Inspection on 23/05/06 for Silverdale

This inspection was carried out on 23rd May 2006.

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

Silverdale 07/11/05

Silverdale 25/05/05

Silverdale 09/02/05

Silverdale 19/07/04

Silverdale 14/01/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOMES FOR OLDER PEOPLE Maple Lodge 116 Lodge Lane Grays Essex RM16 2UL Lead Inspector Mrs Nikki Gibson Key Announced Inspection 23rd May 2006 09:00 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 Maple Lodge DS0000018051.V296336.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. Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maple Lodge Address 116 Lodge Lane Grays Essex RM16 2UL 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) 01375 396789 01385 396789 Mrs Masarath Jahan Khan Mr Mohamad Ali-Khan, Mr Firasat Ali-Khan Manager post vacant Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7 March 2006 Brief Description of the Service: Maple Lodge provides personal care and accommodation for up to 14 older people. It is not registered to care for people with dementia. The home has eight single bedrooms and three shared rooms. Three of these have private en-suite facilities. Bedrooms are situated on the ground and first floor and a passenger shaft lift gives access to the first floor. There is one communal lounge and a separate dining room. The home is furnished, equipped and maintained to a good standard and bedrooms are personalised. There is a large garden area at the rear laid to lawn and planning permission is being sought for an extension. The home is in a residential area, close to Grays Town and Lakeside Shopping Centre. Maple Lodge was registered in 1992 and is a private home. The Service User Guide and Statement of Purpose are under review and the most recent resident and their representatives were not provided with this information and the home did not provide them with Commission for Social Care Inspection reports. The proprietor said that fees at the time of this report range from £375.69 to £395.43 per week. The homes e-mail address is masarathkhan@btinternet.com Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection which covered all the key National Minimum Standards. The site visit took place over 10 hours by two regulation inspectors. During the visit there was a tour of the premises and a selection of records and documents were studied. Time was spent in the lounge and dining room, and with residents in their own rooms observing practice. Five residents were spoken to about life at Maple Lodge. The inspection process also included discussions with one of the three proprietors, all the staff on duty, relatives and visiting healthcare personnel. Surveys were sent to residents, the District Nursing team, the GP Practice and a social work team who are involved in the home. Survey responses have been included in the relevant sections of the report. A pre-inspection questionnaire and other reports and correspondence provided by the proprietors were also used as evidence to inform this report. The home and staff are thanked for their interest and help with the inspection. The proprietor said that it had been a pleasant visit and she thanked the inspectors for their guidance and support. A senior member of staff said it had been helpful to be able to discuss things in depth. Due to the particular concerns raised regarding the welfare of two residents the CSCI inspector made referrals to health and social care agencies to review the residents care and to provide additional support and guidance to the home. What the service does well: What has improved since the last inspection? The proprietors have very recently employed a Management Consultant to help them raise standards and meet National Minimum Standards. Considerable financial investment is also being put into the home which if professional guidance is followed will raise the level of residents’ safety and comfort. Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 6 Staff have recently received training in a range of topics related to the care of the elderly. Nutritional standards have improved with the introduction of fresh fruit and a choice at meal times. A new cook has been employed and resident’s comments about the food were complimentary. A new complaints policy is being introduced and any complaints will be fully investigated and recorded. Fire safety in the home is gradually being addressed and a locking devise on the front door is linked to the fire alarm system to ensure residents would not be trapped in the event of a fire. Considerable refurbishment has taken place and new carpets and some washable floors replaced. All areas of the home are now fresh and odour free. Electrical hazards noted previously have been addressed. Infection control standards in the home have improved. What they could do better: At the last inspection the home was failing in many areas and there were twenty two statutory requirements and seven recommendations were detailed in the report. Immediate Requirement notices were sent to the home on the most urgent issues which put residents most at risk. The local authority monitoring the home had similar concerns and stopped placing new residents. The home is without a manager and struggles to fully understand legal requirements and keep up to date with good practice. The home is making progress, however this is slow and twenty three requirements and seven recommendations are detailed in this report. Prospective residents do not receive information about the home to make an informed choice. There is no evidence of adequate pre-admission assessments taking place. This has lead to an inappropriate placement and the home having difficulty meeting this residents needs. The home must maintain records about the residents which include instructions for staff about the help that each resident needs. Improvements are required in the way residents are cared for. Staff must use appropriate moving and handling techniques, provide the level of help each resident needs and ensure that medication is administered properly, these are serious issues which must be addressed as a matter of urgency. The home needs to provide a wider range of activities suited to the differing interests and abilities of the residents. Residents need to be given the opportunity to exercise choice and control over their daily life and any restriction should be agreed and recorded. Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 7 Staffing levels agreed by the CSCI must be maintained and recruitment practices must be more robust to adequately protect residents. Staff training needs to continue and correct procedures learnt on courses must be introduced into practice in the home. The lack of adequate management in the home must be addressed as it puts residents at risk. Staff lack leadership and supervision to undertake their roles to the standard they would wish. The home needs a quality assurance system in place so they can monitor their success in meeting the aims and objectives of the home. Failure of the home to take urgent action to address the concerns raised in this report may lead to enforcement action taking place. 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. Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 8 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 Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 9 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): 1234 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective residents do not receive adequate information about the home to make an informed choice. Residents are accommodated without adequate preadmission assessments and this has lead to the home not always being able to meet the residents needs. EVIDENCE: The proprietor said that there were plans to review the information about the home and a previous time scale to complete this has not been met and more time was required. Prospective residents do not receive copies of the Statement of Purpose or Service User Guide and they are not given access to Commission for Social Care Inspection reports. In an anonymous survey one resident said that they had not received enough information about the home to enable them to decide if it was the right place for them. The proprietor said that she was going to review her statement of terms and conditions and at present residents did not have copies. No contracts or statement of terms and conditions were available in residents’ files and residents’ surveys confirmed they did not have contracts. Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 10 Resident files inspected did not contain any pre-admission assessment. The proprietor said that she undertakes the assessment herself however the preadmission assessment for a recent resident had been mislaid. The home is registered for older people, not falling within any other category. However, one resident had a diagnosis of Schizophrenia and had serious mental health issues which the staff were not experienced or trained to manage. The resident was isolated and her specific and complex needs were not being met. Maple Lodge does not provide intermediate care. Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans lacked instructions for staff on how residents’ personal and social needs are to be met. Staff worked positively with health care workers but were not always adequately equipped to meet residents needs. Procedures in the home for the administration of some medication were not adequately safe. Staff at Maple Lodge treat residents with kindness but residents privacy and dignity were not always maintained. EVIDENCE: The home acknowledges that their present Care Planning system does not assist them to provide a consistent good standard of care. Staff spoke of being frustrated that the format did not provide space where instructions for staff could be recorded. Scraps of paper with instructions and messages were found loose in care files. There was no risk assessment for a resident who had been provided with bed rails and staff were unaware of what was required to be checked and recorded to ensure the safety of the resident. Concerns about the care plans have been raised with the home for over a year. The proprietor had a sample of an alternative care plan which she said she would discuss with the Management Consultant. Any system used needs to be simple and clear and staff need to be adequately trained in its use if residents are to benefit. Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 12 The dates of GP and District Nurse visits are recorded in a communal book and staff said any other information is recorded in the daily notes. A resident with mental health problems has been accommodated. At present the home is unable to meet her needs, but it was seen positively that the home has now taken steps for a mental health assessment to take place. At present this resident is sitting day and night in an upright chair. The healthcare workers have reported this is adversely affecting her health, particularly the skin on her legs. Steps must be taken to find a way to meet this residents needs and the home must work with other professionals and ensure appropriate equipment is provided. One resident was identified by staff as requiring daily exercises prescribed by the hospital, however there was no evidence in the care plan or daily notes that this takes place. Staff spoke of a resident with glasses, however they were unaware whether they were required for general use or for reading. Wearing the wrong glasses increases a persons risk of falls. It was pleasing to note that all residents wore well fitting shoes or slippers. Most staff have received a half days training in Moving and Handling since the last inspection, so it was of particular concern to see dangerous manoeuvres taking place which put the resident and staff at risk of injury. Concerns about the way this resident was handled has been raised at both previous inspections and has also been raised by the district nursing team. In the presence of the inspectors when staff tried to lift the resident by the armpits she cried out and staff lowered her back into her chair. After that the resident remained in her chair for the following seven and a half hours. At teatime she was seen to be lifted by the armpits, turned and sat in a wheelchair. The resident was clearly not weight bearing. The home was advised to request an urgent Occupational Therapy assessment and in the meantime to discuss the residents needs with the District Nurse and Social Worker. A healthcare worker said that they had noticed that care staff did not always make it clear to the resident what they were going to do and this made the resident very resistant. Residents do not always receive adequate help and support. Following two falls in the night a resident was taken to A and E by ambulance with head injuries. It is recorded in the daily notes that the hospital complained that the resident who was partially sighted and confused was not accompanied by a member of staff and they did not receive adequate information about her. It is also the Placing Authorities policy that staff escort residents until handed over to a relative. The home remains responsible for residents while attending hospital and a failure to escort residents puts them at serious risk. The GP practice report that residents are never brought to the surgery for appointments and on occasions it would be in the residents’ interest for them to be taken to the surgery where a more thorough examinations could take place. The processes for administering medication were inspected. Staff said they had received training since the last inspection, however it had not lead to any Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 13 changes in practice. A brief audit of medication prescribed ’as and when required’ (PRN) identified serious errors. For example one bottle of 28 Senna which was prescribed a year ago now had approximate 40 tablets in the bottle. Staff said that medication is transferred from one bottle to another. They said that sometimes medication is decanted from boxes to bottles or from small bottles to larger bottles, sometimes labels are peeled off and put on other containers. PRN medication had been removed from the prescriptions and Medication Administration Records (MAR) sheets. A separate hand written record was held by the home which did not record the strength or dose of the medication. Initially staff were unaware of the danger of these practices, but became increasing concerned when realising the risks involved and gave a commitment to seek advice and take steps to change all staff practices in line with the Royal Pharmaceutical Society of Great Britain’s guidelines. Staff spoke of residents with respect. On the day of inspection chiropody treatments took place in the privacy of an unused bedroom. Obviously this will not be possible when resident numbers increase and the room is occupied. During the inspection a district nurse provided medical treatment in a residents own room and staff took care to ensure the door was closed and the residents privacy was maintained. However, GPs who visit the home raised concern in their surveys that residents were examined in other residents’ bedrooms. This practice is a breech of privacy for both residents. Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents have very limited choices and the level of stimulation is poor. There is some contact with the local church and visitors are welcomed. The standard and choice of food has improved but staffs awareness of the support residents need was not of a high standard. EVIDENCE: Staff said that ‘activities’ take place between 10.30 am and 11.00 am as that is the only spare time they have between other tasks. On the day of the inspection a game of Bingo took place in the morning and music was played in the afternoon. A member of staff efforts to engage the residents in a conversation about the war was unsuccessful. In the surveys returned by residents the lack of stimulation was raised. One resident said that she would like activities in the evening as well as the daytime. Visitors to the home both relatives and healthcare workers spoke of the lack of physical and mental stimulation. One resident said they would like staff to help them access the garden in summer. In the GP surveys reference was made to the fact that residents have not been seen to access the garden. Staff spoken to were unaware of pastimes suitable for people with dementia and there was a clear training need. The home is advised that providing stimulation and meaningful pastimes is an integral part of good care of the elderly and should not be an optional addition undertaken if time allows. Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 15 The home may wish to obtain further advice on appropriate activities for the elderly from the National Association for Providers of Activities for Older People on 02070789375 Fax 02077359633 Email: info@napa-activities.co.uk NAPA Bondway Commercial Centre 5th Floor unit5.12 71 Bondway London SW1 8SQ The home has fortnightly visits from the Catholic and Methodist churches. One member of staff said that visitors would not be expected to stay during meal times or to visit after 7.00 pm. A more open policy would benefit both residents and visitors. At present there are no facilities where residents can meet their relatives in private apart from bedrooms some of which are shared rooms. The home has rather rigid routine which is task orientated and residents have limited choices. Residents spoken to made reference to not wanting to be any trouble or bother to staff and they were reluctant to make any comment which may have been seen as a complaint. Staff said it was the task of the night staff to get all residents up before they go off duty and they wake residents at 6.00 am. Staff said that residents are put into night clothes after tea but then sit in the lounge until night staff come on duty. This lack of choice was raised at the last inspection, however there was no evidence there had been any change in practice. A new cook has been employed and comments about the lunch were very positive. The cook has already highlighted meals which are not popular and there are plans to amend the menu with input from residents. There were two clear choices on the day of inspection, roast beef or Spaghetti Bolognese and residents were asked the day before for their choices, both of which looked and smelled appetising. The proprietor said that there was no teatime menu as it was always sandwiches or soup. At teatime residents were asked if they wanted fruit or cake. It would be more pleasurable for residents if a selction of fruit and cake had been put on the dining tables and they could have both if they wished. Drinks were provided mid-morning and afternoon. It was disappointing to note that residents were not reminded of the choices available to them eg tea coffee or cold drink. Two meal times were observed and it was noted that residents did not always get the support and help they required and inspection staff went to the assistance of residents so that they could manage and enjoy their meals. Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is developing its complaints procedure and staff have received Protection of Vulnerable Adults training. EVIDENCE: A new complaints system has been introduced and the home has a new log book entitled Complaints and Concerns. Two complaints have been received and there was evidence of action being taken. In their surveys residents said they ‘always’ or ‘usually’ knew how to make a complaint. The complaint procedure displayed throughout the home needs to be updated. Several letters and cards complimenting the home were seen. Staff have recently received training in the Protection of Vulnerable Adults. Two staff were asked about the actions to take if there is a suspicion or allegation of abuse and they demonstrated a basic awareness. One member of staff said she had not received training although her name was on the staffing training matrix. The proprietor said there were plans to update the homes policies and procedures including those relating to the Protection of Adults. This would be an opportunity to provide clear simple guidelines for staff to follow and build staff knowledge and confidence on the actions to take. Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 17 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 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Considerable improvements to the premises have been made recently which has improved the comfort and safety of residents. EVIDENCE: An inspection of the premises was made by both inspectors. Bedrooms were personalised, clean and adequately maintained. It was positive to note that there were no unpleasant odours of stale urine or faeces. Since the last inspection new carpets and lino have been purchased and fitted to some individual bedrooms. A relative described her mother’s room as ‘spotless’. The overhead lights previously highlighted as a health and safety risk have been removed. However, hot surface radiators within some toilet and bathrooms remain uncovered and pose a possible risk of burns to delicate skin. The front door previously a fire hazard now has a lock which is connected to the fire alarm system. Until a new laundry and sluice are provided there is a notice in the laundry reminding staff to wash their hands in the staff toilet. Concern was raised in one of the GP surveys that the ‘bedrooms were poorly lit with low watt light bulbs’. Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 18 It was noted that bathrooms and toilets now have appropriate hand washing facilities. Random hot water taps were checked and did not pose any risk. A member of staff said that they were unaware of the homes COSHH protocols. It was noted that substances which are hazardous to health are now kept in a locked cupboard. Inside were three spray bottles without labels. Staff said they were able to identify two of them by smell. One was said to be diluted disinfectant, however staff were unable to say whether the dilution was suitable for cleaning cuts or disinfecting the floor. This confirmed the risk of having unlabeled bottles and was also raised at the last inspection. Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff levels and recruitment procedures are inadequate and put residents at risk. The level of staff training is slowly improving, but good practice is not always being put into action. EVIDENCE: Staff took an active interest in the inspection and were keen to receive suggestions and guidance. The staffing levels considered appropriate for the number and needs of the residents at Maple Lodge are: • One senior and two care staff during the day • One senior and one care staff awake at night. • With additional support staff to cover domestic and catering duties. Once a manager is appointed they will require some supernumerary shifts to undertake management duties. Staff rotas were studied in detail and discussed with the proprietor and other staff. For some time the afternoon shift has been reduced to two staff and concern about this has been raised by the CSCI. At this inspection the proprietor stated that she had also reduced the staffing level in the evening, some mornings and at weekends. This is unacceptable and the agreed staffing level must be reinstated. It was noted in the accident book that a number of falls took place in the early evening. A member of staff said that in the evening with only two members of staff in the home it was very difficult to adequately care for and supervise residents. The pre inspection questionnaire Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 20 states that three of the current residents exhibit extreme behaviour, ten require help with toileting and two residents require two staff to assist them. The GPs stated that there were not always senior staff available to confer with. The present staffing level puts residents at risk and the full complement of staff must be deployed. None of the staff at Maple Lodge have any NVQ training and none is booked. The home has devised a training matrix which was studied. Since the last inspection (7.3.06) training for staff has been undertaken pertaining to POVA x 6 staff, Health and Safety x 1, First Aid x 1, Food and Hygiene x 4, Medication x 9, Manual Handling x 12, Fire Training x 0, Care Plans x 11, Epilepsy x 1 and Dementia x 3. A random sample of individual staff training files were inspected. The person working in the kitchen does not have an upto date Food Hygiene certificate. As stated earlier in this report staff said that following the Moving and Handling training and the Medication training no changes in policy or practice were made. Poor practice in these areas were observed and this would indicate that further training is required and the homes policies and practices must be updated. A monitoring system needs to be in place to ensure that staff practice is of a good standard. Staff recruitment records were studied and staff spoken to and it was clear that recruitment practices are not robust. For example staff are being employed before Criminal Records Bureau or POVA 1st checks had been returned. Peoples right to work in the UK is not being explored. Adequate written references have not been received for one night staff before employment had started. The information gathered on the application form is not adequate. Poor recruitment procedures can put residents at risk. A basic staff induction sheet was evident on some staff files but not necessarily completed. A more in depth and comprehensive induction format was available, but this has not been commenced. The home lacks management able to adequately induct new staff. Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 21 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 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home lacks proper management and the employment of a consultant is seen very positively as a way forward for the home. EVIDENCE: Staff and residents have lacked the support of an appropriate manager for a couple of years and this has led to acceptable standards of care not being maintained as evidenced throughout this and the two previous reports. The CSCI have held meetings to which all three proprietors were invited to emphasise the seriousness of the situation and to look to a way forward. Some improvements have been made but progress has been slow partially due to the lack of competent management. Thurrock Council Contracts and Commissioning Service also monitor the home and their visit of the 2nd May raised a number of concerns. Thurrock Council have stopped placing new residents at Maple Lodge until standards have improved. The home has now started to work with the CSCI to make improvements and a Management Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 22 Consultant has recently been appointed. The proprietor stated previously that an advert for a manager for Maple Lodge had been in the Job Centre for two years without any applications being made. However, now the proprietors are being more proactive and are actively looking for a suitable manager. There was no evidence of any quality assurance system being used in the home. However, one monthly report for the month of April has been received to meet the requirements of Regulation 26. Residents’ money held in safe custody by the home was not inspected on this occasion, however previous inspections evidenced that adequate records were being maintained. Staff supervision has not been taking place due to a lack of understanding and management in the home. The lack of leadership has caused staff anxiety and a number of staff spoke of being ‘in the dark’ and not included in decisions. Health and safety checks on equipment and services were inspected and were appropriate for Electricity, Gas, Portable Appliances, the passenger lift and the hoist. The home is in the process of addressing the concerns raised by the Fire Officer. The front door no longer poses a fire hazard, however to ensure its proper working it should be checked as part of the weekly fire checks. The home was unaware of the need for regular fire drills to be undertaken by all staff. The homes Fire Risk analysis was basic and the home is advised to discuss it with the fire officer. Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 23 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 2 2 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 2 Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 24 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 OP1 Regulation 4,5,6 Requirement Timescale for action 01/09/06 2 OP3 14(1) 3 OP4 18(1) 4 OP7 15 The registered person must keep the Statement of Purpose and Service User Guide under review. Revised copies must be provided to the residents and the CSCI. (Previous revised timescale not met) The registered person must not 10/07/06 provide accommodation unless the needs of the resident has been fully assessed by a suitably qualified or trained person and a record should be available for inspections (Previous timescale of 19.7.04 not met) The registered person must 10/07/06 promote and make proper provision for the health and welfare of residents. This refers to providing staff with appropriate training to meet the specialist needs of the elderly and ensuring that training is put into action. (Previous timescale of 14.12.05 not met) 10/07/06 The Registered Person must prepare a written plan (“service Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 25 user’s plan”) with consultation with the resident as to how their needs will be met. It must include clear instructions for staff as to how the care is to be provided. It must be written in consultation with the resident and regularly reviewed. (Previous time scale of 5.4.05 not met) The registered person must 10/07/06 ensure that residents receive where necessary treatment, advice and other services from any health care professional. This refers to making referrals and requesting advice when home is struggling to meet a residents needs. The registered person make 10/07/06 proper provision for the safety and welfare of the residents and ensure that they are adequately supervised. This refers to residents being escorted to hospital. The registered person must 10/07/06 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home. This refers to the decanting of medication and the standard of recording of PRN medication. (Previous timescale of 19.7.04 not met) 10/07/06 The registered person must ensure that the home is conducted in a manner that respects the privacy and dignity of residents. This refers to issues related to meal times and medical examinations. 9 OP12 16(2) The registered person must consult with residents about DS0000018051.V296336.R01.S.doc 5 OP8 12(1) 6 OP8 12(1) 7 OP9 13 8 OP10 12(4) 10/07/06 Maple Lodge Version 5.2 Page 26 their interests and provide a programme of activities and provide facilities for recreation. This refers to providing a wider range and a greater extent of stimulation and pastimes suitable for the needs, abilities and interests of individual residents. 10 OP14 12(2) The registered person shall as far as is practical enable residents to make decisions with regard to their care, health and welfare. Residents must be able to choose the times they get up and go to bed and any restrictions should be recorded as an infringement of their rights. The registered person must provide residents with proper and adequate supervision and support at meal times. The registered person must make arrangements to prevent residents from being abused. This refers to policies and procedures on Adult Protection being in place and ensuring that staff have a working knowledge of the actions to take. (Previous timescale of 31.7.05 not met) 13 OP19 23(2)(p) The registered person must ensure that there is suitable lighting in residents’ bedrooms. (Previous timescale of 1.5.06 not met) The registered person must ensure that all staff including night staff undertake fire drills and practices at suitable regular intervals. (Previous timescale of DS0000018051.V296336.R01.S.doc 10/07/06 11 OP15 12(1) 10/07/06 12 OP18 13(6) 10/07/06 10/07/06 14 OP19 23(4)(e) 10/07/06 Maple Lodge Version 5.2 Page 27 21.4.06 not met) 15 OP19 13(4)(a) The registered person must ensure that all parts of the home are as far as reasonably practicable are free from hazards and that unnecessary risks to residents are identified and as far as possible eliminated. Hazards and risks identified at this inspection are: 10/07/06 16 OP26 13 17 OP27 18(1)(a) Some hot surface radiators not covered. COSHH items diluted and in unlabeled bottles. (Previous timescale of 07.03.06 not met) The registered person shall make 01/01/07 arrangements that the sluice and laundry must be positioned in separate areas with adequate hand washing facilities in each. (Previous timescale of 19.7.04 not met) 10/07/06 The registered person must ensure that at all times there are suitably qualified, competent, and experienced persons working at the Home in such numbers as are appropriate for the health and welfare of the residents. Staffing levels as detailed in this report must be maintained. (Previous timescale of 14.04.06 not met) The registered person must ensure that robust recruitment procedures are in place, and applied consistently. Records required by regulation in respect of staff recruitment must be obtained prior to a staff starting work. (Previous timescale of 14.12.05 not met) The registered person must DS0000018051.V296336.R01.S.doc 18 OP29 Schedule 2 10/07/06 19 OP30 13(5) 10/07/06 Version 5.2 Page 28 Maple Lodge ensure that suitable arrangements are provided to ensure a safe system for the moving and handling of all residents. (Previous timescale of 28.04.06 not met) The registered provider must ensure that the home is managed by someone with sufficient training, experience and skill. They must be allocated appropriate hours and undertake relevant training. (Previous timescale of 19.7.04 not met). The registered person must ensure that there is a quality assurance system, which involves feedback from residents, their relatives and/or representatives and other professionals. (Previous timescale of 19.7.04 not met). The registered person must ensure that persons working in the Home are appropriately supervised. The registered person must ensure that risks are identified and so far as possible eliminated. This refers to risk assessments being in place. 20 OP31 8(1)(a) 10/07/06 21 OP33 24 10/07/06 22 OP36 18(2) 10/07/06 23 OP38 13(4) 10/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP2 Good Practice Recommendations Each resident should have a contract/statement of terms and conditions and this should be readily available for DS0000018051.V296336.R01.S.doc Version 5.2 Page 29 Maple Lodge 2 3 4 3 4 5 6 7 OP5 OP7 OP8 OP13 OP28 OP31 OP32 OP36 inspection. The home should be able to demonstrate that prospective residents have to opportunity to visit the home. Formal manual handling assessments should be completed for all residents which identifies the safest way for them to be assisted Accident records for residents should be detailed and include information relating to the nature of the injury, staff interventions and outcomes. The home should have an open policy on visiting and appropriate facilities should be made for visitors. A minimum of 50 of care staff to obtain NVQ level 2 or equivalent. The Manager should obtain NVQ Level 4 in Management and Care. Regular staff meetings are held and are recorded. Staff should be supervised at least six times per year including the manager. Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Maple Lodge DS0000018051.V296336.R01.S.doc Version 5.2 Page 31 - 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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