensive odour. However, a number of rooms still continue to require extra cleaning or odour control mechanisms to deal with the bad dour in those rooms. As commented on in the last inspection report, the home is surrounded by a large grassed area, which needs landscaping to create accessible garden space for service users to enjoy. Instead the home is surrounded by overgrown grass. This aspect of the home remains disappointing as it is the first impression given on arrival. The manager confirmed that plans are underway to address this by the company. The home has written policies and procedures relating to safe handling of hazardous materials for staff to follow. The manager indicated that staff have had training in health and safety, infection control and food hygiene. The laundry machines have facilities for sluicing and washing foul linen at very high temperature to avoid the spread of infection. The above safety measures, practices and policies ensured that service users live in safe and comfortable environment thus promoting the welfare of the service users. Maple Lodge Nursing Home DS0000018201.V285720.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): These standards were not inspected on this occasion. EVIDENCE: The standards relating to this part of the section had not been assessed on this occasion. These standards were examined at the last announced inspection of the 7 September 2005. All the standards were met and at this inspection it was observed that the standards have been maintained and remain satisfactory. Readers wishing to read about these standards should refer to the last inspection report of 7 September 2005. Maple Lodge Nursing Home DS0000018201.V285720.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): 34, 37, 38. The administrative system employed in the home ensured proper accounting and financial procedures in the home. Suitable arrangements for the health and safety, and welfare of service users and staff are in place and are appropriately maintained. EVIDENCE: There are good administrative systems in the home for managing the financial affairs of the service users. The records relating to personal allowance were in order and appropriately accounted for. A computer-based records are kept and receipts are available for all transactions that have been made on behalf of service users. This ensured that service users are protected from any form of financial abuse. Relatives have been consulted on the methods of holding monies for the service users using a single bank account for that purpose. Relatives have the option of managing such monies for their relatives or agree Maple Lodge Nursing Home DS0000018201.V285720.R01.S.doc Version 5.1 Page 18 for the home to manage this using a single bank account in the name of the home. The manager confirmed that most relatives have agreed for service users monies to be placed in a ‘pooled’ account. The company’s Health and Safety policies remain in place and these were made available for inspection. These cover policy areas such as fire prevention and Care of Substances Hazardous to Health (COSHH). The training provided for the staff ensures that the staff maintain safe working practices which safeguard the safety and wellbeing of the service users. Servicing records were examined and it was noted that all portable appliances have been tested. A record is maintained of regular water temperature tests in the home. There is evidence of regular servicing of fire equipment, gas and electrical appliances being carried out by the contracted companies. All the servicing records that were examined were up to date. These included servicing of hoists, water treatment, electrical installation and gas servicing. Up to date servicing and maintenance of these services and equipments ensure a safe environment for the service users and the staff who work there. Maple Lodge Nursing Home DS0000018201.V285720.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 X 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X 3 X 3 X X 2 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 3 X X 3 3 Maple Lodge Nursing Home DS0000018201.V285720.R01.S.doc Version 5.1 Page 20 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 OP21 Regulation 23(2)(n) Requirement The shower facility on the ground floor is inadequate for the needs of the service users and therefore suitable arrangements must be made within reasonable timescale to address this. The lighting in the reception area must improved to ensure that the areas is adequately lit. Suitable arrangements must be made to ensure an effective odour control in some of bedrooms. Timescale for action 30/06/06 2. 3. OP25 OP26 23(2)(p) 16(2)(j) 30/06/06 30/06/06 Maple Lodge Nursing Home DS0000018201.V285720.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP15 OP25 Good Practice Recommendations The practices relating to assistance with meals should be reviewed to ensure that when service users are being assisted this is done in a sensitive manner. The provider should make suitable arrangements to provide a pleasant external surrounding round home. This should include a landscaped garden for use by the service users. Maple Lodge Nursing Home DS0000018201.V285720.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Maple Lodge Nursing Home DS0000018201.V285720.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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