Inspection on 13/12/06 for Maryland

This inspection was carried out on 13th December 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Maryland 05/03/09

Maryland 25/11/05

Maryland 05/08/05

Maryland 13/01/05

Maryland 02/09/04

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

CARE HOMES FOR OLDER PEOPLE Maryland 29 Townsend Drive St Albans Hertfordshire AL3 5RF Lead Inspector Mrs Jan Sheppard Unannounced Inspection 10:00 13 December 2006 – 18 January 2007 th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Maryland DS0000019461.V306390.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. Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maryland Address 29 Townsend Drive St Albans Hertfordshire AL3 5RF 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) 01727 853601 01727 848385 marylandcarehome@aol.com Union of Sisters of Mercy Marcia Tonkin Care Home 32 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (32), of places Physical disability over 65 years of age (32) Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th November 2005 Brief Description of the Service: Maryland Residential Home is set in its own attractive and well maintained grounds in a quiet residential area of St Albans, to the north of the city and close to the City Hospital. Accommodation is offered on three floors served by a passenger lift and four stair-lifts. All thirty-two bedrooms, of which many are of a sufficient size that they are set out as bed/sitting rooms, are for single occupancy. There are spacious communal areas comprising two dining rooms, a lounge on the ground floor, a library, a hair dressing salon and various small sitting areas. The home has a ground floor, eight bedded self-contained unit complete with a new conservatory and an enclosed garden. Residents have access to the convents chapel. Currently the fees range from £463 to £515 per week. Information about the home and the services it offers are contained in its Statement of Purpose and Service Users Guide. Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit was conducted over one day by one inspector during which the manager, deputy manager, staff on duty and residents were all spoken with. A tour of the building was also undertaken and Care and Administration records were checked. This report reflects the observations made in the home on that day and also takes account of the information gathered from the pre-inspection questionnaire recently completed by the homes manager, details given in some thirty three questionnaires completed by the residents and relatives and of other information periodically sent to the Commission from the home. The inspector also made telephone contact with a number of relatives in the weeks following this inspection visit day. This was a positive inspection. Requirements and Recommendations made following the last inspection were found to have been met. Two requirements and one recommendation are made following this inspection. What the service does well: What has improved since the last inspection? Since the last inspection the planned programme of refurbishment works have continued with a rearrangement of some sitting areas, redecorations and some new furnishings being provided. Improvements have also been achieved in the dementia care unit. Various new items of furniture have been purchased, these following OT assessment are to meet the specific changing needs of individual residents. New ways of working have been introduced for the staff this following specialist dementia care training undertaken by some staff and also to accommodate the increased and changing care needs of the residents. Maryland DS0000019461.V306390.R01.S.doc Version 5.2 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. Maryland DS0000019461.V306390.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 Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 does not apply, as this home does not offer intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The care needs of all prospective service users are fully assessed by the manager before visits to the home or decisions about admission are taken. EVIDENCE: The homes pre admission policy and procedures are fully compliant with the requirements of these standards and were seen to have been fully carried out for residents recently admitted to the home. Recently admitted residents spoken with confirmed that their admission process had been handled sensitively and been managed at a pace which suited them. Pre admission needs assessments are reviewed after approximately six weeks in residence to ensure that any changing needs are fully met. Assessments and reviews include relatives whenever the residents wish for their involvement. Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 9 The home provides an up to date Statement of Purpose and Service Users Guide for all prospective new residents. The manager explained the process for one resident recently admitted for whom not all the required information had been divulged. The manager explained that in this instance she had made more than one visit to the prospective residents own home to carry out an assessment and had deferred her admission until the prospective resident was sufficiently fit, this to ensure that the home could fully meet her needs. This resident is now happily settled in the home. Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 10 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. All the residents care needs are set out in their individual care plan. Prompt access to health professionals is available when needed. The homes robust policy and procedures for the storage and administration of medication were found to be being followed and the standards met. Recommendations to further improve some medication procedures are made. Residents are treated with respect and dignity. EVIDENCE: Personal care was seen to be being delivered in a kindly manner by staff that clearly knew their residents well, understood their care needs and were endeavouring to meet these in a manner that retained their dignity and respect. It was noted that the staff worked very well together as a team and that they promoted a calm and relaxed atmosphere within the home. Staff Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 11 were seen to be following the detail as set out in the care plans. The care plans examined were found to be well maintained with clear instruction as to how individual care needs should be met, to have appropriate risk assessments and to be regularly reviewed. Visits by the Doctor were recorded and the District Nursing notes were easily assessable and gave clear instruction as to the care processes to be continued on a daily basis between the nurses visits. The administration of medication was observed to be being carried out discretely and individually in a manner which best suited the needs and wishes of the individual residents. The home uses a Monitored Dosage Medication System provided from a local pharmacy. There is good storage space for medication in a temperature-controlled area with a medication fridge and a controlled drugs cupboard also being provided. Medication trolleys are used to take supplies to the various areas of the home. The MAR (medication administration record) sheets examined were found to be well recorded with no omissions and appropriate detail where variations occurred. Only senior staff administer medication and all have undertaken training to do this. Two residents self administer their medication and it could be evidenced that their wish to do this had been discussed with their GP and was subject to individual risk assessment. The manager explained that she regularly monitors this along with the accuracy of the MAR sheets. To further improve these standards it is recommended that the manager establishes a recording system to evidence her regular spot checks and that individual Controlled Drugs registers are purchased with one kept for each individual resident as this will aid the clarity of the recording of controlled medication administered. A visiting relative who spoke with the inspector confirmed her satisfaction with the manner in which her mother was being cared for. She explained that as a medical professional herself she had frequent contact with residential care services and she described Maryland as one of the best homes she had seen. “ My mother is very happy here, enjoys the activities and appreciates the individuality of the care services” she said. Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 12 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home provides a variety of activities which meet the varied needs of the service users. Relatives and visitors are always welcomed into the home. Good quality and nutritious food is provided. EVIDENCE: Without exception all residents spoken with were very complimentary about the quality and variety of the food. One resident did mention that she sometimes found the vegetables too hard and the kitchen staff agreed to address this comment. The serving of lunch was observed by the inspector. The meal was presented in an appetising manner with residents, who are helped to make a daily menu choice, being reminded as the meal was being individually plated for them and their portion size requirement checked. The food was of good appearance and colour and residents confirmed that it was served at the correct temperature and that it was very tasty. Abundant Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 13 supplies of fresh fruit were seen to be available in many locations around the home. Staff were observed to be assisting residents to eat in an appropriate manner and individually assessed speed and to be retaining the residents dignity whilst encouraging them to do as much for themselves as they could comfortably manage. The home has a varied weekly activities programme led by the homes regular staff as well as external organisers who visit the home. Classes include Art Therapy, Music and Memory sessions and an Exercise class. On the day of this inspection a concert given by a local orchestra was very much appreciated by the residents. One told the inspector “ we have a concert given by this ensemble every year and they just get better and better.” The manager explained that individual sessions tend to be held in the mornings with group activities in the afternoons. Since the last inspection the home has twice hired a “Jambulance” coach and taken residents to visit Portsmouth and a trip to the London Eye. The ’jambulance’ is a specially adapted coach that can transport residents with medical needs, safely. Other more local visits to garden centres and to take lunch in a country pub were also mentioned. Several residents talked to the inspector about these outings, which were clearly much enjoyed. The manager discussed her wish to further develop the range of activities offered especially to accommodate the needs of the residents on the extra care unit. Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 14 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The home has a robust complaints procedure and follows the Safeguarding Adults procedures as set out in the Hertfordshire County Council joint Agency Guidelines. EVIDENCE: There have been no formal complaints nor any new incidents concerning Safeguarding Adults since the last Inspection. The records relating to Joint Agency Meetings held earlier this year which concerned a complaint made some years ago evidenced that the home follows its comprehensive complaints procedure and works closely with other agencies in matters relating to adult protection. The inspector was shown a number of letters complimenting the care given to service users that have been received since the last inspection. Staff all attend training on safeguarding vulnerable adults and whistle blowing procedures. Staff spoken with during this inspection were familiar with what action they should appropriately take if they ever had suspicions concerning possible abuse. Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 15 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): 19,22, 23,24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home is spacious, well appointed and maintained and adequately meets the space and facility provision standards. However on the day of this inspection it was not entirely free of odour and although the home was generally safe one exception was noted that could leave the residents at risk. EVIDENCE: The home was found to be very clean and tidy with spacious space provision and attractive decorations. One identified bedroom, had a strong odour associated with incontinence. A number of radiators were found not to have low surface temperature covers which could put residents at risk. All radiators have these covers and that new risk assessments must be completed whilst these works are carried out. Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 16 All the residents spoken with said that they were very happy with the homely environment of the home the communal facilities provided and their individual bedrooms which were all seen to be very well personalised reflecting their individual interests and tastes. The manager showed the inspector the annual programme of refurbishment and improvement, which is gradually being carried out. Specialist equipment is provided for each resident to meet their particular needs following an OT assessment. This promotes the residents ability to retain their independence for as long as possible. Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is adequately staffed with experienced and qualified carers who seemed to be very positive about their work and to work well together as a team. The home has robust policies and procedures for the recruitment of staff which ensure the proper protection for the service users. EVIDENCE: Staff were seen to be working well together as a team and to be providing support for the residents in a kindly unhurried manner this allowing them to do as much for themselves as it is safely possible for them to do. Staff were found to be familiar with the needs of the residents and a good rapport was seen to exist between them. The home continues to retain a very stable core group of dedicated and welltrained staff. No staff has left since the last inspection and no existing staff have been subject to any disciplinary action. Staff who spoke to the inspector during this inspection all said that they were happy working at the home, happy with the manner in which they were managed and with the training opportunities offered them. Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 18 The home has a robust recruitment policy and does not employ staff until all the statutory identity and security checks have been carried out. The three staffing files examined during this inspection of recently recruited staff evidenced that this was so. The home offers good internal training with each staff member having an individual annual training needs profile with mandatory repeat training courses being monitored closely. The number of staff attaining NVQ level 2 has increased over the past year but still does not meet the requirement for 50 of staff on any shift to have attained this qualification. Howeve, the manager explained that a number of more recently recruited staff do hold overseas nursing and care qualifications which are currently being verified by our UK standards board. Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is run in the best interests of the service users. The registered manager provides strong leadership with in the home. The health and safety of the residents is promoted by the homes good maintenance of its safety checks and procedures. EVIDENCE: Since the last inspection a new deputy manager has been appointed. She is appropriately experienced for this role and holds an NVQ level 3 qualification. The manager confirmed that a supervision matrix is in place to ensure that all staff receive formal supervision at least six times a year. Staff spoken with Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 20 confirmed to the inspector that they felt themselves to be well supervised and managed and that they could always speak to the manager at any time. Regular staff meetings are now held with appropriate agendas and minutes being kept. Without exception residents, relatives and visiting professionals interviewed for this inspection confirmed that the manager and her team were always very approachable and make every effort to sort out any problems quickly. A relative commented that “ the managers usually sit with an open door it is always possible to speak with them and am always made to feel welcome when visit the home.” The records relating to Fire testing, the monitoring of water temperatures, risk assessments for the environment and safety checks for the homes equipment were seen to be well maintained this ensuring the safety of the residents at all times. Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 21 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? no 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 OP26 Regulation 23(2)(d) Requirement The Registered Manager must ensure that all areas of the home are kept free from odours including those that could be associated with incontinence. Timescale for action 22/02/07 2. OP19 13 (4) (a) The Registered Manager to ensure the safety of the residents at all times must arrange for all radiators to be protected with low surface temperature covers. These to be provided in vulnerable areas of the home by 31/3/07 and in other areas by 31/6/07 with work progress reports submitted to the CSCI. 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 23 No. 1 Refer to Standard OP9 Good Practice Recommendations It is recommended that the Manager establishes a system to evidence when management checks are made to ensure the accuracy of the medication administration records. Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Maryland DS0000019461.V306390.R01.S.doc Version 5.2 Page 25 - 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. 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