Inspection on 05/03/09 for Maryland

This inspection was carried out on 5th March 2009.

CSCI found this care home to be providing an Excellent 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

Maryland 13/12/06

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 20/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Maryland 29 Townsend Drive St Albans Hertfordshire AL3 5RF     The quality rating for this care home is:   three star excellent 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: Patricia House     Date: 0 5 0 3 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 25 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Maryland 29 Townsend Drive St Albans Hertfordshire AL3 5RF 01727853601 01727848385 MARCIATONKIN@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Union of Sisters of Mercy Name of registered manager (if applicable) Marcia Tonkin Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: 1. The registered person may provide the following category/ies of service only: Care home only Code PC 2. The maximum number of service users who can be accommodated is: 30 to service users of the following gender: Female whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category Code OP Dementia Code DE Physical Disability Code PD Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 25 care home 30 Over 65 8 30 30 0 0 0 Brief description of the care home 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 conservatory and an enclosed garden. Residents have access to the convents chapel. Currently the fees range from 520 to 600 pounds per week. Information about the home and the services it offers are contained in its Statement of Purpose and Service Users Guide which are displayed in the entrance foyer together with the last CQC inspection report. Care Homes for Older People Page 5 of 25 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: three star excellent 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 key inspection of this service was completed on 18th January 2007. The information in this report is based on an unannounced inspection of the home, which took place over one day with one regulation inspector carrying out the work of the Commission. For the purposes of this report the Commission will be referred to as we. The registered manager was on duty throughout the day and we spoke with staff, residents and visitors. We visited all parts of the home and checked a variety of records. Care Homes for Older People Page 6 of 25 Before the inspection the manager had completed and returned to the Commission an annual self-assessment quality review, the Annual Quality Assurance Assessment, (the AQAA).This document included statistical information about the home and confirmation of policy reviews and equipment checks. We have also reviewed any other information we have received about this service between inspections. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 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 25 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. Standards 3 and 4. Standard 6 does not apply to this home. People using this service can be sure their needs are fully assessed and that the home can meet these and any specialist needs they might have. Evidence: During the inspection we tracked the care plans of some of the newer residents in the home. In all cases detailed assessments had been completed by senior staff in the home and, where appropriate, copies of care summaries had been provided by referring agencies. From this information initial care plans had been completed so that all the staff and the residents concerned were clear about individual needs and how it had been agreed to best meet them. The home has a separate dementia unit and we spent time speaking with residents Care Homes for Older People Page 10 of 25 Evidence: and care staff here and observing some of the activities taking place. The unit has its own secure garden and patio area and two members of staff were on duty while we were there. There is a range of equipment available to the residents in the dementia lounge and we saw some residents colouring books and drawing onto a board. One resident was involved in oregami and one was playing a ball game with a member of staff. Some soft toys were available and one was being held by a resident. Such toys are thought to provide comfort for some confused people. The dementia lounge also has a cage with two canaries in and staff said that some residents really enjoy the bird noises made. Care Homes for Older People Page 11 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9, 10 and 11. People who use the service can be sure their care needs will be appropriately met in the way they prefer and that the system for the administration of medication in the home is thorough and protects them from the risk of harm. Evidence: We spoke with a variety of residents during the visit and tracked a selection of the corresponding care plans. We found that the care planning was detailed and accurately reflected the needs of the people we had met. We saw appropriate health needs described and saw evidence that needs had been met and saw records of Health professional involvement where appropriate. We saw management plans showing how a residents special needs should be met and saw corresponding records showing that these needs had been met. The documents contained appropriate risk assessments including those for falls prevention and moving and handling. The records also contained emergency records to be used should any resident go missing from the Care Homes for Older People Page 12 of 25 Evidence: home. We also noted that at least one resident had completed a living will and that details were in place in the care records. The plans we looked at had been signed by the people concerned and residents confirmed they had been involved in their care planning. We spoke with care staff who said they have access to care plans at all times and regularly read the plans to ensure they are aware of residents current needs. We saw the daily records completed by staff and these demonstrate how care needs are met on a daily basis. The residents and visitor we spoke with said that staff at the home always maintained peoples dignity and privacy and provided services in the way they preferred. We observed that relations between staff and residents was excellent and that there was mutual respect between all parties. The visitor confirmed that they had been coming to the home for a long time and that they were always welcomed and that the care provided was excellent. The home has a comprehensive medication policy which is kept under review and was up to date. We observed the administration of medication during the visit and no errors were found in the system or the recording. The storage of medication was also appropriate and the storage was secure. Two residents currently self-medicate their drugs out of choice and we saw risk assessments and procedures in place to ensure this process was safe and residents were protected from harm. Care Homes for Older People Page 13 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15. People who use the service are provided with the daily stimulation they prefer and are supported to remain as part of the community. The meals provided in the home are nutritious and varied and help to support peoples good health and general well being. Evidence: During the inspection we saw the activity plan for the week displayed in the home. Events were advertised for every morning and afternoon. On the day of the visit residents had an exercise session provided and we saw more individual activities provided in the dementia unit. The home has a dedicated quiet room and we spoke with one resident who was reading in this area. The resident confirmed that they were reminded about the daily events by staff but that everyone could choose what activity they attended. One resident had chosen to remain in bed on the day and we spoke briefly with them. They were beautifully dressed and had water, soft toys and a call alarm positioned for easy reach to ensure their comfort. Another resident showed us the paintings they had completed and said they especially enjoyed this regular activity. There were photographs displayed of recent celebrations and trips out which had taken Care Homes for Older People Page 14 of 25 Evidence: place and staff said that more trips had been planned. One resident was in the garden during the visit and was appropriately dressed to ensure they were warm. Residents confirmed that a religious service took place daily in the home and there is a loop system in place in a communal hall for Mass to be shared. The manager confirmed that a Eucharist service also takes place and that all residents in the home would be supported to maintain their religion whatever the denomination. Care staff also confirmed that televisions were not left on all day if no one was watching them and that they varied the daily provision providing a mix of music, video recordings and television according to peoples wishes. Residents and the visitor we spoke with said there are no restrictions on when visitors are welcomed in the home and that personal choices were encouraged and supported by the manager and the staff. We saw the mid-day meal served during the visit and the food was beautifully presented and looked appetising . The residents we asked said the food was always excellentand that they always had a choice of at least two meal options. The tables in the dining room were nicely set and residents said they have sherry and juice offered every day. We noted that tea and coffee was served after the meal and residents told us this was provided every day. The menu was clearly displayed and the food served was as advertised. Residents also said that they have snacks provided during the day and that tea and biscuits, sandwiches and chocolate are offered each evening. We saw jugs of water provided in all the bedrooms we visited and saw water and glasses positioned in communal areas around the home. We visited the kitchen which had been recently up graded. Currently there are four residents who have diabetes and the chef confirmed that these people are provided with the same food and choices as other residents but the meals are adapted to meet the diabetic needs. The chef confirmed that records will now be kept to show what each resident eats each day to comply with current Health guidelines. The home has had a recent visit from the Environmental Health Officer and no concerns were raised. Care Homes for Older People Page 15 of 25 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. Standards 16, 17,and 18. Procedures followed in the home ensure that any concerns or complaints are listened to and that people who use the service are protected from abuse. Evidence: The home has written procedures covering complaints, safeguarding and whistle blowing. We spoke with some staff members who confirmed they had read these policies and were aware of their implications. care staff also confirmed they had received recent training in safeguarding and whistle blowing. No complaints had been received by the home or by the Commission about the service. The manager confirmed that all residents are registered for postal voting and are supported by staff to vote in elections if they wish to. Care Homes for Older People Page 16 of 25 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. Standards 19 and 26. People who use the service benefit from living in a comfortable home where the procedures followed help to protect them from the risk of infection. Evidence: We visited all parts of the home briefly during the inspection. All areas of the home were clean and looked homely and well maintained. Radiators have been covered to protect residents from the risk of harm and all the bedrooms we visited had call alarms in place with long leads where appropriate to ensure residents could access them at all times. We saw clear signage around the home so that all residents can be sure where bathrooms and toilets are sited and remain as independent as possible. Some residents confirmed that they had their own bedroom door key and some rooms had locks on the doors out of residents choice. The home provides assisted baths and showers for ease of use for residents and one area has a stair lift enabling the residents concerned to access the higher floor. We spoke with care staff who confirmed that they had access to disposable gloves and aprons at all times and all communal bathrooms and toilets contained liquid soap and paper towels. The use of these items is considered essential for maintaining good Care Homes for Older People Page 17 of 25 Evidence: infection control. Staff also told us that they were provided with two tunics which could be washed at home or on the premises so that the spread of any infection was minimised. Care Homes for Older People Page 18 of 25 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. Standards 27, 28, 29 and 30. People who use the service are supported by well trained and professional staff and are protected from abuse by the thorough recruitment procedures implemented in the home. Evidence: We spoke with residents and a visitor and they all felt that there were always enough staff on duty in the home to meet their needs. Residents praised the staff and said that call alarms were always answered promptly, both in the day and at night. We spoke with some newer staff and they said that their induction training had lasted for about two weeks and was thorough. They said that all staff can say if they are not confident about any area after training is complete and further training is then provided, with no pressure applied to finish quickly. A domestic worker we spoke with confirmed that they are given full induction training and are provided with up to date information about the home to ensure they feel part of the staff team and are kept aware of any relevant issues. The manager said that all staff in the home are either doing or have completed Care Homes for Older People Page 19 of 25 Evidence: relevant NVQ training. This includes cleaning staff, support staff and kitchen staff. The manager has completed a new training plan for all staff which is comprehensive and will be provided by an external company. Details were provided during the inspection. We checked a selection of staff recruitment files and saw evidence that all appropriate checks had been in place before staff started work at the home. Care Homes for Older People Page 20 of 25 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. Standards 31, 33, 35 and 38. People who use the service can be sure that the home is well run and that procedures followed ensure their views are listened to and ensure that they are protected from the risk of any unnecessary harm. Evidence: The manager is registered with the Commission and demonstrated, during the visit, a comprehensive knowledge of all the current guidance which relates to people living in care homes. The residents, staff and visitors we spoke with all praised the manager and said that their views were listened to and all felt included in decisions made about the home. The manager is currently the named link person who liaises with the Health Protection Agency to ensure current Health information and advice is always available. The manager also completes regular audits of the care provided and one of the trustees of the home provides regular monitoring visits to ensure the home continues Care Homes for Older People Page 21 of 25 Evidence: to run efficiently. The home operates a formal quality assurance programmer and surveys are regularly provided for residents and other stakeholders for their comments. There is also a suggestions book displayed in the foyer and families and visitors are able to write comments in this to enable the manager to be sure that the care provided is as people prefer. Regular residents and staff meetings are held and minuted to ensure that everyones views are heard and acted on. No money is held in the home for residents. The manager said that there are facilities in the home to pay for any expense needs a resident might have and the family would then be invoiced for the amount of money used. Families generally deal with the residents finances or residents can handle their own affairs for as long as they wish. We saw no areas in the home where any hazardous substances were accessible to residents and care staff confirmed that they were well trained in assisting residents to transfer safely should they need help. The fire records we checked were all in order and the care staff we asked said they had all been involved in recent fire evacuation practices. Care Homes for Older People Page 22 of 25 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 23 of 25 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 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Older People Page 25 of 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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!