Inspection on 26/01/09 for Mapleton Road

This inspection was carried out on 26th January 2009.

CSCI found this care home to be providing an Good service.

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 31/01/08

Mapleton Road 28/03/07

Mapleton Road 23/06/06

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Mapleton Road 87 Mapleton Road Chingford London E4 6XJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Peter Illes     Date: 2 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Mapleton Road 87 Mapleton Road Chingford London E4 6XJ 02085292266 02085246564 christina.adamu@walthamforest.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : London Borough of Waltham Forest care home 24 Number of places (if applicable): Under 65 Over 65 24 dementia Additional conditions: Date of last inspection Brief description of the care home 0 87 Mapleton Road is a care home registered to provide personal care for a maximum of twenty-four older people with a diagnosis of dementia. The home is managed by L.B. of Waltham Forest as part of the boroughs in-house residential care resources for older people. The home is a large detached, single storey building with twenty-four bedrooms. All bedrooms are single rooms with a washbasin and two bedrooms have ensuite facilities. There is a large main kitchen where meals for residents are prepared. In addition, there are two small kitchenettes where drinks and snacks can be prepared. Facilities for residents 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. The home is situated in a quiet residential area in North Chingford and is near local bus routes, shopping facilities, library and a leisure centre. A stated core purpose of the home is to Provide quality support for vulnerable people in the community by empowering service users. Information about the service, including CSCI inspection reports, are available on request from the home. The current weekly charge is £639:63. Care Homes for Older People Page 4 of 29 Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection on this service was completed on 31st January 2008. This key unannounced inspection took approximately seven hours with the registered manager being available to assist throughout. There were twenty-three people accommodated at the time of the inspection, one of those was in hospital at the time and there was one vacancy. The inspection was undertaken by the lead inspector who was assisted by an expert by experience, employed by Help the Aged. An expert by experience is a person who, because of their shared experience of using services, and/ or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in Care Homes for Older People Page 6 of 29 or use the service. However, terms such as we, our and us are used in this report where appropriate to indicate that inspection activity is undertaken on behalf of the Commission. The inspection activity included: meeting and speaking with the majority of people living in the home although communication with the majority was limited because of their communication needs; independent discussion with a social worker who visited on the day; independent discussion with a district nurse who visited on the day; detailed discussion with the registered manager and deputy manager and independent discussion with a number of care staff, the cook and the laundry person. Further information was also obtained from: an Annual Quality Assurance Assessment (AQAA) that had been submitted by the home to the Commission prior to the inspection, a tour of the premises and documentation kept at the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their representatives benefit from up to date information about the home to help them decide if it can meet the persons needs. The needs and preferences of people referred to the home are properly assessed to assist staff in meeting these. Residents and their representatives also benefit from having a Statement of the Terms and Conditions giving them information about living in the home. Evidence: The homes annual quality assurance assessment (AQAA) states a Statement of Purpose, a Service User Guide and the last Inspection Report are available to any prospective service user and/ or their relative to enable them to make informed choices. A satisfactory and up to date Statement of Purpose and Service User Guide was seen during this inspection. The home has recently reviewed these documents and a more accessible Service User Guide has now been introduced. Care Homes for Older People Page 10 of 29 Evidence: Five residents were case tracked and as part of this process their files were inspected. Four of these residents had been admitted to the home since the last inspection and the fifth had lived at the home for a longer period. All the files showed that the home had received clear assessment information before the person was admitted including about their assessed needs and their preferences regarding how these should be met. This included a community care assessment and specialist assessments from healthcare and other professionals where appropriate. There was evidence on each file that the home had also undertaken its own assessment prior to admission to make sure that the home could meet the persons needs. Following admission a six week review is held to check that the home is meeting the persons needs properly. Evidence was seen of review meetings being held including review notes on files. On the day of the inspection a social worker from the L.B. of Waltham Forest attended the home for a six week review of one of the people who we case tracked. We spoke to the social worker independently and she confirmed that the home had received assessment information and that the registered manager and her staff had been helpful through the admission process. She went on to say that their were a number of issues still being resolved for the person she was reviewing that was outside of the admission process and the homes responsibility, including sorting out the persons finances. Despite this she stated that she felt the admission process had been handled well. We noted that files inspected also contained a Statement of the Terms and Conditions for the person living in the home; the AQAA stated that a copy of this was given to the resident at the point of moving into the home. The home does not provide intermediate care. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs and preferences are set out in their care plan with clear guidance for staff on how to address these in a way that the person prefers. People are appropriately supported in meeting their health care needs with access to a range of appropriate healthcare professionals. Satisfactory medication policies and procedures are in place to safeguard people living in the home. People are also treated with respect and dignity by staff, which they appreciate. Evidence: The homes annual quality assurance assessment (AQAA) states, Individual care plans are in place for service users, drawn up in conjunction with the relative and/ or service users themselves, along with key workers and the manager of the home. At the last inspection a requirement was made that care plans must be more detailed regarding their mobility needs and that there must be evidence that the plan had been agreed with the person or their representative. This requirement was seen to have been complied with. The files of the five residents inspected were all found to be up to date, showed the persons needs and preferences and gave guidance to staff on how to Care Homes for Older People Page 12 of 29 Evidence: meet these. Evidence was also seen that the plans are reviewed at least monthly and more often if a persons needs change. An example of this was that one persons care needs had recently changed because of their health and evidence seen that the care plan had been amended at the time to reflect this rather than waiting for the monthly review. Evidence was also seen of a signed Consent to Service Users Care Plan form on each file inspected; we were told that this was introduced as a result of the requirement made at the last inspection. The forms seen had been signed by either the person themselves or their relative. Care plans were also seen to be informed by a life history including sections such as Things I like/ make me happy. An example of this was one person whos plan specified their cultural food preferences and also stated that the person likes reading, listening to the radio and putting on a bet. Evidence was also seen that staff were assisting people meet their preferences as well as their assessed needs. Care plans were also informed by clear risk assessments and we were told by the registered manager that the format of these had been reviewed since the last inspection to make them more comprehensive. The risk assessments seen showed evidence of being reviewed monthly and included the following sections: the risk identified; the degree of the risk; any patterns/ triggers regarding the risk; guidance to staff on how to reduce the risk; the residents view of the risk and the relative/ advocates view of the risk. An example of this was the recording of risks associated with a resident who had a heart pacemaker fitted. Risk assessments seen included moving and handling and their was an additional section on residents files seen called Safe System of Work that was in effect an overview of all the areas covered by risk assessments. Staff spoken to independently were able to describe how they reduced risks for individual residents. It was noted that the home operates a staff Key Worker system. One key worker was spoken to independently and described relevant tasks including helping their resident keep their room as they wished and accompanying the person to buy clothes and to attend medical appointments. This system seemed to work well although their was no specific record of key working activities outside of the residents daily notes. A good practice recommendation is made that a written monthly summary is kept by the key worker of the work undertaken during the month. This is to assist share knowledge of the resident across the staff team and to provide additional information when the residents care plan is reviewed. Records were seen to evidence that residents health needs are monitored and addressed. This included records of recent appointments with a GP, district nurse, hospital appointments, chiropodist and community dentist. A community nurse that visited during the inspection told us that she was visiting twice a week at the time and had no concerns about the home. She went on to tell us that staff are very cooperative and helpful. The healthcare records seen on files included an overview of Care Homes for Older People Page 13 of 29 Evidence: each appointment for easy monitoring with more detailed notes for each appointment including the outcome and any further action required following the appointment. Staff spoken to were able to describe how residents were supported with various healthcare needs. At the last inspection a requirement was made that staff must be aware of the circumstances in which to administer as required PRN medication. This requirement was being complied with and records of PRN medication were sampled to evidence this. The home has a satisfactory medication policy and procedure that was seen in the medication room. Medication and medication administration records (MAR) charts of a number of residents were sampled and indicated that residents are appropriately supported in the administration of medication. In addition each residents file contained a list of the medication that the person was prescribed and the reason for this. No one at the home was prescribed controlled medication at the time although the home had appropriate storage facilities should this be required. Evidence was also seen that staff that administer medication receive appropriate training to assist them to do so safely, this training is provided by the dispensing chemist that the home uses. Staff spoken to confirmed that the training was useful. The homes AQAA states, We respect service users privacy and dignity and personal care is given in service users bedrooms. This was observed to be the case on the day of the inspection and all residents appeared well groomed and presented. Staff were seen interacting with residents in a relaxed and appropriate way, including taking time to chat to people as well as carrying out their respective tasks. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home enjoy a range of appropriate activities that meet their needs and that they enjoy. Relatives and other visitors are made welcome at the home, including to regular relative meetings, which assists support both residents and their relatives. People are encouraged to exercise as much choice and control over their lives as they can to maximise their independence. They are also provided with a range of healthy and nutritious meals that they enjoy. Evidence: At the last inspection a requirement was made that residents are supported to undertake individual social and leisure pursuits and another requirement made that information is presented in an accessible format; evidence was seen during this inspection that these requirement were being complied with. The homes annual quality assurance assessment (AQAA) states, The home supports service users to participate in a variety of leisure and social activities at individual or at group level. The home has a planned activities programme that involves bringing in outside entertainers on special occasions. There was pictorial activities timetable seen at the home that specified activities each day. These ranged from reminiscence, music, board games, coffee morning, bingo and a sherry morning. During the inspection a staff Care Homes for Older People Page 15 of 29 Evidence: member was observed running a reminiscence group using cue cards to assist in developing discussions and residents appeared both engaged and enjoying the session. The LB of Waltham Forest has a designated Dementia Support Team and we were told this could be accessed as a resource to advise on dementia care including appropriate activities. However, the registered manager told us that it could be difficult to access this on a regular basis. Given that Mapleton Road is a home designated for the care of people with dementia a good practice recommendation is made that the registered provider negotiates more structural and regular support for the home from the Dementia Support Team. Evidence was also seen of various outings from the home including to local parks, and of a range of other one off activities including birthday parties. It was also noted that the home ran events to celebrate a range of cultural diversity including black history month, St Patricks Day and St Georges Day. Records of other events included events to mark Valentines Day, Remembrance Day and Guy Fawkes. The ethnic origin of the majority of the residents at the time of this inspection were white British however the registered manager stated that the needs of people from different cultural backgrounds and religions could and would be met as appropriate. The homes AQAA states, The Council provides training to staff on Equality and diversity, including respecting the sexual orientation that service users may present. The AQAA states, Service users can have visitors anytime and without prior notification to the home. The home holds regular resident and relatives meetings and records of these, including the latest one on 21/01/09, were seen to evidence this. We were also pleased to see that relatives may access free Dementia Training for Informal Carers, that is organised by LB of Waltham Forest. Records showed that the home had a significant number of visitors and feedback from satisfaction feedback forms from relatives that were sampled were very positive. People living at the home are generally unable to manage their finances, which are managed through the local authority as a corporate appointee or via relatives. People living at the home are able to bring their personal possessions into the home and rooms seen during a tour of the building showed bedrooms personalised to varying degrees, and example being a resident that had bought in a sofa from their previous home. At the last inspection a requirement was made that the home must keep a log of all meals provided including morning and afternoon teas, and evidence that soft fruits are offered at least twice per day. The home has a pictorial menu that was seen and which showed a range of options for each meal. The home also operates a Caribbean menu, that is available for any resident, that included rice and peas, ackee and salt fish and Care Homes for Older People Page 16 of 29 Evidence: curried goat. Evidence was also seen that the home can cater for other dietary needs including Halal, Kosher and vegetarian.The cook on duty on the day was spoken to and presented as being competent and knowledgeable, the kitchen was clean and tidy with up to date health and safety records that were sampled. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has accessible procedures for dealing with concerns and complaints that are well publicised to assist in dealing with any matters raised in a timely manner. Residents are also protected by the homes safeguarding adults policy and procedures, which are also well publicised, up to date and understood by staff. Evidence: The homes annual quality assurance assessment states, We recognise that complaints are integral to the development of services. We encourage service users and/ or their relatives to complain about the services we provide if the service falls short of their expectation. The home has a clear and up to date complaints procedure that is included in the service user guide with an accessible summary displayed around the home. The homes complaints log showed that two complaints had been received directly by the home and had been appropriately investigated in accordance with the complaints procedure. There was a copy of a third complaint that was being dealt with directly by the LB of Waltham Forest, this was from a neighbour in an adjoining property and was in relation to trees on the boundary of the home. Communication with most residents was limited due to their particular needs although feedback indicated that residents are happy to discuss any concerns or worries they may have with staff or managers at the home. No complaints about the home have been received by the Commission since the last inspection. Care Homes for Older People Page 18 of 29 Evidence: At the last inspection a requirement was made that the home must consolidate and further develop recent improvements in its safeguarding adults (adult protection) practises and this requirement was being acted upon. The home had a current copy of LB Waltham Forests safeguarding procedures, including accessible information distributed around the home.There had been one safeguarding referral made since the last inspection in relation to care of identified residents at night time. This had been appropriately reported at the time, including to the Commission. Evidence was seen that the allegation had been properly investigated by LB of Waltham Forest under their formal multi-agency procedures. This allegation had been substantiated and the home had taken robust action to address the situation. Evidence was seen that all staff had received training or refresher training in safeguarding adults since the last inspection. Staff spoken to independently were able to describe the actions they should take if an allegation or disclosure of abuse was made to them. Evidence was seen that the home has a satisfactory Whistle-Blowing policy that staff were aware of. Evidence was also seen that staff received training in the implementation of the Mental Capacity Act and this included an introduction to the section of the Act that comes into force in April 2009 regarding deprivation of liberty. This is specifically about providing care to people who have not the capacity to give informed consent. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is well decorated, furnished, maintained and that meets their needs. However, further work to refurbish the homes shower rooms may further enhance the experience of those that use these facilities. The home was clean and tidy throughout, creating a pleasant environment for people accommodated, staff and visitors. Evidence: The homes Service User Guide states that the home was purpose built in 1989. The home consists of two twelve bedded units, named the Yellow and Blue units, with an inter-connecting entrance foyer. Each unit contains: twelve single bedrooms with a sink (one of the bedrooms in each units has en-suite facilities), a spacious dining/ lounge area and suitably adapted bath, shower and toilet facilities. In addition the home has a central kitchen, laundry and a generally attractive landscaped garden that contains a suitably fenced fish pond. Although the pond is a valued resource for residents, especially in the summer, it would benefit from being cleaned and refurbished to maximise its attractiveness to residents and other people that visit or work in the home. A good practice recommendation is made regarding this. However, a detailed tour of the building was undertaken as part of this inspection and the building is judged to be meeting the needs of the current residents. Care Homes for Older People Page 20 of 29 Evidence: The home has an effective and ongoing maintenance and redecoration programme with evidence that the main kitchen and some communal areas had been redecorated since the last inspection. Although the majority of residents bedrooms do not contain en-suite facilities the home does have sufficient bath, shower and toilet facilities to meet residents needs. At the last inspection a requirement had been made that identified repairs be carried out to the shower rooms and this was seen to have been complied with. However, although clean and safe it was noted that, probably because of the heavy usage the shower rooms receive, these still looked rather well used and tired. The registered manager stated that these may be refurbished in the new budget year, 2009/ 2010. A good practice recommendation is also made about this. The home had suitable laundry facilities to meet the current residents needs with clear infection control policies and procedures in place. The homes laundry person was spoken to and was clearly conversant with the needs of the residents in this area. At the last inspection a requirement was made that the home must take action to address unpleasant smells in some residents bedrooms and this requirement was being complied with. On the day of the inspection the home was found to be clean, tidy and free of unpleasant smells. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to meet their needs by sufficient staff who have a range of skills, qualifications and competencies. The homes recruitment policies and procedures assist in protection residents. Evidence: At the last inspection a requirement was made that the home reviews its staffing levels to ensure that it can meet the assessed needs of residents and this requirement had been complied with. The homes annual quality assurance assessment (AQAA) states, We have experienced and dedicated staff to support and provide care to people with dementia. An up to date rota was seen that accurately reflected the staff on duty during this inspection. The rota showed five care staff and one senior carer on duty on the morning and afternoon shifts with the registered manager or deputy manager being in addition to this. We were told that the number of carers on the day shifts had been increased from four to five following the staffing review. There are two waking staff on duty at night who can obtain advice and support from a nominated on-call manager. This staffing level was judged sufficient to meet the needs of the current residents. We did note however that the safeguarding issue identified in the Complaints and Protection had occurred at night time, although we saw evidence that this had been Care Homes for Older People Page 22 of 29 Evidence: satisfactorily addressed at the time. However, a good practice recommendation is made that the home considers the viability of deploying a third member of staff on duty at night and of nominating a member of staff to be designated as shift leader each night. This could further assist in managing, coordinating and prioritising the range of care and other tasks undertaken on the night shift. Evidence was seen that all of the eleven permanent care staff had achieved the national vocational qualification (NVQ) level 2 in care and four of those had achieved NVQ level 3. The home has made progress in filling care posts on a permanent basis since the last inspection and we were informed that a pool of known agency and bank staff were used where necessary and that assisted in maintaining continuity of care. The homes AQAA states, The home is fully compliant with the necessary recruitment checks as outlined in Schedule 2 of the Care Homes Regulations 2001. The files of two care staff that had been redeployed to the home since the last inspection were inspected to evidence this. Both files contained: an enhanced criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check, an application form, two references, proof of identity with a photograph and evidence of entitlement to work where appropriate. A staff training matrix was inspected and showed evidence that staff are offered regular training and refresher training. Training that staff have received in the past twelve months included: moving and handling, safe administration of medication, safeguarding adults, a three day in-house course on caring for people with dementia, Mental Capacity Act training and a one day introduction to the deprivation of liberty safeguards (DOLS), that come into effect on 01/04/09. The home also had a training plan for 2009/ 2010 that was seen and which identified where staff would benefit from refresher training in core areas. Staff spoken to during the inspection confirmed that they received regular training and found this helpful. We were told that the LB of Waltham Forest had stopped issuing certificates of attendance to individual staff members when they attended in-house training courses. This seemed a shame for staff that attended the course as they did not have evidence for their own portfolio and not helpful for the home in evidencing training in individual staff files. A good practice recommendation is made regarding this. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from the service being managed by a competent, qualified and experienced registered manager. People accommodated and other stakeholders are regularly consulted to promote and monitor the quality of the service they receive. Peoples financial interests are safeguarded while living in the home. Staff are provided with supervision to support them meet the needs of people accommodated and to assist in their own development. A range of effective health and safety procedures protect people living in the home. Evidence: The registered manager told us she had been managing the home for nine years. She is a registered first level nurse and has achieved the national vocational qualification (NVQ), level 4 in management. In addition the registered manager has achieved the NVQ A1 Assessor award, has undertaken a range of other training to keep her skills up to date and is in the process of completing a specialist distance learning course with the University of Bradford on person centred dementia practice. The registered Care Homes for Older People Page 24 of 29 Evidence: manager is supported by a deputy manager, who is also a first level registered nurse. Both registered manager and deputy manager presented as being knowledgeable, skilled and enthusiastic about their roles. Feedback from staff at the home and other professionals spoken to as part of this inspection was positive about the home, including its day to day management. At the last inspection a requirement was made that the home develops a quality assurance system that reflects the communication needs of the residents. Evidence was seen that the home is continuing to work hard to comply with this. Evidence was seen that the home holds quarterly meetings with relatives and residents, which are minuted, with the last meeting being held on 21/01/09. Annual surveys are undertaken and in 2008 the provider organisation had commissioned a specialist voluntary group to report on the experiences of people with dementia in a number of the provider organisations services, including Mapleton Road. The report was generally positive and is a useful resource for further improvement to services. In addition to this residents are consulted on an individual basis regarding their day-today life including their preferences, e.g. choosing carpets for their rooms. Finances of people living at the home are dealt with by the L.B. of Waltham Forests receivership department or by their relatives. Peoples personal allowances were seen to be kept securely at the home in individual wallets. Evidence was seen that staff receive individual supervision once a month and also receive annual appraisals. Staff spoken to confirmed this and were positive about both the formal and informal management support they received. A range of satisfactory health and safety documentation was seen. This included a gas safety certificate, electrical installation certificate and portable appliance testing. The homes fire log was also inspected and included an up to date fire plan and fire risk assessment along with evidence that the fire fighting equipment is regularly serviced and that fire drills are held 6 times a year. Evidence was also seen that a Fire Officer from the London Fire Service (London Fire & Emergency Planning Authority) had visited the home in August 2008 and was satisfied with the fire precaution arrangements at the home at that time. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The home should introduce a written monthly summary by the key worker of the work they undertake during the month. This is to assist share knowledge of the resident across the staff team and to provide additional information when the residents care plan is reviewed. The registered provider should negotiate more structural and regular support for the home from the Dementia Support Team to further assist the home develop expertise in the support and care of people with dementia. The home should clean and refurbish the pond to provide a more enjoyable experience for residents that use the garden. The home should refurbish the homes shower rooms to provide a more enjoyable experience for residents that use these facilities. The home should consider the viability of deploying a third member of staff on duty at night and of nominating a member of staff to be designated as shift leader each night. This could further assist in managing, coordinating and prioritising the range of care and other tasks undertaken on the night shift. 2 12 3 20 4 21 5 27 Care Homes for Older People Page 27 of 29 6 30 The provider organisation should provide staff that attend in-house training courses with individual certificates of attendance to evidence this and to assist them maintain their own training portfolios. Care Homes for Older People Page 28 of 29 Helpline: 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 We want people to be able to access this information. 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