Inspection on 28/03/07 for Mapleton Road

This inspection was carried out on 28th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report 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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Mapleton Road 87 Mapleton Road Chingford London E4 6XJ Lead Inspector Zita McCarry Unannounced Inspection 28th March 2007 02:30 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.V331737.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.V331737.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.V331737.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd June 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.V331737.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the findings of an inspection undertaken at the end of March 2007. The inspection was undertaken by 2 inspectors and was unannounced. A tour of the building was undertaken and the inspectors spoke with service users and staff. The inspectors read records relating to the management of the home and care records relating to the care provided to service users living in the home. The registered manager was on duty during the inspection and assisted in the process. The inspectors would like to thank everyone for their co-operation throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: The service have failed to demonstrate there are sufficient staff on duty to meet the needs of service users. The home has failed to adhere to the organisations safeguarding procedures. Mapleton Road DS0000058682.V331737.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. The summary of this inspection report can be made available in other formats on request. Mapleton Road DS0000058682.V331737.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.V331737.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. Service users and relatives can be assured that the home will take steps to ensure it can meet their needs before making an admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed the records pertaining to the recent admission of a service user. There was an up-to-date care needs assessment undertaken by a social worker. The home also undertook its own assessment prior to admission. Both assessments identified the issues for the prospective service user and the homes assessment addressed presenting risks that were considered before admission. Mapleton Road DS0000058682.V331737.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. However service users are not consistently administered their medication as prescribed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed the care plans for 2 service users. The care plans reflected all areas of need as detailed in the National Minimum Standards. The care plans were concise and provided staff with sufficient detail on the level of assistance the service user needed in the activities of daily living. One of the care plans was undated with no evidence of the service user’s or advocate’s signature. The service must be able to demonstrate that the service users and or advocate agree with the arrangements the service is putting in place to meet their needs. However on balance the inspector was pleased to note that on the risk assessment for the service user his personal view of the risk was well reflected and considered as part of the process. The service has in place a life story work for service users, on one file were there was none the service Mapleton Road DS0000058682.V331737.R01.S.doc Version 5.2 Page 10 was able to demonstrate contact had been made with relatives to seek information around the service users family/social history. The service has one service user who currently has a sacral pressure sore, there was evidence that she had this sore on admission to the home from hospital. Records were seen that the district nurse was managing this aspect of nursing care for the service user. There was appropriate pressure relieving equipment in place. The inspector read records of accidents that had occurred in the service all records detailed good evidence of a prompt response by staff. In the instance where a service user sustained a head injury prompt medical attention was sought. The homes management of service users medication was inspected; there was evidence that service users were not having their medication as prescribed. For three service users the home had not recorded date of commencement of the medication so it would be unable to undertaken it’s own management audit to ensure service users were receiving their medication as prescribed. Service user A Prescribed Metronidazole suspension to have 10mls 3 times a day for three days. The service users should therefore have had the medication administered on 9 occasions however the MAR showed the medication was administered on 19 occasions. Similarly Augmentin suspension was to be administered 10mls three times a day, only 100mls were provided. The medication should therefore have been administered on 10 occasions again records evidence a disparity in that it was recorded as administered 13 times. Service User B Prescribed antibiotic Trimethoprin 200mg to take one table twice daily for 5 days therefore should have taken 10 administrations however inspection of the MAR evidence that the medication had been administered on 13 occasions. Staff were observed to be positive and respectful in their interaction with service users. Service users have access to a phone to make and receive calls independently of staff. Service users confirmed to the inspector that staff are respectful of their privacy and consistently knock before entering their rooms. Mapleton Road DS0000058682.V331737.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. However service users cannot be assured that the service will provide sufficient staff to support them at mealtimes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On one care plan seen there was reference to a service users interest in painting and drawing. However on tracking the support the service users received in undertaking this pursuit there was no record of it being offered. However the home does provide activities for groups of service users in their respective lounges such as quizzes, coffee morning and sing-a-longs. For a dementia care service this is insufficient, service users who have varying levels of functioning and cognition will need varying levels of support. There are service users who live in Mapleton Rd who required extensive staff support to have any meaningful social interaction. There was no evidence of this being planned for or provided in the care plans checked. Mapleton Road DS0000058682.V331737.R01.S.doc Version 5.2 Page 12 There was good evidence that family and friends of service users are welcomed in the home the inspector read some very positive comments received for relatives which acknowledged how reassured they felt having their mother cared for at Mapleton Road. Mealtimes in the home are busy periods of the day and there was evidence that services users choice was somewhat negated by the process. For example a service user requested to have a cheese sandwich but staff served him a sandwich with a different filling. There was evidence also that service users were not served the soup as advertised on the homes menu. The menu advertised a tomato soup for the evening meal however chicken soup was provided for that meal. Failure to provide service users with accessible and accurate information undermines there ability to make informed choices about their daily lives. Mapleton Road DS0000058682.V331737.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. However service users cannot be assured that staff will adhere to established safeguarding protocols. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s record of complaints was reviewed there were two complaints recorded. One complaint was from a relative who had reported to the senior staff on duty that she was very concerned about unexplained bruising on a service users hands. There was substantial evidence on the risk assessment that due to medication and integrity of the service users skin that she would be prone to bruising. The home acted promptly in seeking medical advice from the service users doctor who in turn spoke with the concerned relative. The complainant was satisfied with the outcome of the complaint. However the Commission is concerned that the service deviated from the established process of notifying the placing authority and safeguarding team in line with local protocols. As a local authority service the home has clear guidelines in place for responding to actual or suspicions of abuse, including whistle blowing procedures. Staff have received training in safeguarding service users. Mapleton Road DS0000058682.V331737.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. Service users in Mapleton Road live in a safe clean and comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has engaged a gardening service which has restored the external space to an accessible, safe and attractive area for service users to access. Staff and service users report that more people are now making better use of this garden facility. The service has disabled access and has appropriate equipment in place to meet the needs of service users. A tour of the home was undertaken and the inspector saw that the service’s redecoration program had been completed. The service appeared clean and well maintained it was free from any malodours. It was noted the service has Mapleton Road DS0000058682.V331737.R01.S.doc Version 5.2 Page 15 laid new carpeting and flooring. Service users bedrooms seen by the inspector were well personalised. Service users are supported to find their way around by good signage and their bedroom doors had both graphics and their names to help them identify their private space. The service was clean and free from malodours on the day of the inspection. The laundry had appropriate sluicing facilities and the capacity to meet the needs of the service with an impermeable floor covering. Mapleton Road DS0000058682.V331737.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 30 Quality in this outcome area is adequate. However service users cannot be assured of prompt assistance when required . This judgement has been made using available evidence including a visit to this service. EVIDENCE: Inspection of the staff rota evidenced that it was an accurate reflection of staff on duty. The service has 2 units with 12 service users living on each unit. There are 2 care staff supporting each group of 12 service users. In addition to this the service is supported by a shift leader, who has the role of supervising practice, administering mediations, organising appointments and the day to day running of a shift. The shift leader does not provide hand on care unless in an emergency. There has been no deputy manager in the home for several years despite there being funds allocated for this in the budget. The manager has put in place an information pack for senior carers leading the shift but this is insufficient to support the service in the long term. Staff were observed to be very positive in their interaction with service users. However it was noted during the evening meal that service users were not Mapleton Road DS0000058682.V331737.R01.S.doc Version 5.2 Page 17 getting the support they required in a timely fashion. One carer had to leave the dining area for almost 15 minutes to provide personal care to a service user. This meant there was only on carer left to support 11 service users with their evening meal and two of those required assistance with feeding. It was noted that one service user had a bowl of soup put in front of him where it remained for 20 minutes, support was only given after staff were prompted by the inspector. The home has been unable to demonstrate that the are sufficient staff on duty particularly at peak periods such as mealtimes. The outcome for service users is unsatisfactory. As a local authority provision the service’s recruitment of staff is centralised and managed by a human resources department. There have been no new staff recruited into the service although a carer was re- deployed for the local authority’s home care service. The recruitment process of the home was not checked at his inspection. Inspection of a random selection of staff files evidenced training on moving and handling, food hygiene, risk and information sharing, person centred approach to dementia, and skills for care. All care staff employed directly by the local authority hold an NVQ 2 award in care and only employee agency workers holding the qualification. Mapleton Road DS0000058682.V331737.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 38 Quality in this outcome area is adequate. However the service will need to demonstrate how service user feedback is reflected in the development plan of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager holds the required the qualifications for the post. She has extensive experience in the care of older people and is familiar with the conditions presenting within the users group. However there was evidence at this inspection that whilst the manager did respond to unexplained bruising the response was not in line with best practice and the organisations protocols. Mapleton Road DS0000058682.V331737.R01.S.doc Version 5.2 Page 19 A variety of records were reviewed to assess how the service manages health and safety in the service. These included regular fire alarm panel checks, weekly call point tests, emergency light tests and monitoring of the food storage temperatures. There was evidence that the fire alarm system had a full service in January 2007, gas safety certificates and lifting hoist certificates were all in date. The arrangements for managing service users funds were not tested at this inspection they will be fully tested an the next key inspection. The service has undertaken a survey seeking feedback from service users with dementia on the quality of the service provided to them. The outcome of the survey was presented in quantitative results only and gave little sense of service users experiences of living in the service. The survey will need to be adapted to record their experiences along with other stakeholders and demonstrate how the service develops in responding to their feedback. Mapleton Road DS0000058682.V331737.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 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X x 3 Mapleton Road DS0000058682.V331737.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 OP27 Regulation 18 Requirement 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 manager must develop a quality assurance system that reflects the communication needs of the service users. (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. Not tested. The registered manager must ensure that service users and or their relatives agree to the plan of care. The registered manager must ensure that service users have DS0000058682.V331737.R01.S.doc Timescale for action 20/09/07 2. OP33 24 20/09/07 3. OP29 19 20/09/07 4 OP7 15 20/09/07 5 OP9 13 20/09/07 Mapleton Road Version 5.2 Page 22 6 OP12 12 & 15 7 OP18 13 8 OP14 12 9 OP15 12 10 OP27 18 11 OP27 18 12 OP31 18 their medications as prescribed. The registered manager will have to ensure the service supports service users undertake individual social and leisure pursuits. The registered manager must ensure that the service adheres to the established safeguarding protocols. The registered manager must ensure information is presented in an accessible accurate format to support service users make informed choices. The registered manager must ensure service users are adequately supported to eat their meals. The registered provider must ensure there are sufficient staff on duty to meet the assessed needs of service users at all times. The registered provider must ensure that the deputy manager post is recruited into without delay. The registered provider must ensure that the manager of the service has all training gaps identified. 20/09/07 20/09/07 20/09/07 20/09/07 20/09/07 20/11/07 20/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Mapleton Road DS0000058682.V331737.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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