Inspection on 18/10/07 for The Maples

This inspection was carried out on 18th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Maples 14/06/06

The Maples 12/01/06

The Maples 27/04/05

The Maples 08/12/04

The Maples 27/04/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 The Maples 327 Hoylake Road Moreton Wirral CH46 0RN Lead Inspector Diane Sharrock Key Unannounced Inspection 18 - 29th October 2007 12:30 th The Maples DS0000018946.V347686.R01.S.doc Version 5.2 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 The Maples DS0000018946.V347686.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 Adults 18-65. 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. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Maples Address 327 Hoylake Road Moreton Wirral CH46 0RN 0151 678 6956 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) www.c-i-c.co.uk. Community Integrated Care ** Post Vacant *** Care Home 5 Category(ies) of Learning disability (5) registration, with number of places The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Date of last inspection 5th March 2007 Brief Description of the Service: The Maples is situated by Moreton Cross on the Wirral and is close to the main shopping area. The home is a dormer bungalow with single bedroom accommodation being provided on both the ground and first floor. A bathroom with toilet and a separate shower room is provided on the ground floor with a further toilet situated on the first floor. There is a separate dining room that is also used as a seating area at the rear of the building and a lounge situated at the front of the home. The home has some equipment and some adaptations in place to meet the assessed needs of the service users accommodated. There is a limited amount of off road parking available to the front of the home and a large garden to the rear. The fees for the home are from £60.16 to £81.35 each week, Social services pay £330.50 per week. The Company agree to pay £500 each per year for a holiday. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced site visit took place on the 18th/29th October 2007 where time was spent reading records and looking at the building and meeting people at the home. A system called, ‘case tracking’ was used as part of the visit. This involves looking at the support a person gets including their care plans, medication, money and bedroom and living area. Case tracking was used to look at life at The Maples for two of the people living there. Time is also spent meeting with people who live there and with staff about how they meet the person’s needs and choices. Discussions took place with two staff and the manager, 5 comment cards were received from residents which had been filled in by staff and relatives and 2 staff comment cards were also submitted to us and their views are incorporated into this report. An easy to read summary of this report is available. If you would like to see a copy please ask the staff working at The Maples. The manager contributed to the inspection process by completing a selfassessment form. The information gathered from the site visit along with any information about the home that we have received since the last key inspection, has been used to write this report What the service does well: Support is provided to the people living at The Maples to make there own daily decisions and spend their time mostly in activities that they enjoy, including going on an annual holiday. Some areas of the home are accessible to people who have physical disability and there are a number of aids and adaptation available to support people with their mobility and their personal care. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are 2 outstanding requirements and a number of concerns identified at this visit so the company will be asked to produce an improvement plan to tell us what they will do to improve the home. Sometimes there are not enough staff at The Maples which stops people going out and doing what they like. The company must produce an action plan regarding the recruitment and selection of staff stating what they will do to make sure they have enough permanent staff to give the stability and support to enhance the resident’s quality of life. A review of procedures for staff absences must take place so that the home is safely managed at all times. The management of health and safety at the home must be reviewed to guarantee and commit to the safe support to all residents. Risk assessments must be in place for all identified hazards including, the current driveway, gardens and low level beds, actions must be in place for identified risks with moving and handling and challenging behaviour. Updated maintenance checks must be in place for all facilities including the electrical installation and fire extinguishers. These actions will help to make sure that the company invests and manages the home appropriately to help keep everyone safe. All staff must have police checks and appropriate supervision before being given the responsibility of managing the home. Complaints procedures should be developed further into a format similarly achieved with care plans so that residents are supported in understanding what this procedure is. Care plans and the development of personal care and activities should be reviewed and actions taken to increase the residents choices and accessibility to the right support. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 7 To review the current menus and the current shopping so that more fresh food can be purchased to replace the processed foods and meals currently offered so that residents have a better choice of improved standards of meals. Money belonging to the people living at The Maples is managed centrally by the organisation. Resident’s monies must be reviewed and managed in their best interest, financial policies and procedures must be clear and accurate and explain any financial outgoings, including purchasing of equipment, holidays and the communal minibus. The company must provide clear and accurate contracts, financial agreements and financial assessments to evidence that any actions they take are in the best interests of people living in the home. The company should be clear in making people aware of their responsibilities in providing the right care and equipment and upkeep of facilities at the home. A training plan should be put together which looks at the individual support of everyone at The Maples including agency and bank staff. This would help to ensure that staff have the skills to meet peoples support needs and that they are up to date with current good practice and make sure residents are safe at all times. All staff must have access to at least 5 days paid training per year and be able to safely and adequately support the residents and be up to date in basic training including, fire training, moving and handling, food hygiene, health and safety, abuse awareness, induction, supervision and medication. A development plan should be produced and shared with residents, staff and relatives to show what plans are taking place regarding the decoration and maintenance of the home including the garden and drive way, the décor of the bedrooms and lounge, purchase of necessary and appropriate comfortable chairs, replacement of bed. Residents, staff and relatives opinions must be taken into account regarding the development of their home, including the company plans for the future of the home. Any proposed developments or plans to move residents must take the resident and their representative’s opinions into account, and the company must be able to show they are acting in the best interest of the residents. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 /5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate information is provided prior to residents moving into the home EVIDENCE: Since the last key inspection no new residents have moved into The Maples. There are polices and procedures in place to ensure that sufficient information is obtained about the person, including an assessment of their needs, to ensure that The Maples can meet their choices and support needs. Residents living at The Maples have complex needs and they have all lived in the home for a number of years. Following the previous inspection it was identified that the contracts for residents needed to be updated so they were clearer and protected the residents rights, these contracts were not found or produced during this visit. There is no evidence that any attempt had been made to involve family members or independent advocates. There was no evidence to show that a range of options had been considered to ensure residents are receiving best value for money with regard to their transport needs. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6/7/9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People’s individual needs and choices are recognised within the service, however they are not always fully supported to increase their independence. EVIDENCE: An individual care plan is in place for all of the people living at The Maples. Two of these were looked at during the site visit and all had been recently reviewed. This helps to make sure that any changes to the persons support needs or their choices are noted and can be acted upon. Care plans contain information about the support the person needs with their personal and health care and gave some detailed information about how to provide this. The plans have been developed with the use of pictures to try and make them easier for the residents to understand and read. There is however limited information about how the service identifies and meets people’s social needs and personal needs. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 12 The opportunity for residents to make decisions and their needs known relies to some extent on the staff team understanding and responding to their nonverbal communications. This was observed during this visit and care plans reflected the staffs understanding and knowledge and rapport with the residents. However it was also noted that the home rely heavily on the use of regular agency staff and have had long term recruitment problems in keeping the stability of a staff team. This led to residents being managed and supported on occasions by staff who had not been trained or assessed as competent to support residents, which can potentially put residents at risk and impinge on their daily routines. Staff comment cards stated, “a lot of agency staff are used.” “Sometimes there are no regular staff on, the home had been staffed with only agency staff on a regular basis and sometimes there is nobody adequately trained to administer medication.” Risk assessments were in place in all plans however updated actions for risks associated with moving and handling and challenging behaviour had not been carried out and some staff were not up to date with specialised training in these areas. This lack of information, training, staffing and reviewing of existing information may lead to staff not having the information they need to successfully support the person. The organisation manages most people’s money however due to all of the staff team on day one of this visit being supplied by agency staff the residents monies had to be managed by the staff on duty. There was no evidence that residents gave permission for transfer of their money from their account for any transaction or for any payments taken by the company to purchase equipment, holidays or the use of the communal minibus. There was no evidence or information to show what type of account residents monies are stored in and there was no information as to what type of account manages monies taken from them to pay for the communal minibus. This practice does not support people to learn everyday living skills such as budgeting nor does it give them control or flexibility in planning their day. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 13 Residents rights are not always protected and procedures for managing residents money was not clear to help safeguard them and to evidence good practice in promoting their rights. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12/13/15/16/17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A lack of staff availability sometimes means people cannot engage in activities they enjoy. EVIDENCE: Staff were observed to have a good rapport with residents and were observed to assist residents in various choices. Resident’s rights, likes, dislikes and choices were seen to be respected. Residents and staff have had occasional meetings to discuss the running of the home. However no recent minutes of these meetings were seen and there was limited information on how anyone was kept informed and included in the developments. The care plans provide the staff team with information about what activities residents enjoy and also provide risk assessments regarding all activities The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 15 undertaken in the community. The risk assessments have been produced to support residents to overcome difficulties and engage in activities in a safe manner. However on day one of the visit due to staff absences and the use of agency staff the team had a low number of staff that were left to take responsibility for the management of the residents. The planned activity for hydrotherapy did not take place as staff felt the staffing levels were too low. The management of staffing levels had affected the resident’s choices for the day until staff tried to get further agency staff in for a later shift. Staff felt that the current use of the communal minibus wasn’t best use of residents monies as in the past month it had only been used 4 times. Some staff said this had been discussed prior to our visit and they were hoping to get rid of the bus so residents could use public transport more, they felt that because only 2 staff could drive the bus it restricted the daily use of it. Everyone can go on an annual holiday if they choose. Staff talked about recent holidays including a trip to Wales in a caravan. Staff said that the residents have enjoyed these holidays and look forward to going again. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18/19/20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs are adequately supported by staff . EVIDENCE: The care plans and risk assessments provide the staff team with information about the most appropriate and safe way to support residents with their personal care needs. Records showed that people are supported to access and get to health care appointments. This includes regular appointments such as seeing the optician and dentist as well as more specialist appointments such as hospital visits and accessing equipment services eh wheelchairs assessments. Daily records showed that staff do not always record what type of personal care has been given so its not always clear that residents personal care is met. However it was clear from meeting the people living there, that they had had help from staff to maintain their personal cleanliness and appearance. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 17 Equipment is provided to meet some people’s needs and help prevent health issues occurring. It was noticed that one person had previously paid for their own specialised chair and staff discussed who was responsible in replacing the resident’s old beds. During day 2 of the visit the manager explained that she had already arranged the replacement of 2 low level beds and felt that an electric bed was going to be jointly funded by both a resident and the company. There are no policies or guidance for staff regarding the companies responsibilities in maintaining and replacing equipment at the home and there was no guidance for staff regarding acting in the best interests of residents when purchasing equipment on their behalf, especially when they could not give staff permission to access their money and buy things. The homes staff manages all five residents medication needs including ordering, storing and administering. Medication was stored and recorded correctly, with clear records of medication received and given or not given. This helps to reduce the risk of mistakes occurring and provides a clear audit trail to check people receive their medication correctly. The staffing at present is mainly provided by agency staff and there was no evidence on day one to show staff had been provided with sufficient medication training or assessment to ensure they were competent to administrate and safely manage medications. Staff files showed out of date training records with no information on recent training for staff. Staff comment cards stated, “Sometimes there are no regular staff on, the home had been staffed with only agency staff on a regular basis and sometimes there is nobody adequately trained to administer medication.” The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22/23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are adequately protected but are at risk by poor management of staff training EVIDENCE: Residents receive information about how to complain in the statement of purpose. Complaints procedures are in ordinary printed formats and may be best developed into a format similarly achieved with care plans using pictures so that residents are supported in understanding what this procedure is. One staff comment card stated, “ There are a lot of issues within the home that need addressing for example. staffing issues, health and safety, service users care plans not being followed, service users health issues and mobility issues not being addressed.” Staff comments are important in the development of the home and they are not always included in the development of the home, these serious comments must be reviewed further by the company to obtain staff opinions on the service provided to residents. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 19 Training records were out of date and staff on duty had not been provided with abuse awareness training or any type of structured induction while they were left with the responsibility of managing the home. However staff explained they had received training with other employers and showed they were able to address issues and were aware of who to contact within the company if they had any concerns. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24/30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Maples provides an adequate home for people to live in. Current facilities. Need be improved upon EVIDENCE: All bedrooms and shared areas were clean and tidy and provided some parts of the home to be quite homely and modern in style, however the lounge was in need of refurbishment and development to offer a more modern and accessible lounge with better seating and facilities. Some of the bedrooms seen had been personalised to reflect the hobbies and styles liked by residents however some were in need of redecoration and repair. There was a staff shortage on day 1 of the visit, and staff had worked hard to make sure that the home was warm, clean and tidy. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 21 Although parts of the home are adapted for use by people with physical disabilities, other parts are not. The 2 bedrooms upstairs are only accessible by the residents who are mobile. There are downstairs bedrooms and a bathroom with an adapted bath and shower provided. The two bedrooms upstairs were in need of recordation and refurbishment to improve the current facilities for the residents. Two beds were noted to be old and low in level and had very thin hard mattresses. There were no risks assessments in place or development plans to state what actions were being taken to reduce any associated risks or improve the comfort for residents. The manager explained she had ordered 2 new beds for some of the residents and was hoping to get half the funding from the company for one residents bed and get a contribution from the resident’s own funds, as they needed a more expensive electric movable bed. There was no evidence to show the resident had given permission for their funds to be accessed and used to replace her current inappropriate bed. The manager acknowledged that some of the beds were probably over 18 years old. Discussion took place with the manager regarding the company’s legal responsibility to make sure that all residents admitted to the home have the necessary equipment to meet their needs. There was no maintenance, decoration or development plan to let people know when their room or bedroom would be redecorated. The manager had arranged for the companies maintenance person to come to the home to start decorating the residents bedrooms to help improve their current living areas in view of the discussions held with the manager on the first visit. The kitchen is a domestic kitchen and not really accessible to all of the residents. On the outside of the home the gardens are unkempt with weeds and moss covering the drive making it unsafe in parts and made to feel and look neglected giving a poor outlook and poor view from residents rooms. The paving has not been maintained and has become uneven and potentially slippery, a concern raised by the staff at the home. There were no risk assessments for any of these hazards and staff were unsure what actions were to be taken to reduce these risks. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 22 There is a designated laundry room, which is well equipped to meet the needs of the people living there and has a clear system in place for preventing any cross infection occurring. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32/34/35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The people living at The Maples are adequately supported by staff however sometimes a lack of staffing can impact on residents’ lifestyle and choices. Residents are not always protected by the recruitment procedures. EVIDENCE: The home currently has five and a half fulltime support worker post vacancies, which are being covered by the home’s existing staff, bank staff and agency. The service manager is currently visiting the home on a weekly basis and offers the house manager formal supervision on a monthly basis and support and guidance on each visit During the site visit the people living there were seen to be unable to take part in activities planned at the local hydrotherapy pool due to low staffing levels. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 24 Agency staff had been left with the responsibility of managing the home during day 1 of the visit and had not received any training from the company, nor had received any type of induction or fire training. These serious concerns around the current poor management of staffing and the identified risks associated to the residents were brought to the attention of 3 senior staff within the company so they could review the risks and take necessary actions to make the home safe and adequately staffed. Staff spoken with during the visit explained that they are in the process of recruiting more care staff and anticipate them starting work soon however they explained it had been a longstanding issue to try and keep staff at the home and they felt that was why they had to regularly use agency staff. Training records were seen during this visit and discussed with staff, however the records were poorly maintained and records out of date, with most staff in need of basic training and updates in such topics such as fire training, moving and handling, food hygiene, health and safety, abuse awareness, induction, supervision and medication and challenging behaviour. One staff comment card stated, “I have not had any training within the company…” Updated and appropriate training would help to ensure staff are up to date with current good care practices and can support people safely. The current poor management of training is putting both staff and residents at risk. On day 2 of the visit a basic tick list for induction was observed. A new member of staff had worked regularly over the previous months at the home without any induction and given great responsibilities in managing the home, including the residents care, finances and administering medications. The induction was not sufficient to support the person in their role in supporting residents and meeting the persons training needs. The staff spoken with displayed a good knowledge of the people they support and their individual support methods and choices. Staff were observed to spend time talking with people as well as providing the more practical support that they required. A sample of files were looked at for staff who have different roles within the service. These showed that before any one commences work in the home a series of checks are carried out, such as obtaining references and a CRB (Criminal Records Bureau) check. These checks help to ensure that staff are safe and suitable to work with the people living there. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 25 All staff on duty were agency staff and they did not have staff files to show evidence of any safety checks or evidence of their training needs and competences. One member of staff working at the home had only had a POVA check, (a basic legal check) and was working unsupervised and managing the home. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37/39/42 Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. The home is not managed appropriately and residents are at risk because of poor record keeping regarding safety checks, and a lack of documented planning has lead to service improvements not being noted and carried out. This means the health, safety and welfare of people living in the home is not always protected. EVIDENCE: The manager explained that she has 7 hours a week to carry out her managerial role and finds this difficult in trying to implement all necessary records and actions necessary for the management of the home. The manager was asked to resend her pre inspection questionnaire (AQAA) with updated information about the home as it was only partially completed, This questionnaire has still not been submitted to the commission. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 27 One staff member talked about a recent meeting were she felt they talked about a lot of things and how they would improve things at the home, including the meals and menus, the staffing vacancies, the minibus and how they felt they should get rid of the bus, and the companies intentions to close the home and move the residents to other houses. Residents, staff and relatives opinions had not been sought and staff could not find any recent minutes of any type of staff/resident relative meeting. Minutes of a previous meeting with senior staff from the company were available regarding proposals to move residents to supported living houses, however there was no staff or resident/relatives from the Maples at this meeting. There was no evidence to show there is any type of regular planned consultation about the developments in the home especially regarding the current management of finances, the use of the minibus or the plans to move to other homes. It was difficult for staff to find recorded maintenance checks and certificates in the current filing system however some checks were produced and showed regular checks by contractors to keep facilities maintained and safe. Some records and certificates could not be found during both visits including ones recently for the fire extinguishers. One certificate for the electrical installation carried out in 6/10/06 highlighted numerous concerns and areas that needed attention as the contractor had described the check as “unsatisfactory.” No evidence was found regarding what actions had been taken by the company to repair and improve the electrics based on the maintenance contractor’s professional expertise. The manager felt that the actions would have been acted upon but could not find any evidence to show the company had made the homes electrical system safe following the maintenance check in October 2006. Risk assessments could not be found for all identified hazards seen during this visit, including, the current unkempt driveway and gardens, the low-level beds. The lack of assessments could put people at risk of accidents. Actions had been identified for risks assessments with moving and handling and challenging behaviour however there was no evidence to show staff had had the appropriate training or updated training for these 2 highlighted topics to make sure safe practices are acted upon by staff. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 2 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 x 2 X 1 X X 2 x The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 29 Yes Are there any outstanding requirements from the last inspection? 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 YA5 Regulation 5 Requirement Timescale for action 12/02/08 2. YA7 12 3. YA35 18 1 ab Residents’ must have contracts in place that show the legal responsibilities of both parties regarding the purchase and maintenance of the home’s minibus so that the company can show they are acting in the resident’s best interest and protecting their rights. Repeated requirement from the previous inspection Residents’ or their 12/02/08 representatives should be involved in the decision-making regarding entering into Hire Agreements for the use of the Home’s minibus. This involvement must be documented to show that the company have acted in the resident’s best interest and protected their rights. Repeated requirement from the previous inspection A review of procedures for staff 08/01/08 absences must take place so that the home is safely managed and staffed in appropriate numbers at all times so that staff can meet the residents needs. DS0000018946.V347686.R01.S.doc Version 5.2 The Maples Page 30 4. YA34 19 1 schedule 2 All staff must have police checks and appropriate supervision. So that residents can be protected by good recruitment and selection policies and procedures. The management of health and safety at the home must be reviewed to safely support everyone at the home. Risk assessments must be in place and up to date for all hazards. Updated maintenance checks must be in place for all facilities including the electrical installation and fire extinguishers. The way in which money belonging to the people living at The Maples is managed must be reviewed and shown to be managed in their best interest. The company must provide clear and accurate, financial agreements and financial assessments to evidence that any actions they take are in the best interests of residents. Resident’s monies must not be stored in any company account. This will ensure that their rights are protected and they are supported to become as independent as possible. 08/01/08 5 YA42 13 4 5 08/01/08 6 YA7 20 1 12/02/08 The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 31 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 2 Refer to Standard YA6 YA7 Good Practice Recommendations Care plans and the development of personal care should be reviewed and actions taken to increase the residents choices and accessibility to the right support. Financial policies and procedures must be clear and accurate and explain any financial outgoings eg, including purchasing of equipment, holidays and the communal minibus. The company should be clear in making people aware of their legal responsibilities in providing the right care and equipment and upkeep of facilities at the home. To support and facilitate residents to access a variety of age and culturally appropriate activities on a regular basis and make sure staffing levels meet the residents needs and never restricts their daily living and quality of life. Complaints procedures should be developed further into a format similar achieved with care plans so that residents are supported in understanding what this procedure is. Some areas of the home would benefit from redecoration and an assessment of how they meet people’s needs. A development plan should be produced and shared with residents; staff and relatives to show what plans are taking place regarding the decoration and maintenance of the home. This should include the garden and drive way, the décor of the bedrooms and lounge, purchase of necessary and appropriate comfortable chairs, replacement of beds. Consideration should be given to altering the design of the kitchen to provide more accessible and inclusive facilities. This will increase people opportunities to take part in and observe everyday activities. Menus should be reviewed to include staff suggestions to provide more fresh food and home made meals. A training plan should be put together which looks at the individual support of everyone at The Maples including agency and bank staff. This would help to ensure that staff have the skills to meet peoples support needs and that they are up to date with current good practice and DS0000018946.V347686.R01.S.doc Version 5.2 Page 32 3 YA12 4 5 YA22 YA24 6 YA24 7 YA32 The Maples 8 YA34 9 YA39 make sure residents are safe at all times All staff must have access to at least 5 days paid training per year and be able to safely and adequately support the residents and be up to date, in eg, basic training including, fire training, moving and handling, food hygiene, health and safety, abuse awareness, induction, supervision and medication. The company must produce an action plan regarding the recruitment and selection of staff stating what they will do to make sure they have enough permanent staff to give the stability and support to enhance the resident’s quality of life. Detailed inductions must be implemented so that staff are adequately supported to meet the residents needs and be able to safely work at the home. A system for regularly reviewing the quality of the service must be implemented and reviewed. Regular staff, resident and relative meetings should be carried out. Residents, staff and relatives opinions must be taken into account regarding the development of their home. Any proposed developments or plans to move residents must take the resident and their representative’s opinions into account regarding the development of their home and the company must be able to show they are acting in the best interest of the residents. The Maples DS0000018946.V347686.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Merseyside Area Office 2nd Floor, South Wing Burlington House Crosby Road North Waterloo L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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