Inspection on 05/02/07 for Maple Tree Lodge

This inspection was carried out on 5th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Maple Tree Lodge 13/04/09

Maple Tree Lodge 14/04/08

Maple Tree Lodge 23/01/08

Maple Tree Lodge 08/11/05

Maple Tree Lodge 07/07/05

Maple Tree Lodge 22/02/05

Maple Tree Lodge 24/08/04

Maple Tree Lodge 28/02/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Maple Tree Lodge 87 Byron Street Loughborough Leicestershire LE11 5JN Lead Inspector Mick Walklin Key Unannounced Inspection 5th February 2007 11:00 Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 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 Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 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 Adults 18-65. 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 Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maple Tree Lodge Address 87 Byron Street Loughborough Leicestershire LE11 5JN 01509 269637 01509 269637 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) Aspire Lifestyle Limited Vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No additional conditions of registration. Date of last inspection 8th November 2005 Brief Description of the Service: Linden Cottage is a small home that is registered to provide care for three residents with learning disabilities. Two residents lived at the home at the time of this inspection. The home is a bungalow, located on a quiet residential road in Loughborough. All residents have their own bedrooms and there is a lounge/dining room, bathroom and kitchen. The home has a pleasant garden to the rear. All residents are supported to access a range of day care and leisure activities. The range of fees at present is £970 - £1202 per week. Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was undertaken using a review of all the information available to the inspector regarding the service history of Maple Tree Lodge, and through undertaking a visit to the home. The fieldwork visit took place over 6 hours. The acting manager was present during the fieldwork visit. The main method of inspection used was called case tracking which involved tracking the support that the two residents living at the home receive through the checking of their records, discussion with them, the care staff and observation of care practices. A tour of the building was undertaken. Documents connected with the running of the care home were also inspected. What the service does well: What has improved since the last inspection? What they could do better: Residents should be given information about what services they can expect, and what extras they have to pay for. Staff should be given training about what to do if they think that residents have suffered abuse. Some work needs to be done in the house to make it safer, and the company must tell the commission what they are going to do about the office and laundry equipment in the spare bedroom. Residents, their relatives, social workers and health workers should be asked about what they think of the home, and whether they have any ideas for improvements. Residents should be given information about Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 6 what to do if they have a complaint. There should be a yearly training plan for staff. The manager would benefit from more supernumerary time to enable her to carry out her role properly. 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. The summary of this inspection report can be made available in other formats on request. Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 & 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Pre-admission procedures are satisfactory, to ensure that residents needs can be met. Residents do not have accessible information about their terms and conditions of occupancy, so they are not fully informed about what they can expect. EVIDENCE: The previous inspection identified that none of the residents files contained a guide to the home that was accessible to people with a learning disability. A service user guide is now produced, which provides basic information for residents in easy read format. There have been no recent admissions to the home, so this standard could not be fully inspected. The acting manager talked about how she deals with any new referrals to the home. She would ask for information, such as needs assessments, from the placing social worker. She could then judge whether the home could meet the persons needs, and whether they are likely to mix well with the existing residents. The person would be invited to visit on a number of occasions, together with their family. New admissions are for a three-month trial period. Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 9 Residents have core contracts from their placing authorities, and terms and conditions contained in their files. However, these are not available in a format or language appropriate to residents needs. Not all of the core terms in the contract were being met. For example, one of the core contracts places a responsibility on the provider to “ensure the provision of essential services, such as soap and shampoo”. However, residents have to buy their own toiletries. Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans provide staff with good information about residents support needs. Staff communicate well with residents to ascertain their choices. Residents are encouraged to develop independent living skills, within a safe environment. EVIDENCE: Care plans contain a good range of information about residents needs. There are good assessments giving information about the level of support that residents require for day-to-day activities. Both files have a person centred plan for the resident, which has a ‘life map’, details of family and social contacts, and good information about likes and dislikes. There is also a section called ‘Things I like and need from the people who support me’. Care plans are reviewed every month, and there are good daily records from each shift. Both residents have a severe learning disability and communication difficulties, and require a high level of support. Staff explained the communication Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 11 methods that they use to help residents make choices and decisions. One said, “We have to know the residents well to recognise how they communicate. One resident uses basic finger spelling, and the other uses pictures and symbols to communicate”. Another member of staff said, “I like working in a small unit – we get to know the residents well. We can communicate better, and recognise when they are becoming distressed”. Staff were seen to use a variety of methods to communicate with residents, including signing, use of symbols, and objects of reference (for example, showing a resident three objects, and asking them to chose one). There are a good range of risk assessments, for activities, manual handling, behaviours and household risks. Staff said that they try to encourage residents to be as independent as possible, but recognise that risks must be minimised. The kitchen is kept locked when not in use, and staff explained that this is for safety reasons. Residents can access the kitchen when they need to, as long as they are accompanied by staff. Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are a good range of activities to stimulate residents, and ensure that they are part of their local community. Contact with family and friends is recorded, and catering arrangements reflect individual choices. EVIDENCE: Residents have busy activity timetables, with are a mixture of home based and community activities. Both residents attend college one day per week, where they join in sessions such as art, drama and music. On the day of the inspection, one resident had gone out shopping, and enjoyed a meal out. The other resident had baked some cakes. Both took part in arts and crafts, and games in the afternoon, which they appeared to enjoy. Staff use their own vehicles for outings, and they also have the use of a people carrier and minibus on occasions. One member of staff said, “It would be brilliant if we had our own transport”. They make use of a number of local facilities, and will Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 13 shortly start using a multi-sensory room at a local hospital. Both residents went on holiday to Butlins in the summer. One resident has contact with his family. The person centred plans contain details of other friends and family contacts. Care plans also contain a ‘Residents Charter of Rights’, but this is not in easy read format. One resident has restrictions set on the amount of personal belongings that he can bring into the living room. This is because of previous problems that this had caused. Staff were able to justify the reasons for this, and the resident appeared happy with the restrictions. Catering arrangements are of a domestic arrangement. Care staff are responsible for cooking, and residents participate in some aspects of meal preparation. Menus are on a four-week rolling rota, but are flexible to accommodate individual choices and planned activities. However, staff said that they struggle to stay within the £60 monthly budget. One resident has special dietary considerations, and staff are fully aware of his needs. Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive a good level of support, and there are good arrangements with local health providers, which ensure that residents health care needs are met. Medication procedures ensure that medication is administered safely. EVIDENCE: Staffing levels allow 1-1 support to be provided, and enables residents to have individualised activity plans. Staff demonstrated a good knowledge of the support needs of residents, and were observed to frequently consult residents about their preferences. Staff said that both residents choose what time they go to bed, and get up. Both residents are seen by a consultant psychiatrist. This is usually every six months, or as required. They also receive regular health checks at the local surgery. Staff explained that they are introducing ‘Health Action Plans’, to identify health needs and promote a healthy lifestyle, and are receiving training shortly. There are arrangements in place for dental and opticians services, and a chiropodist visits every month. One resident is seen by a Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 15 dietician, and has had recent involvement with an occupational therapist, to assess his mobility and eating. The other resident is awaiting an assessment by a speech and language therapist. Medication is stored in a locked filing cabinet in the spare bedroom. A perpacked administration system is used. A pharmacist provides training for all staff. Administration records are fully completed, but there was some confusion with the pre-printed administration records sent from the pharmacy. The dates did not correspond with the days of the week, and this was amended by one of the staff. Staff are clear on the policy for homely remedies, which are only given with the agreement of the doctor. Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are not enabled to make complaints as they are not provided with the complaints procedure in an accessible format. Residents are placed at risk of harm due to the lack of staff training. EVIDENCE: There has been one complaint since the last inspection. This was from a neighbour, and related to the garden, and has now been resolved. There is a complaints procedure in the statement of purpose, but this is not available to residents in easy read and pictures format. The previous inspection found that staff had not received adult protection training. Although staff were aware that they had to report suspicions or allegations, they said that they have still not received formal training. The home has a copy of the Multi-Agency Vulnerable Adult Protection document ‘No Secrets’. Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with a comfortable environment, although they do not have access to all areas at all times, which may affect their wellbeing. There are some outstanding maintenance issues, which require attention. EVIDENCE: The previous inspection highlighted some maintenance issues, some of which are still outstanding. The previous inspection also identified that the bathroom requires redecorating, and a risk assessment should be carried out with regard to the stone steps from the patio to the garden. The acting manager has obtained quotes for a walk-in bath, and a ramp into the garden, but has not received approval for this. One of the bedrooms requires some redecoration, but the other is extensively personalised with pictures and personal possessions. Although the home is registered for three residents, the spare bedroom is used as an office, and Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 18 there is also a tumble drier in this room. The night staff sleep on a sofa bed in the lounge, so residents cannot get into to the lounge when the member of staff is asleep. There are no other places for the filing cabinets and tumble drier. Therefore, the company who run the home must tell the commission what they are going to do about this, before the room is used as a bedroom again. The acting manager said that the home is changing to waking night staff. However, if in the future, they go back to night staff sleeping-in, a separate room for staff must be provided. Staff undertake cleaning duties, with the assistance of the residents. The home was clean on the day of the inspection. Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels enable residents to receive good levels of support. Recruitment and selection of staff protects residents. Care of residents would be improved through co-ordinated staff training. EVIDENCE: There are two staff on duty during the day, working with the two residents. This allows good levels of individual support to be provided. Staff said, “Because the staff team is small, we struggle if any staff are off sick”. There are two key workers for each resident. One member of staff said, “Staffing is fine – it allows us to provide 1-1 support”. The files of two recently employed staff were inspected, and both contained evidence of a thorough selection process, and contained the documents necessary for the protection of residents. Staff described the training available as “OK”. One of the new staff said that her induction had been helpful, and that she had shadowed experienced staff Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 20 for a week. She said, “The induction was absolutely useful – I felt comfortable and confident with the information”. She had completed an induction checklist on her first day, which covered basic information, such as procedures in case of an emergency. The home does not use the Learning Disabilities Awards Framework (LDAF - a training programme for staff working with people with a learning disability, which the Government recommends all staff complete). However, all staff have completed a National Vocational Qualification (NVQ). There is no annual training plan, but staff make use of distance learning packs from a college. Staff complained that they have to attend training in their own time, and do not get paid for it. The National Minimum Standard is that staff receive at least five paid training and development days per year. Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are benefiting from a well managed and organised service. However lack of robust quality assurance systems, including health and safety checks, places residents at risk. EVIDENCE: The acting manager has worked at the home for four years. She has completed NVQ level 4, and is undertaking additional units to complete the registered managers award. However, no application has been received by the commission to register her as manager. The acting manager is only allocated 5 hours management time per week, and this is inadequate. Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 22 Staff said that they are well supported by the acting manager, and regular staff meetings are held. They said that the home is well organised, and that they work well together as a team. There are no annual quality monitoring systems in place, or evidence of regular quality audits. The care manager visits the home on a regular basis, but there was no report from these visits since October last year. Health and safety documentation was generally well organised. However, two issues of concern were identified. • • There is no evidence that the fixed electrical wiring has been checked periodically. A report from a servicing visit in November 2004 expressed concerns about the lack of emergency lighting. The fire alarm system consists of two wired smoke detectors, and the local fire safety officer should be contacted for advice as to whether fire precautions are adequate. Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 1 X X 1 X Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5 Requirement The registered person is required to provide each resident with a written contract, in a format or language appropriate to each service users needs. This is outstanding from previous inspections. The registered person must ensure that staff receive sufficient training and subsequent update training in the protection of vulnerable adults. This was a recommendation from the previous inspection, and is now a requirement. The registered person must ensure that the maintenance issues identified are dealt with. This was a recommendation from the previous inspection, and is now a requirement. The registered person is required to provide a satisfactory action plan in relation to the reprovision of laundry and office facilities, prior to the spare DS0000001759.V324129.R01.S.doc Timescale for action 30/04/07 2. YA23 13(6) 30/04/07 3. YA24 23 30/06/07 4. YA24 23 31/03/07 Maple Tree Lodge Version 5.2 Page 25 bedroom being used to accommodate another service user. 5. YA39 24 The registered person must establish a system for reviewing and improving the quality of care provided by the home. The registered person must attend to the health and safety issues identified. 30/06/07 6. YA42 13 31/03/07 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 YA22 Good Practice Recommendations The complaints procedure should be available in accessible format for service users. The home should use the Learning Disabilities Awards Framework (LDAF) as the induction foundation training for new staff. Staff should have an annual training plan, and receive five paid training and development days (pro rata) per year). The acting manager should be allocated more supernumerary time to carry out her role effectively. The acting manager should apply for registration with the Commission for Social Care Inspection. YA35 3. 4. 5. YA35 YA37 YA37 Maple Tree Lodge DS0000001759.V324129.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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