Inspection on 06/12/05 for Mapleton Road

This inspection was carried out on 6th December 2005.

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 28/03/07

Mapleton Road 23/06/06

Mapleton Road 10/03/06

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 6th December 2005 1:00 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.V269161.R01.S.doc Version 5.0 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.V269161.R01.S.doc Version 5.0 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.V269161.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st January 2005 Brief Description of the Service: 87 Mapleton Road is a care home registered to provide personal care for a maximum of twenty-four older people with mental health needs. The home is a large detached, single storey building with twenty-four bedrooms. All bedrooms are single rooms with a washbasin. Only two bedrooms have ensuite facilities. There is a large main kitchen where meals for service users are prepared. In addition, there are two small kitchenettes where drinks and snacks can be prepared. Facilities for service users include two large communal lounges with dining areas. There are seven toilets, two bathrooms and two shower rooms. One of the bathrooms has an assisted bath. Mapleton Road DS0000058682.V269161.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is the result of a four hour unannounced inspection on an afternoon in mid December 2005. The manager was not on duty so some records were unavailable for inspection. As part of the inspection the inspector read care records pertaining to the care of the service users and other documents relating to the running of the home. The inspector observed the interaction between staff and service users and how staff carried out some of their work. The inspector toured the home and saw some service users bedrooms in addition to the main kitchen and communal living space, laundry and bathrooms. The inspector spoke with both service users and staff about living and working in the home. The inspector would like to thank everyone at Mapleton Road for their assistance in the inspection process. What the service does well: What has improved since the last inspection? The service has recarpeted most areas of the home and this has dramatically reduced the malodour. More appropriate care planning and risk assessments have been introduced and whilst this is an improvement these need further development. The service has improved it recording and administration of service users medication. Mapleton Road DS0000058682.V269161.R01.S.doc Version 5.0 Page 6 What they could do better: 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.V269161.R01.S.doc Version 5.0 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.V269161.R01.S.doc Version 5.0 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, 4 The home fails to fully assess whether or not it can meet someone’s needs before they are admitted and staff do not always know new service users needs. EVIDENCE: The inspector read the file of a recently admitted service user. There was evidence that the home had assessed the service user before admission and had the opportunity to gain extensive information. The admission was planned. Both the care management report and the previous care setting had noted behaviour that may well present risks to other service users or staff. The inspector spoke with staff on duty including the person in charge of the shift who were able to detail the service physical care needs and medical issues. However no-one was aware of the issues behind the service users transfer from another home or that there was a possible a risk to other service users. The information was not recorded on either the home’s assessment or on the risk assessment. The service user told the inspector that Mapleton Road was “OK but the other place was better.” Mapleton Road DS0000058682.V269161.R01.S.doc Version 5.0 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, The home does not make adequate arrangements to care for very ill service users. EVIDENCE: On arrival at the home the inspector was concerned to see a very frail service user not receiving the appropriate level of support needed. She was in a wheelchair with in an extremely uncomfortable position with neither her feet or head supported. The inspector spoke with staff who transferred the service user into a more comfortable position. The inspector was concerned about the apparent poor health of one of the service users staff confirmed she had been discharged from hospital a week earlier and they were concerned about her deterioration. Despite the concerns she had not been seen by her GP although staff made arrangements for this during the inspection. The staff in charge told the inspector that the district nurses had seen the service user the previous day, although there was no record of this visit on the district nurses notes. There was a pressure mattress on the service users bed to help prevent pressure sores, however it was not at the correct setting and staff did not understand its operation. Staff confirmed the service user was spending Mapleton Road DS0000058682.V269161.R01.S.doc Version 5.0 Page 10 prolonged periods in bed however there was no guidance or information about the steps staff need to the taking to prevent pressure sores or the care of a bed bound service user. The inspector read the care plan and risk assessment neither of which reflected the service users condition for example the risk assessment described how the service user needed the assistance of staff to walk and was at risk of falling however the service user was unable to stand and required the use of a hoist to be transferred. The inspector observed some very sensitive and appropriate care during the course of the inspection however it was noted with concern that on two occasions staff did not offer service users any reassurance or explanation before using the hoist to transfer them. Neither was a member of staff mindful to knock on a service users door before entering her bedroom. The service users medication is securely held. All Medication Administration Records have a photograph of the individual service user. The inspector checked a random sample of medication and found the medication held and records were in order. Mapleton Road DS0000058682.V269161.R01.S.doc Version 5.0 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 The routines and practices in the day to day running of the home do not always promote the wellbeing for service users with dementia. EVIDENCE: Individual social and leisure activities are not planned for rather the home offers service users groups of activities. The inspector observed a quiz taking place in the afternoon. A service user told the inspector “I like to do things and keep busy but there isn’t much for me to do here”. The home has two large through lounges both of which have music playing. When the inspector arrived in the home the radio in one lounge was at a volume that the inspector was unable to hear the staff speaking to her and had to request for the volume to be reduced. In the same lounge the volume on the television was turned off with only the picture on the screen. It further adds to anyone’s confusion to see a newsreader on the television but hear only Pop music. The noise level in the lounge was not conducive to any form of social interaction. When the inspector raised her concerns to staff about the level of noise she was informed that the service users all enjoyed the music playing. However the inspector met one service user who said she was feeling cold sitting in the foyer but declined to return to the lounge because of the “endless racket”. Mapleton Road DS0000058682.V269161.R01.S.doc Version 5.0 Page 12 The home has a very small quiet lounge in which service users may sit or receive visitors. From reviewing care files it was evident that the home does keep family and representatives appropriately informed and there are no restrictions on visitors. In one service users bedroom the inspector noted that that an external lock had been put on her wardrobe. Staff stated they have access to the key but the service user does not. A member of staff explained that this was because the service user may put soiled clothing or pads in the wardrobe. It is an extremely disempowering experience for someone not to have free access to her own clothing and to see that other people do. It is an example of a service users rights being infringed upon rather than adequate and appropriate supervision and support. The inspector saw the lunch served to the service users, two of whom confirmed it was “OK”. However there was no alternative offered as recorded on the menu. The inspector then checked the prepared evening meal and found that it was not as recorded on the menu. Mapleton Road DS0000058682.V269161.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The home failed to follow its own adult protection procedures following an unexplained injury. EVIDENCE: The inspector read a letter from the manager to a relative in response to a complaint. Whilst the letter was detailed there was no information in the file detailing the actual complaints or concerns. The shift leader explained to the inspector that all complaints/concerns are recorded in the staff communication book. The home will have to have a central record in which the details of all complaints are documented and available for inspection. Several weeks before the inspection the Commission was advised that a service user sustained a serious unexplained injury which resulted in a hospital admission. In this instance the service failed to take prompt action in line with its own adult protection procedures. Mapleton Road DS0000058682.V269161.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 25, 26 The home has undertaken a lot of work to improve the environment for service users. EVIDENCE: The home was clean and free from any malodours. Considerable work has been done to improve the environment including recarpeting, and renewing unit kitchen surfaces. Staff told the inspector that some new bedroom furniture had been purchased, however the inspector saw some bedrooms with wholly inadequate furniture and fabrics. Some sheets were threadbare and the program to replace old mattresses and divans must continue. Curtains need to be fixed on rails. In the late afternoon of the inspection the inspector found the unit corridors to be cold, this was as a result of service users bedroom windows being open from morning. The uncomfortably low temperatures reduce the service users choice of areas to sit by preventing them access to their private accommodation. Mapleton Road DS0000058682.V269161.R01.S.doc Version 5.0 Page 15 The inspector observed staff to be using a variety of aids and equipment to support service users. Whilst there was some signage around the home to guide service users many service users bedrooms lacked any means to assist service users identify their personal space. Mapleton Road DS0000058682.V269161.R01.S.doc Version 5.0 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, 30 There are insufficient staff on duty to meet the needs of the service users. EVIDENCE: Several service users during the course of the inspection commented positively on staff describing them and “very nice” and “kind”. Staff on duty told the inspector felt they were rushed in their role and had insufficient time to spend quality time with service users. From observation the inspector agrees with the staff teams perception, it was of concern that the staffing rota appeared to lack any flexibility to meet the change in service users health needs. The inspector was concerned that staff did not have sufficient time to adequately support with a very ill service user as they were very occupied meeting the day to day care needs of the other service users. The staff team is already stretched so there needs to be additional staffing resources available at times of increased dependency such as periods of ill health or when a service user is dying. At previous inspections the service has been required to undertake a review of its staffing levels particularly around meal times this requirement remains unmet. The inspector checked the homes rota for the day of the inspection and noted it did not reflect the staff team on duty. Whilst the number of care staff to Mapleton Road DS0000058682.V269161.R01.S.doc Version 5.0 Page 17 provide care to service users was the same not all staff recorded as on duty were actually in the home. The manager was unavailable on the day of the inspection and the inspector was unable to access any staff files to review the homes recruitment, or training these will be tested at the next inspection. Mapleton Road DS0000058682.V269161.R01.S.doc Version 5.0 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): 36, 38 The home takes steps to promote service users and staffs’ health and safety. EVIDENCE: Although the inspector had no access to files all staff on duty confirmed they received regular supervision and support. The inspector reviewed a variety to records the home keeps to demonstrate it maintains the health safety and welfare of service users and staff. Chilled food is stored at safe temperatures, which are monitored twice daily; the home checks and maintains records of water temperatures. The home ensures fire fighting and detection equipment is regularly tested, serviced and maintained. Mapleton Road DS0000058682.V269161.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 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 2 17 X 18 2 3 3 X 3 X 2 2 3 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 3 X 3 Mapleton Road DS0000058682.V269161.R01.S.doc Version 5.0 Page 20 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 OP4OP3 Regulation 14 Requirement The registered person must ensure that identified issues are appropriately risk assessed prior to admission and that staff are kept informed of such issues. The registered person must ensure each service user has a comprehensive care plan that describes how the service will meet their presenting needs. The registered person must ensure all service users receive prompt medical support. The registered person must ensure all staff receive training pressure area care and the use equipment. The registered person must ensure staff receive training in the principles underpinning good practice such as privacy, dignity and respect. The registered person must ensure service users individual social and leisure needs are planned for. The registered person must ensure service users have access to their personal belongings. DS0000058682.V269161.R01.S.doc Timescale for action 23/02/06 2 OP7 15 23/02/06 3 4 OP8 OP8 13 13 20/01/06 23/03/06 5 OP10 18 23/02/06 6 OP12 15 23/02/06 7 OP14 12 23/02/06 Mapleton Road Version 5.0 Page 21 8 9 OP14 OP16 12 &16 22 10 OP18 13 11 12 OP25 OP24 23 23 13 OP21 23 The registered person must ensure service users are offered a choice of main meal. The registered person must ensure all complaints received are logged in a record that can be presented for inspection. The registered person must ensure the prompt reporting of all unexplained injuries to service user in line with adult protection procedures. The registered person must ensure that bedrooms are at a comfortable temperature. The registered person must ensure bed linen is replaced as necessary and continue replacing beds. The registered provider must ensure that the wall surfaces in all bathrooms and toilets are made good and these areas redecorated. (Repeated) The registered person must ensure the staffing rota accurately reflects the staff on duty. The registered person must ensure that staff receive training in the care of the dying. 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.) 20/01/06 20/01/06 20/01/06 23/02/06 23/03/06 23/02/06 14 OP27 18 23/02/06 15 OP30 18 20/03/06 16 OP27 18 23/02/06 Mapleton Road DS0000058682.V269161.R01.S.doc Version 5.0 Page 22 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.V269161.R01.S.doc Version 5.0 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. Extracts may not be used or reproduced without the express permission of CSCI Mapleton Road DS0000058682.V269161.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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