Inspection on 10/03/06 for Mapleton Road

This inspection was carried out on 10th March 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Mapleton Road 26/01/09

Mapleton Road 31/01/08

Mapleton Road 28/03/07

Mapleton Road 23/06/06

Mapleton Road 06/12/05

Mapleton Road 31/01/05

Mapleton Road 03/08/04

Mapleton Road 13/03/04

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

CARE HOMES FOR OLDER PEOPLE Mapleton Road 87 Mapleton Road Chingford London E4 6XJ Lead Inspector Zita McCarry Unannounced Inspection 09:40 10 March 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Mapleton Road DS0000058682.V284331.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. Mapleton Road DS0000058682.V284331.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Mapleton Road Address 87 Mapleton Road Chingford London E4 6XJ 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) 0208 529 2266 0208 524 6564 London Borough of Waltham Forest Ms Christina Adamu Care Home 24 Category(ies) of Dementia - over 65 years of age (24) registration, with number of places Mapleton Road DS0000058682.V284331.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2005 Brief Description of the Service: 87 Mapleton Road is a care home registered to provide personal care for a maximum of twenty-four older people with mental health needs. The home is a large detached, single storey building with twenty-four bedrooms. All bedrooms are single rooms with a washbasin. Only two bedrooms have ensuite facilities. There is a large main kitchen where meals for service users are prepared. In addition, there are two small kitchenettes where drinks and snacks can be prepared. Facilities for service users include two large communal lounges with dining areas. There are seven toilets, two bathrooms and two shower rooms. One of the bathrooms has an assisted bath. Mapleton Road DS0000058682.V284331.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is report is the result of an unannounced inspection of Mapleton Road in February 2006. The inspector read records pertaining to the running of the home and care files about the care delivered to service users. The inspector also spoke with service users and staff and had to opportunity to observe the activity within the home. The inspector would like to thank service users and staff for their assistance in the inspection process. What the service does well: What has improved since the last inspection? What they could do better: The home needs to demonstrate how it provides care for people with dementia within its care planning system. It also needs to provide more appropriate activities aimed at promoting the wellbeing for individual service users. These are areas of care provision that have been a repeatedly weak in Mapleton Road. It is the inspector’s view that these problems stem form insufficient staff and the absence of a permanent experienced senior team. It is of concern that the management team consists of one manager one senior carer and three Mapleton Road DS0000058682.V284331.R01.S.doc Version 5.1 Page 6 agency senior care workers. This is inadequate for a service that provides care for such vulnerable service users with complex needs. 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 Road DS0000058682.V284331.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 Mapleton Road DS0000058682.V284331.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, 5 The home undertakes assessments to ensure they can meet needs before a service user is admitted. EVIDENCE: The inspector checked the file of a recently admitted service user and noted there was a Community Care Assessment completed by a social worker and a detailed assessment of need undertaken by the home prior to admission. The assessment identified issues around personal care however the manager confirmed these issues had not presented since admission. The inspector noted there was a signed licence agreement in place also. It was evident that on admission staff had made good observations on how the service user was adjusting to the home, the recordings were clear and concise. Mapleton Road DS0000058682.V284331.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): 7, The home does not adequately describe how staff are going to meet individual service users needs. EVIDENCE: The inspector read the care plans of two service users and noted the improvement detailing the activities of staff to meet the needs of the service users. However this still requires more work for example on one of the plans checked under the mental health need it noted, “X suffers from dementia”. The home is registered to provide service for people with dementia so that would be expected. It is unfortunate however that in a home for people with dementia there is no description of how her mental health needs will be met. The inspector tracked some accident and incident documentation and it was evident that service users receive emergency health care. From reading service users files there was evidence of service users receiving support from health care professionals. District nurses visit the home to provide any nursing support required. Mapleton Road DS0000058682.V284331.R01.S.doc Version 5.1 Page 10 On the social files checked the inspector noted there was a bereavement plan in place. Mapleton Road DS0000058682.V284331.R01.S.doc Version 5.1 Page 11 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): 12, 14 The provision of individualised social and leisure activities is inadequate. EVIDENCE: Rather than actively plan for individual service users to take part in a leisure or social activity the home provided group activities and records when the service users took part. This is inadequate particularly in a service for people with dementia where ability to understand and take part varies considerably for one individual to another. The activities recorded as being provided were inadequate, for example there was lots of listening to music, or chatting tot other service users and watching television. In a home where the music or television provides a background to the service users day this is not an activity provided to stimulate service users interests and promote service users self-esteem and wellbeing. In a months recording of activities provided there was the occasional reminiscence session or quiz. At the last inspection the inspector was concerned about how the service managed presenting behaviour. Staff had a lock fitted to the service users wardrobe to prevent her having free access to her clothing. A requirement was made to ensure that all service user had access to their personal belongings. Mapleton Road DS0000058682.V284331.R01.S.doc Version 5.1 Page 12 However at this inspection the inspector was concerned to note that this infringement of the service users rights remained in place. The home had sought the agreement of the service users next of kin and social worker for her clothing and toiletries to be locked away. The explanation given by the manager was that the service user attempted to wash her clothing in her bedroom sink using her toiletries. The staff were concerned that the service user may slip on the floor. The service was unable to demonstrate how they had attempted to understand the service users reality and develop a care plan that would address the issue of her possible attempts to self care and maintain her independence. When there is such a major infringement on someone rights it would expect to be recorded in risk assessment and care plan. There was no reference to the service user not having access to her personal belonging within the risk assessment and it was only briefly noted in the care plan under health and safety needs. Following discussion with the manager about alternative approaches to managing the service users care the inspector met with the service user and asked her about how she felt about her belongings being locked away. The service user threw her arms up in the air and said “Alleluia, someone’s heard! I’m absolutely up in arms about this, but what can I do about it?” Mapleton Road DS0000058682.V284331.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): 16, 18 The home has and accessible complaints procedure. EVIDENCE: There have been no complaints recorded since the last inspection; the manager has set up a central log for documenting all concerns brought to staff attention. The service has a clear complaints procedure in place. Staff have received training in adult protection, the local authority procedure is in place and there have been no referrals made to the adult protection team. Mapleton Road DS0000058682.V284331.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): 19, 24 Service user live in a clean environment although some areas require redecoration. EVIDENCE: The home remains clean and hygienic there were no mal odours. It was noted that the there was a hole in the wall of the blue bathroom and bedroom no requires redecoration. The manager advised the inspector that new bed linen had been ordered but it has not yet arrived in the service. Mapleton Road DS0000058682.V284331.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 Although qualified there are insufficient staff on duty to meet the individual needs of service users. EVIDENCE: Recruitment to the service is centralised in the organisations human resource department. The Commission had previously been advised that preemployment checks were in place for the staff team. However on checking the files it was evident that the human resource department did not in fact have the required documentation was not in place. The inspector noted required documentation recorded as missing on pro-forma checklists. However the manager stated that the missing documentation had recently been provided. There was however evidence of two staff working in the service without satisfactory CRB disclosures. The inspector issued an immediate requirement notice to ensure that these staff could not work in the service unless satisfactory disclosures were presented. The registered provider must ensure that no staff are employed unless the documentation detailed in Schedule 2 of the Care Home Regulation 2001 in satisfactory and in place.29 The manager confirmed that all the care workers in the home hold a level 2 NVQ qualification. The inspector has been concerned about the adequacy of staffing levels in the service, and had previously required that they be reviewed this work has not been undertaken. The low staffing levels in the home have an impact on the Mapleton Road DS0000058682.V284331.R01.S.doc Version 5.1 Page 16 quality of life experienced by service users for example the home offers group activities as there are not the resources to allocate staff to undertake some one to one work with service users. There was evidence that in one instance health and safety concerns are addressed by infringing service users rights rather that improving the level of supervision of the service user or the provision of an activity that would promote the service users self-esteem. Whilst the number of staff on duty is a concern the inspector is also concerned that there is insufficient senior staff to support the team. The manager works with one senior careworker and 3 agency senior careworkers. She has no deputy manager in post. It is evident that these gaps within the team need to be addressed. Mapleton Road DS0000058682.V284331.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): 31, 33, 35 The manager is competent in her role and there is a robust system in place to protect service users monies held. EVIDENCE: The manager holds her NVQ 4 award and is also a qualified 1st level nurse. She has extensive experience in managing this service, she is recognised and knowledgeable and competent. However as noted earlier the inspector has concerns that the manager does not have a permanent senior staff team to lead and a deputy to act in her absence. Although the manager and service manager budget for cyclical expenditure the is no annual development plan in place to improve outcomes for service users. The service will have to develop a means of obtaining the views of service users and demonstrate how these reflect on the service provided. Mapleton Road DS0000058682.V284331.R01.S.doc Version 5.1 Page 18 The managing organisation acts as a receiver for 4 service users, additionally the home hold cash deposited by relatives for service users. The inspector undertook a random check of personal monies held for three service users. There were receipts for all expenditure and receipts issued for all monies received. The cash actually held matched the running balance. Mapleton Road DS0000058682.V284331.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 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 1 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X X STAFFING Standard No Score 27 2 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X X Mapleton Road DS0000058682.V284331.R01.S.doc Version 5.1 Page 20 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 The registered person must ensure each service user has a comprehensive care plan that describes how the service will meet their presenting needs. (Repeated) The registered person must ensure all staff receive training pressure area care and the use equipment. (Repeated) The registered person must ensure service users individual social and leisure needs are planned for. (Repeated) The registered person must ensure service users have access to their personal belongings. (Repeated) The registered person must ensure bed linen is replaced as necessary and continue replacing beds. (Repeated) The registered provider must ensure that the wall surfaces in all bathrooms and toilets are made good and these areas redecorated. (Repeated) The registered persons must review staffing levels and DS0000058682.V284331.R01.S.doc Timescale for action 23/05/06 2. OP8 13 23/05/06 3. OP12 15 23/05/06 4. OP14 12 23/04/06 5. OP24 23 23/05/06 6. OP21 23 23/05/06 8. OP27 18 23/05/06 Mapleton Road Version 5.1 Page 21 9 10 11 OP14 OP24 OP33 15 23 24 undertake any actions identified out of the review so as to ensure it has sufficient staff to meet the assessed needs of service users throughout the day and night. A report of actions undertaken following this review must be forwarded to the inspector. (Repeated.) The registered manager must ensure that service users are fully consulted about their care. The registered manager must ensure that bedrooms are adequately decorated. The registered manager must develop a quality assurance system that reflects the communication needs of the service users. 23/05/06 23/06/06 23/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Mapleton Road DS0000058682.V284331.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ 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 Mapleton Road DS0000058682.V284331.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. 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