CARE HOMES FOR OLDER PEOPLE
Mapleton Residential Home Ashburton Road Newton Abbot Devon TQ12 1RB Lead Inspector
Judy Cooper Announced 16 June 2005
th 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 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. Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Mapleton Residential Home Address Ashburton Road, Newton Abbot, Devon, TQ12 1RB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01626 353261 01626 202713 info@devon.gov.uk Devon County Council Mrs Margaret Jean Breslan Care Home 26 Category(ies) of Dementia (26), Old age, not falling within any registration, with number other category (26), Physical disability over 65 of places years of age (26) Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20/10/04 Brief Description of the Service: Mapleton is a large detached building on a busy road (set back a little), less than a mile from Newton Abbot town centre. The home is on a bus route and there is a general store adjacent. The home has recently almost completed a major refurbishment programme, involving the ground floor of the home, which has resulted in the increased size of several of the ground floor bedrooms, and general upgrading of others on this floor. The entire ground floor is now being used to accommodate up to twelve long stay residents in single rooms (although none are en-suite, there are adequate communal W.C.’s within close proximity of each room). Two of the bathrooms on this floor have assisted bathing facilities, including an assisted shower area. There are also two disabled toilets and a further toilet and shower unit. There are two lounge areas, one with French doors out to the front garden and one of which is to benefit from the erection of a conservatory area, which will then lead in to the rear garden. There is also a dining area and a kitchen. The home’s office, laundry and sluice areas are sited on this floor and are also currently being upgraded. A small smoking area has been provided. Permanent service users, who are using this floor, have direct access to the home’s level garden, which again has been, and continues to be, upgraded. The first floor is to be upgraded to provide facilities for up to twelve service users receiving intermediate care and this facility is intended to operate independently. A shaft lift ensures there is level access throughout the home.
Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over one day. Several standard written feedback forms were received prior to the inspection from residents and their relatives. Opportunity was taken to tour the premises, examine records and policies and talk with the manager, residents and staff. The majority of the current residents were spoken with during the inspection. Staff on duty were also observed and spoken with, whilst in the course of undertaking their daily duties. What the service does well:
The home provides permanent residents with a very well maintained, homely, bright, relaxed, comfortable, environment. Residents benefit from a “community spirit” within the home and are encouraged and enabled to socialise with each other as desired. The management and staff enable residents to maintain good links with the nearby local community and visitors are encouraged and welcomed into the home. The result of which is that residents benefit from companionship with each other and continue to feel a valued part of the local community. The very stable staff group are well trained and work well together as a team, which ensures that residents’ needs are known and well met, whilst residents have a sense of continuity and security due to most staff remaining in post for long periods of time. Staff morale is particularly high and consequently the atmosphere in the home is a very positive one which residents benefit from. Additional staff training has allowed staff to have a fuller understanding of each others’ roles and responsibilities which aids general understanding, within the staff, as to why, and how, certain tasks are carried out. The overall effect is such that the home is transparent and open with good communications, both within the staff group and with those involving the residents. Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
Care plans should be in place for any short-stay respite client to ensure staff are fully aware of these residents’ needs. The management of the home should not offer the residents’ communal facilities within the home, as a venue for staff training events, involving other staff from other homes. (However it should be noted that this had only, so far, happened the once and was only done after consultation with the residents who were in agreement on this occasion). Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 Page 7 Short-stay residents must have a plan of care drawn up, which they have been involved with and agreed to, identifying how their needs are to be met whilst staying at the home. 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. Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 Page 9 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 standard(s) 3 (6is currently not applicable) The admission process continues to be well managed and residents are given clear information regarding the service. EVIDENCE: Since the last inspection the home has not admitted any new permanent residents, due to the upgrading works in progress, however the manager continues to offer some short stay facilities, to those clients that would benefit from such a stay. The majority of these clients are known to the home and have regular stays. By observing a current short stay resident’s records, it was noted that a satisfactory admission procedure was undertaken, which had involved the resident’s care manager. This had ensured that Mapleton was the appropriate home for the resident’s respite stay. The resident was spoken with and confirmed that they knew where they were coming to, as they had been before, and that they were always made very welcome and felt safe and well looked after at the home. Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 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 standard(s) 7,8,9,10 Although residents are looked after well in respect of their health and personal care needs on a daily basis, short stay residents are at risk of not having their needs fully met as care plans are not in operation for these clients and therefore staff may be unaware of their identified needs. Residents’ rights to privacy could be compromised if the residents’ communal lounge/dining room continues to be used to provide a venue for Devon County external staff training events. EVIDENCE: Care plans, for permanent residents, contained all relevant details appertaining to providing for individual residents’ care. The care plans had been regularly reviewed with the resident. The plans contain details of any routine health care needs, and verbal feedback from residents confirmed that they felt they were very well looked after with professional advice sought from other professionals as required e.g. District Nurses, continence advisor etc (who was visiting on the same day the inspection took place). The home’s accident recording was seen to be in order. The home’s policies and procedures, regarding the administration of medication, were in order and the medication cupboard and medication records
Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 Page 11 were inspected and found to be satisfactory. Designated staff only administer medication and all staff have received appropriate, accredited training. It was noted that, the administration of medication, was undertaken appropriately by a member of the management staff, whilst the inspection was in progress. During the inspection it was also noted that staff treated residents with a great deal of respect and with due regard for their individual needs. An example of this was seen when a staff member was seen speaking and attending to the needs of a resident who had some degree of confusion. The resident was treated with kindness and understanding and consequently was able to participate in a general conversation with other residents. It was also noted that all care was being made to two residents who were poorly. This ensured that the residents were cared for sensitively and they received appropriate attention. Feedback from one relatives card stated “-----has been at Mapleton for along time. The care is very good and the staff are very kind. The room is lovely and ---- is looked after very well.” Another stated that the care and attention given was “excellent” It was concluded, following discussion with the manager, that the residents’ communal lounge would no longer be made available for any outside staff training event, as residents’ rights to privacy could be compromised as a result. Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 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 standard(s) 12,13,14,15. Residents enjoy a peaceful, pleasant yet varied life at the home, with visitors very much encouraged and links encouraged and maintained with the local community. Various informal activities such as gentle exercise, etc are made available whilst residents also benefit from nutritious, well planned and varied meals. EVIDENCE: Staff undertake activities with residents and there are other planned activities provided by outside entertainers. There was an activities folder within the home’s entrance, which had records of all activities that were/had been available. Many residents and their families used the words “happy and satisfied” to describe the overall standard of their daily life. There were several “thank you” letters displayed, all very complimentary about the care provided. The home operates an open visiting policy and, during the day of inspection, visitors came and went, whilst the visitor’s book clearly showed that the residents had many visitors at varying times throughout the day.
Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 Page 13 The routines within the home are flexible to ensure that residents can choose how they spend their time. Some had chosen to spend their time in the communal lounges, enjoying each others company, whilst others had chosen to spend their time in their rooms. Residents’ individuality and respect were noted as being maintained by the staff, and residents verbally confirmed this. Residents stated that they were happy with the meals provided and that there was always choice made available. On the day of inspection the meal was chicken casserole, fresh vegetables, followed by apple crumble. To end the meal, small pieces of fresh fruit were served to each resident to help encourage residents to eat fresh fruit. It was pleasing to note both the preparation and presentation involved with this, and to see residents really enjoy the fruit as they were able to both manage and eat it with ease. The cook was also noted as being very aware of residents’ individual likes and dislikes. A feedback card contained the following “I am always impressed by the variety of food that is presented and admire the thought that goes into the menus”. Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 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 standard(s) 16,18 Arrangements for protecting residents and responding to their concerns are satisfactory. EVIDENCE: Residents’, relatives’ and staff comments confirmed that people feel comfortable discussing any concerns they may have with the manager. The home’s complaint policy remains in order with all residents having received a copy of the complaints procedure, and this is also displayed in a communal area of the home. There have not been any complaints, within the past twelve months, either internally or made directly to the CSCI. The home continues to maintain appropriate, updated adult protection policies and staff receive mandatory training in this area Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 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 standard(s) 19,26 Mapleton provides very comfortable, clean and well maintained accommodation in respect of the areas being used by the residents. Some areas of the home are still in the process of being upgraded and as such this accommodation is not available to the current residents and has not yet fully met the required environmental standards. EVIDENCE: Inspection of the home, showed the home continues to be in the process of undertaking upgrading works to ensure that it will be to be suited for its intended purpose of providing twelve permanent beds and twelve intermediate care beds. The ground floor (named The Maple Unit) is now almost completed and provides permanent accommodation of a good quality. It continues to be to the manager’s and staffs’ credit that these works have been/are being well managed ensuring residents’ health and safety continues to be maintained with as least disruption as possible, for the six permanent residents (as well as any short stay residents), that are currently living in the home. The areas being
Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 Page 16 used by the residents were seen to be clean, safe and very comfortable. Some bedrooms have been enlarged and all on the ground floor have been completely refurbished. All rooms were seen to have been personalised as desired and residents had several personal items in their rooms. Residents had been involved in choosing colour schemes etc and all were very complimentary about their rooms, and proud to show them off! Residents’ bedrooms are provided with a suitable lock to ensure privacy is maintained. Health and safety assessments have been undertaken and continue to be updated to reflect any changes, caused by the building works. A feed back card contained the following “ Mapleton is immaculately clean and bright and the refurbishment is nice”. Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Staff at the home are well trained. They presented well in both appearance and manner. Staff are employed in sufficient numbers to meet the current resident groups’ needs. The staff recruitment programme continues to ensure that suitable staff are employed to work with the residents, thereby ensuring residents are fully protected. EVIDENCE: Staffing levels were noted as being fully able to allow staff to meet residents’ needs both during the day the day and at night. Residents said that they felt well looked after and that staff were always available if needed. Some very positive verbal feedback was received from the residents and their relatives as to the standard of care received, and the manner the care was delivered. The staff group remains very stable with minimal staff changes. Some internal promotion has taken place, to fill the vacancies arising from the newly created internal post of night care officer and full recruitment procedures were in place. This has ensured that residents’ continue to well protected, being cared for by suitably selected staff. Residents verbally confirmed that they felt confident with, and well looked after by, the staff. Training continues to be very well planned and supports the staff in providing for the varied needs of the residents, with NVQ training and other external, as well as internal, training provided. During the inspection staff members
Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 Page 18 confirmed that they had been given sufficient training and support to allow them to undertake their duties with confidence. Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35,38 The home is managed efficiently and well with the manager seeking residents’ as well as their relatives, staff and other professionals views as to the running of the home. The home is providing a safe environment for the residents, by ensuring the required health and safety standards are met and maintained. EVIDENCE: Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 Page 20 The manager has been in post for approximately eighteen months. She has many years experience of working with this resident group and has successfully completed her Registered Manager’s Award incorporating NVQ level 4 in care and management. The staff and residents spoke highly of the managers’ ability to manage the home and all said that they felt they could easily approach her. Comments such as “wonderful” and “very approachable” were said about the manager. The home undertakes a programme of thorough internal quality monitoring with residents’, their relatives, other professionals and staff feedback invited as part of the overall process. One comment received by an outside professional was noted as saying “ Staff are always very helpful, clients are seen in private, family if attending are welcome and clearly have good relationships with Mapleton staff. In all cases the comments of resident and families have been favourable regarding the home”. A representative from the Devon County Council undertakes a monthly, in depth, quality audit visit where several aspects of the running of the home are examined and reported on, including consultations with the residents. This ensures that all practices within the home are regularly reviewed and that the care continues to be of a good standard and as residents would expect/want. The management will look after monies for residents if desired. In depth records of these transactions ensure that residents who use this service have their finances protected. Routine health and safety issues are well managed within the home with the required records being made available and all being seen to be up to date, which confirms that residents are cared for in a safe and secure environment. Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 4
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 x x 3 Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 Page 22 NO 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 OP7 Regulation 15 Requirement All residents must have plan of care, which, where possible, has been undertaken with the resident and agreed by the resident. Timescale for action 16/07/05 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. Refer to Standard OP10 Good Practice Recommendations The management of the home should not offer the residents’ communal facilities within the home, as a venue for staff training events, involving other staff from other homes. Mapleton Residential Home D54-D07 S32567 Mapleton V222114 160605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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