Inspection on 27/04/05 for The Maples

This inspection was carried out on 27th April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Maples 18/10/07

The Maples 14/06/06

The Maples 12/01/06

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 Helen Carton Unannounced 27 April 2005 09:30 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 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 Stationary 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 F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 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 Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Community Integrated Care CRH 5 Category(ies) of LD registration, with number 5 places of places The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 08 December 2004 The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 5 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 quiet seating area at the rear of the building and a lounge situated at the front of the home. The home has equipment and 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 Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. There are five people living at The Maples. This inspection was unannounced and took approximately five hours over two days. The inspector spent time with two residents and spoke to three members of the staff team one of which was the manager. What the service does well: What has improved since the last inspection? Since the last inspection visit to the home the care planning systems have improved with greater detail being provided. Thus giving the staff team clear guidance as to the best way to support residents particularly with personal care needs. The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 and 5. The owners are providing contradictory information with regard to who is financially responsible for the home’s transport. The financial arrangements for residents are unclear and do not provide enough safeguards to prevent possible financial abuse. EVIDENCE: Residents living at The Maples have complex needs resulting in all five adults having difficulty in communicating their needs to others. All five residents have lived in the home for a number of years. The home has little information about residents’ lives before they moved into the home including any pre admission assessments. The inspector discussed with the manager the need to attempt to produce past life histories to help the staff team to provide the most suitable support to residents. Examination of records in the home showed that information held in the home’s statement of purpose and the residents’ contracts is contradictory. With the owners of the home saying they will provide a minibus for use by the residents and yet the residents contracts showing that residents are to pay towards the purchasing and running cost of the minibus. Discussion with the manager also highlighted that residents are paying different amounts. This is not clear in any information provided by the owners to residents or their The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 10 supporters. The owners do not appear to have involved independent advocates for those service users who have no family contact to make sure the monies spent on the home’s minibus is the best use of their money. The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7 and 9. The care planning system provides a good level of information and guidance to the staff team. The home’s risk assessments are limited and do not provide detailed information and guidance resulting in a possible risk of injury to both service users and members of the staff team. EVIDENCE: There is clear and detailed information in residents care plans providing the staff team with clear guidance as to the manner in which residents prefer to be supported in their daily lives. The home also completes documents called essential lifestyle plans that provide information about residents’ likes and dislikes including preferred routines and leisure activities. The inspector discussed with the manager the need to ensure activities detailed in the essential lifestyle plans are carried out regularly and documented in the residents’ activity plans. The risk assessments currently used in the home provide the staff team with limited information. Particularly those to direct the staff team as to the best way to support residents who may be presenting with aggressive or The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 12 inappropriate behaviour. This could potentially put both residents’, the staff team and members of the public at risk. Staff members spoken to during the visits to the home were able to tell the inspector how they would support a resident who was experiencing a difficult time and displaying aggressive behaviour. However the home had not produced a risk assessment to reflect this information and approach. The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 14, 16 and 17. More could be done by the owners’ and the manager to provide meaningful opportunities for residents’ to take part in particularly those identified in the essential lifestyle plans. The staff team support residents to maintain their levels of independence. EVIDENCE: The home has activity plans for all residents that details outings, activities and one to one time offered by members of the staff team. However at the time of the visit the home had not managed to provide the activities identified in the essential lifestyle plan. The home has a new minibus with three members of the staff team having the necessary experience to use it. This has increased the frequency and amount of time service user spend accessing community and leisure activities. The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 14 Residents’ are accessing local facilities such as cafes’ shops and pubs in the Moreton area. However access to specialist activities and past times are not being routinely provided by the home. Meal planning and residents likes and dislikes are documented in the care plans and meals are discussed during team handovers and meetings. The manager and members of the staff team informed the inspector making observations during mealtimes is the main way in which they are aware of the meals enjoyed by residents. Records show residents go out for a meal at least once a week. During the visit the inspector observed the manager and members of the staff team supporting residents in a respectful friendly manner. Members of the staff team were able to show they had a good knowledge and understanding of residents needs. The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 and 20 The care plans and medication documentation provide the staff team with good information enabling them to support service users appropriately and safely. EVIDENCE: Care plans provide the staff team with good information as to the best way to support service users with their personal care needs. Including how individuals like to bathe, have their hair washed and the order in which they like to dress. This level of information helps staff to minimise any stress or anxiety that assisting with personal care support may cause. The inspector discussed the need to ensure as much information about residents lives prior to moving to The Maples is documented. To enable the staff team to more fully understand some of the behaviours displayed by the residents during their daily lives. The home administers residents’ medication. A sample of records indicates all medication administered is recorded and there are policies and detailed procedures in place to ensure the safety of residents. The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The home has a complaints procedure however it is not user friendly. There is detailed information with regard to the safety and protection of vulnerable adults. The owners have a detailed restraints policy and procedure however the staff team did not demonstrate a knowledge of this document. This could lead to the use of unsuitable physical interventions and unsafe situations for residents. EVIDENCE: The home has a detailed complaints procedure with timescales for action and responses to concerns raised, however this documentation is lengthy and not user friendly. The home has a detailed policy and procedure with regard to the protection of vulnerable adults. The manager demonstrated a clear understanding of her role with regard to alerting the appropriate agencies if abuse is disclosed or witnessed. The home has a detailed policy and procedure with regard to the use of restraint. The inspector is concerned the staff team where not fully aware of the techniques and instructions held in these documents. The manager acknowledged this and advised the inspector further training and discussions would take place with the staff team. The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27 and 30 The owners are providing a homely environment with a high standard of furnishings and cleanliness. The staff team work hard to enable residents to personalise their home. However safety and maintenance checks have not been carried out on the hoist resulting in unsafe practice taking place. EVIDENCE: Since the last visit to the home the owners have begun a program of refurbishment with the lounge, dining room, and hall being decorated. New bedroom furniture has been provided in three of the five bedrooms with the remaining furniture having been ordered. The manager informed the inspector new carpets, curtains and bedding have been ordered and are to be fitted to all areas of the home. New dining room furniture and a three-piece suite have been ordered and the home is expecting delivery shortly. The inspector viewed a sample of residents’ bedrooms and found them to be comfortable, homely and reflecting the likes and personalities of residents. The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 18 The home has a shower room and separate bathroom with a hoist being used to support residents to use the bath. Discussion with the manager highlighted the need for the hoist to be serviced, as there were no records indicating when this had been carried out last. On the day of the visit the home was clean and tidy with the laundry facilities being housed in an outhouse in the garden. The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,34 and 35 Residents are not always protected by the home’s recruitment practices. Also records did not support the assertion of an appropriately trained staff team. However the reduction in the use of agency staff has provided the residents with continuity of care. EVIDENCE: The training records held by the home were very limited with the manager unable to confirm when the staff team had undertaken training in the following areas: management of challenging behaviour, epilepsy care, first aid, health and safety and basic food hygiene. A selection of staff files where examined with the majority having the required information and checks being made. However not all files had medical references, criminal records bureau and protection of vulnerable adults checks notifications. The inspector noted there is a considerable time lapse between when new staff members start working at the home and when they are allocated a place on the owners’ induction training. This timescale must be reduced to ensure consistency of approach and safe care practices. The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 20 Formal one to one support is provided every two months as part of these meetings training needs are identified and any issues with regard to care practices. At the time of the visit three members of the staff team are undertaking NVQ training, with one member of the team having gained NVQ level 3. Since the last inspection visit the home has significantly reduced the number of agency staff used within the home. The manager has also recruited designated bank staff to work between the owners’ two Wirral Homes. The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39,41,42 and 43. There has been progress in some areas of the home, such as care planning. However at times the residents’ rights and best interests are not being promoted and safeguarded. EVIDENCE: The manager informed the inspector she is to commence NVQ level 4 managers’ award in September 05. The owners’ have not produced questionnaires to canvass the views of the residents their supporters or other persons visiting the home. To ensure the service they are providing meets the needs and expectations of the residents. The home’s record of accidents suffered by residents is well maintained. Examination of the fire logbook indicated the checks that need to be made to ensure residents’ and staff members safety have not been being made at the The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 22 necessary intervals. Records indicated that the staff team have not received fire safety training within the required timescales. The inspector checked the water temperatures in the bathroom and found the water temperature being delivered from the sink tap was very hot. The manager informed the inspector the taps had thermostatic controls on them to regulate the temperature. The manager advised the inspector she would contact the maintenance department and have the fault rectified by the end of the day. Service users do not access the bathroom areas without staff members support. At the time of the visit the home’s business plan had not been completed. The home’s risk assessments and management plans are limited and do not appropriately support residents in their daily lives. The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 2 x x 1 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 1 x 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 x x 3 Standard No 11 12 13 14 15 16 17 x x 2 2 3 2 3 Standard No 31 32 33 34 35 36 Score x 2 2 x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Maples Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score 2 x 1 x 2 1 2 Version 1.30 Page 24 F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc 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 1,7 Regulation 4 Requirement The registered persons must ensure the statement of purpose accurately reflects the facilites to be provided by the home. With particular regard to the purchase and maintenace of the homes minibus. The registered persons must ensure the service user guide and terms and conditions accurately reflect the serives to be provided by the home and those that are the responsibilty of the residents. The registered persons must ensure risk assesments and management plans are produced where challenging, inappropriate behaviour have been identified. The registered persons must ensure activities detailed in residents care plans are provided at regular intervals. The registered persons must ensure the complaints procedure is appropriate to the needs of the servcie users.With particular regard to the language and layout. The registered persons must ensure the staff team are fully F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Timescale for action 20/6/05 2. 16,5 5 20/6/05 3. 9 13 20/6/05 4. 13,14 16 30/8/05 5. 22 22 30/8/05 6. 23 13 30/6/05 Page 25 The Maples Version 1.30 7. 32,33,35 18 8. 37 8 9. 39 24 10. 41 16 11. 42 13 aware of all policies and procedures used in the home. With particular regard to the restraints policy. The registered persons must ensure training is provided to the staff team.To ensure they have the necessary skills and knowledge to support service users in the most appropriate manner. With particular regard to the staff team being fully aware and confident about the contents of the restraints policy and procedure. The registered persons must ensure an application form is forwarded to CSCI with regard to the registering of a manager within the stated timescale. The registered person must ensure effective quality assurance and quality monitoring systems based on seeking the views of service users are in place to measure success in achieving the aims, objectives and statement of purpose of the home. With particular regard to canvassing the views of stakeholders in regular contact with the home. The registered persons must ensure detailed documents and records are kept with regard to how the organisation manages service users monies. This must include details of who has been involved in the decision making to ensure all financial arrangements are open and transparent. The registered persons must ensure safety and maintenance check are made on faciltiies and equipmet used and accessed by service users. With particular F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc 30/9/05 30/6/05 30/8/05 30/8/05 30/6/05 The Maples Version 1.30 Page 26 12. 43 12 regard to fire equipment and lifting equipment. The registered persons must ensure the overall management of the service, within or external to the home ensures the effectiveness, financial viability and accountability of the home. With particular regard to the production of a service specific business plan. 30/6/05 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 Good Practice Recommendations The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection Liverpool Area Office 3rd Floor 10 Duke Street Liverpool, L1 5AS 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 The Maples F52_F02_S18946_TheMaples_V223693_270505_Stage 4.doc Version 1.30 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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