Inspection on 23/06/06 for Mapleton Road

This inspection was carried out on 23rd June 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.

Other inspections for this house

Mapleton Road 26/01/09

Mapleton Road 31/01/08

Mapleton Road 28/03/07

Mapleton Road 10/03/06

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 Key Unannounced Inspection 23rd June 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 Mapleton Road DS0000058682.V300216.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 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.V300216.R01.S.doc Version 5.2 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.V300216.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th March 2006 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.V300216.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a report of an unannounced inspection undertaken at the end of June 2006. The manager was on annual leave so the shift leader assisted the inspector. The inspector met with service users and staff, read documents relating to the care of service users and running of the home. The inspector would like to thank everyone for their co-operation in the inspection process. What the service does well: What has improved since the last inspection? What they could do better: Both the internal decoration and repairs must be completed both within the home and attention must be given to ensuring a safe garden for the service users to access. Having staff employed in the service that have insufficient pre-employment checks compromises service users welfare. Mapleton Road DS0000058682.V300216.R01.S.doc Version 5.2 Page 6 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.V300216.R01.S.doc Version 5.2 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.V300216.R01.S.doc Version 5.2 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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff at the home make arrangements to find out as much as possible about the prospective service user before admitting them. EVIDENCE: The inspector read the file of the most recently admitted service user and noted that there was both a comprehensive assessment of need and a preadmissions assessment undertaken by the home in place. The home’s own assessment of need addressed all areas of need as detailed in the national minimum standards. The inspector was pleased to note that the home is obtaining life histories of service users; the inspector read a very detailed history of one service user provided by a close relative. Such information is crucial to improving staff knowledge about service users who are not always able to provide this history themselves. This can only have a positive impact on the care provided. Mapleton Road DS0000058682.V300216.R01.S.doc Version 5.2 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, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. However the staff must improve their record of treatment following accidents and ensure all risks are addressed. EVIDENCE: The inspector read a service users care plan and noted it contained a good level of detail to guide staff in provision of service users care. The care plan noted the service users preferences that could be tracked by the to the history provided by the family and social worker. It was positive to also note that the service were planning to meet the individual social and leisure preferences of service users. On tracking the social activities planned against those offered and taken part in it was evident that they were being provided as planned. The inspector noted in one service users risk assessment that staff had recorded falls as the only risk however there were other risks evident that the staff team had not addressed such as the side effects of a prescribed anticoagulant medication that may cause a service user to excessively bleed in the event of an accident. However another risk assessment seen was more comprehensive and did address all areas of risk identified. Mapleton Road DS0000058682.V300216.R01.S.doc Version 5.2 Page 10 The inspector reviewed the accident in the service since the last inspection. It was noted that one service user had a high frequency of accidents however the home had made a referral for a physiotherapist assessment who provided the service user with a walking aid and this has improved mobility. The inspector tracked an accident that resulted in a service users attendance at accident and emergency for treatment to arm and head injuries. The service user returned from hospital in the early hours of the morning, however there was no detail recorded of treatment administered, nor was there any record on the medical visit record. Treatments following accidents must be recorded. The inspector checked the homes medications system. Staff administer all service users medication which are held securely in appropriate locked cabinets. The inspector tracked a random sample of medication held and their records and found them to be in order. The pharmacist providing the medication undertakes a monthly visit and checks the medications held and records maintained. The inspector observed staff assisting/guiding service users to their bedrooms to deliver personal care. The inspector considered the interaction between staff and service users to be relaxed and respectful. One service user said of staff “they’re lovely”. Mapleton Road DS0000058682.V300216.R01.S.doc Version 5.2 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, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service makes and effort to ensure service users can bring their personal possessions on admission. EVIDENCE: There was good evidence that the home is attempting to provide for individual service users social and leisure preferences. The home maintains a record of activities service users took part in and when tracked these were evident in service users individual plans. The inspector observed a variety of activities staff were undertaking with service users such as playing cards, reminiscing and listening to appropriate music. There is no restriction on visiting in the home. It was evident that relatives involvement is welcomed in the provision of the life history work seen. Currently at Mapleton Road there are no service users who manage their own finances. However on touring the home there was evidence that service users had taken some of their favoured possession into the home when admitted. One service user took his sofa from home and staff told the inspector how each evening he went to his room and relaxed on his sofa to watch television. Mapleton Road DS0000058682.V300216.R01.S.doc Version 5.2 Page 12 The staff team have addressed previous concerns about a service users access to her personal possessions. The inspector joined two service users at the end of lunch both of whom reported that they enjoyed their meal. The inspector saw the menu plan and this tallied with the food provided. Mapleton Road DS0000058682.V300216.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has made arrangements to ensure that staff are instructed in their responsibilities in protecting service users. EVIDENCE: The service has had one complaint since the last inspection and this was addressed appropriately within the organisations timescales. The service provides an accessible complaints procedure for service users and relatives acting on their behalf. The manager has completed training on adult protection investigations. As a local authority provision the service adheres to Waltham Forest’s adult protection procedures. There have been no enquiries since the last inspection. The inspector described a fictitious scenario to the shift leader of a reported incident that may evidence adult abuse. From the response given the inspector was satisfied that appropriate action would be taken. All the staff in the service have received training on adult protection. Mapleton Road DS0000058682.V300216.R01.S.doc Version 5.2 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service does not provide accessible space for service users to use safely. EVIDENCE: The inspector went for a walk in the grounds with two service users and was concerned about the state of this area. A hosepipe was stretched across the walkway; shrubs and briers had overgrown the walkways and presented obstacles and hazards to anyone wishing to have some exercise and sunshine. Garden furniture was strewn across the very uneven lawn and shrubs had grown so height they obscured the view from service users bedrooms. One service users who takes a walk in the garden areas every day after lunch said it was a shame and believed the “owners had run out of money” hence the level of neglect. Safe accessible grounds are crucial particularly for service users with dementia and the absence of this is a cause for concern. It would appear that a redecoration program commenced over a year ago ended before completion. The inspector saw damaged bathroom walls from damp rising from the shower room, a shower chair smeared with what Mapleton Road DS0000058682.V300216.R01.S.doc Version 5.2 Page 15 appeared to be faeces, walls damaged by furniture and not made good and very badly damaged flooring in one toilet. There was evidence of strong odour of urine in some of the bedrooms despite frequent carpet cleaning. There was still a clear need for more new beds and furniture in some rooms. The service will also have to address their storage issues and not use bathrooms for storing equipment, in one bathroom the inspector noted a laundry trolley and commode chair. The inspector was pleased to note that some service users bedrooms were well personalised and inviting. Mapleton Road DS0000058682.V300216.R01.S.doc Version 5.2 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): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service fails to protect service users by undertaking appropriate checks on staff. EVIDENCE: On inspecting the homes staff rota plan the inspector noted discrepancies where the rota noted a carer finishing half and hour before her shift as recorded on the staff allocation record. Similarly, the rota noted that a member of staff was recorded as working on the day of the inspection when in fact staff reported she was on three weeks leave. The staff rota must provide an accurate record of what staff work and the cover provided. The service has previously been required to submit a review of staffing levels but the service has failed to comply. Currently all care staff in the home hold an NVQ level 2 award. Examination of staff files was undertaken at the centralised Human Resources Department for the Borough. It was identified that three staff either had no files, or there was no evidence that a CRB disclosure had been obtained. This position greatly compromises the welfare of service users, is contrary to Regulations, and immediate remedial action is now required. Enforcement action will be taken for failure to comply with the stated requirement. The inspector was advised that 19 staff had undertaken training on death and dying provided by the health trust, staff have recently undertaken moving and Mapleton Road DS0000058682.V300216.R01.S.doc Version 5.2 Page 17 handling refresher training in addition to in-house training on privacy, dignity and respect. Senior staff have also received training on supervision. Mapleton Road DS0000058682.V300216.R01.S.doc Version 5.2 Page 18 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, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. However the home needs to further develop its quality assurance system. EVIDENCE: The registered manager of the home is a qualified nurse and holds a level 4 NVQ award in management. There was evidence that she recently updated her training in adult protection investigation. The manager is familiar with the conditions and diseases associated with old age. The manager is competent in running of this service. There was evidence of service users meetings where feedback was sought on areas such as the quality of food, and service users were advised of the redecoration of the home. However this area still requires further development primarily on how best to elicit feedback from all service users with cognitive Mapleton Road DS0000058682.V300216.R01.S.doc Version 5.2 Page 19 impairment and how that feedback can influence the development of the service. The inspector checked a variety of records that demonstrated that the home took appropriate measures to maintain service users health and safety. There were records to evidence that the home stores chilled foods at a safe temperature. The home undertakes weekly alarm and call point checks. There has been a recent gas safety check, lifting equipment service and a renewed insurance certificate. Mapleton Road DS0000058682.V300216.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X 2 x 2 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X x 3 Mapleton Road DS0000058682.V300216.R01.S.doc Version 5.2 Page 21 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 OP8 Regulation 13 Requirement The registered manager must ensure that identified risks are addressed and staff are provided with strategies to manage them. The registered manager must ensure that treatment following accidents is clearly recorded on the service users records. The registered provider must take steps to ensure that the issues with the garden and grounds are rectified and that service users are provided with a safe accessible area to walk outside The registered manager must ensure that bathrooms are not used for storage of equipment. The registered manager must take action to address the mal odours in some service users bedrooms. The registered manager must ensure that equipment is appropriately cleaned after use. The registered provider must ensure that the wall surfaces in all bathrooms and toilets are made good and these areas DS0000058682.V300216.R01.S.doc Timescale for action 25/09/06 2 OP8 17 & 12 25/09/06 3 OP19 23 25/09/06 4 5 OP19 OP26 23 23 25/09/06 25/09/06 6 7. OP26 OP21 23 23 25/09/06 25/09/06 Mapleton Road Version 5.2 Page 22 8. OP27 18 9 OP29 19 10. OP24 23 11. OP33 24 redecorated. (Repeated) The registered persons must review staffing levels and 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 person to ensure that no person works in the home unless a satisfactory CRB disclosure has been obtained by the Local Authority. The registered manager must ensure that bedrooms are adequately decorated. (Repeated) The registered manager must develop a quality assurance system that reflects the communication needs of the service users. (Repeated) 25/09/06 25/08/06 25/09/06 25/09/06 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.V300216.R01.S.doc Version 5.2 Page 23 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. 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