Care Home: Maple House

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What the care home does well People have control over their environment and can get out in to the garden and into the kitchen when they want to.The garden is safe and enclosed and has space for people to play football and ride bikes. The guide in the laundry shows you how to do your laundry. This has been done using a sequence of photographs so it is user friendly and means that people can be more independent. People have individual activity plans and activity boards with pictures so they know what they will be doing. The manager and staff team are stable and know service users well.Staff said that the manager is approachable and supportive. Staff write a detailed monthly review of care plans so any changes can be picked up and acted on. Service users appeared happy and relaxed. What has improved since the last inspection? Improvements have been made to the environment including a new kitchen, some new carpets and some parts of the home have been redecorated. A room has been converted to a sensory room where people can relax. Improvements have been made so the environment supports communication. For example there is a pictorial menu board showing the meal choices of the day. There are pictures and symbols of activities so people can choose what they want to do. This means that people can make choices. The manager has reduced the length of shift that staff work. This means that staff work early or late shifts, not long days and are less tired and stressed which benefits service users. Each person has a mini plan in their room. This is a two page booklet with symbols and pictures showing what is most important to the person. This means that new staff can see at a glance the important things to know about the person. Personal goals and aspirations have been identified and recorded for each person. They now plan to add a plan of support so staff know what to do and by when to help people achieve. The company yearly audit of the service has been improved. This protects service users by checking the service is safe. What the care home could do better: Improvements to the environment will make Maple House a nicer place to live.Some windows inside and out are in need of repair or replacement as the paint flaking off and they do not look attractive. Currently there is no suitable safe locking device on the first floor bathroom door so peoples privacy is not protected. The bedroom doors on the landing are different so do not match. This means that they look odd and there is not an ordinary domestic standard finish. Some bedroom doors do not have suitable safe locking devices. This means that people cannot keep their valuable belongings safe and their privacy cannot be assured. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Maple House 32 Julian Road Folkestone Kent CT19 5HW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kim Rogers     Date: 1 5 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Maple House 32 Julian Road Folkestone Kent CT19 5HW 01303251618 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Lothlorien Community Ltd care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Maple House is registered to provide 24hour residential care and support for up to 6 adults with learning difficulties. Maple House is located in a quiet residential area on the outskirts of the costal town Folkestone. There are public amenities and good transport links close by. The property is a substantial detached house with a parking facility to the front for up to 3 cars. The accommodation is arranged over two floors. There is a large garden to the rear of the property. Fees start at about 1081.00 pounds per week. For more information about the fees Care Homes for Adults (18-65 years) Page 4 of 28 Brief description of the care home and services please contact the Provider. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection of the service and included an unannounced site visit over two days by one inspector. The site visits were carried out on 10 and 15 April 2009. The previous key inspection was carried out on 24 April 2007. We carried out an Annual Service Review on 27 April 2008. All of the key minimum standards were assessed at this inspection. We spoke to service users and staff on the first day of the inspection. We spoke to service users, the manager and area manager on the second day. The manager is now registered with us as required at the last inspection. This means that he has passed the fit person process and people know he is a fit person to manage the home. Care Homes for Adults (18-65 years) Page 6 of 28 We sampled records, made observations and had a look around the home. We found that they have made some improvements. We looked at the Annual Quality Assurance Assessment or AQAA that the manager completed. This gives information about what the home does well and how they intend to improve.We looked at other information we have received about the home including any concerns, complaints and notifications about incidents and accidents. What the care home does well: What has improved since the last inspection? What they could do better: Improvements to the environment will make Maple House a nicer place to live. Care Homes for Adults (18-65 years) Page 8 of 28 Some windows inside and out are in need of repair or replacement as the paint flaking off and they do not look attractive. Currently there is no suitable safe locking device on the first floor bathroom door so peoples privacy is not protected. The bedroom doors on the landing are different so do not match. This means that they look odd and there is not an ordinary domestic standard finish. Some bedroom doors do not have suitable safe locking devices. This means that people cannot keep their valuable belongings safe and their privacy cannot be assured. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments are carried out or obtained before a person moves in. There is some written information about the home. Evidence: We found that no one has moved in recently so the assessment process could not be fully tested.Staff talked about the need to consider compatibility with existing service users. Staff said it is important that people get on together before they move in. The AQAA says the company have plans to improve the assessment tool to include peoples aspirations and personal goals.We found there is some written information about the home. This is produced in text and symbols. We found that people are given contracts detailing the terms and conditions of their stay. These are produced in text and are in service user plans. The AQAA says they plan to improve information about the home so that it is meaningful to more people. Care Homes for Adults (18-65 years) Page 11 of 28 Care Homes for Adults (18-65 years) Page 12 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their needs and personal goals will be recorded and supported. Risks are identified and assessed and people have the communication support they need. Evidence: We found that each person has a service user plan detailing their needs and what staff should do to meet those needs. We found that people have been involved in developing their plans. The manager has added pages to the company provided care plan to make sure that staff have the detailed information they need to give good support. Personal goals and aspirations have been identified and recorded. However, in the service use plan sampled we found no detailed plan to support the persons goals. So there is nothing to say what staff should do and by when. Without this who, what and by when the person may not achieve their goals. The manager said this planning is in the early stages and plans to develop this further to include support plans. Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: We found that potential risks to people are identified, recorded and assessed. Action that staff should take to minimise risks is also recorded. This protects people.We found that key workers write monthly reviews of service users plans. This is detailed and ensures that any changes are identified at an early stage so that support can be changed if needed. We found that how people prefer to communicate is recorded. This means that staff know what people are trying to say so can support choice and decision making.The environment supports communication in that there is a board with photos and pictures showing the meal choices of the day. There is also an activity board showing what is on offer. A staff board is planned showing who s on duty. This all means that service users can go and find out things for themselves rather than have to rely on staff telling them. Care Homes for Adults (18-65 years) Page 14 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to take part in a range of activities. Hobbies and relationships are supported. People have the support they need to plan and prepare meals. Evidence: We found that people have the opportunity to take part in a range of activities in house and in the community.One person has a work experience placement that they said they enjoy.People attend activities like sports including swimming and horse riding. One person has support to go to church. People go to local clubs, shops and discos so feel part of the community.We found that hobbies are supported. We found that people have the support they need to keep in touch with family and friends. One person went to stay with their parents on the first day of our visit. Other Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: people said that they would be seeing their families and friends over Easter. We found that people have support to take part in planning and preparing meals.People meet up to plan the menu and go to the local shops for provisions.The meal choices are displayed in the kitchen so people can see what is on offer without having to ask the staff.We found that people have free access to the kitchen so can get to drinks and snacks when they need to. We found that some people would like to develop more independent skills like cooking. This is recorded in individual plans although the support plan is vague. Without detail of who will support what and by when, the person may not achieve the outcome of developing their skills.The manager agreed to add more specific detail and add timescales Care Homes for Adults (18-65 years) Page 16 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their personal and health care needs will be supported. Medication practice is safe. Evidence: We found that peoples personal care needs are recorded in their individual plans. This means that staff know how people prefer to be supported. We found people have the support they need with personal care. There are two bathrooms and all but one bedroom has a wash hand basin. We found no suitable safe locking device on one of the bathroom doors so peoples privacy cannot be protected. The manager agreed to address this. We found that health needs are recorded in individual plans. We found a document called a health action plan although there is no plan with this showing what staff need to do to improve and support peoples health. We found that people have the support they need to attend health appointments. We found that records are kept of health appointments and the outcomes. Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: We found that staff have worked with the local community team and other health care professionals to support peoples health needs. We looked at the storage of medication and sampled some administration records. Currently people have to come to the office for their medication. This is not a clinical area as there are no hand washing facilities and there are distractions like the telephone. The manager said he would be talking to people about the possibility of storing peoples medication safely in their rooms. This means people will have some control over their medication, with the right support and have some privacy and less distraction when taking their medication. We found that staff have training before they administer medication to people. Staff then have their competency assessed regularly by the manager to ensure they are still safe to give out medication. Care Homes for Adults (18-65 years) Page 18 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know their complaints will be listened to and acted on. People are safeguarded from harm and abuse. Evidence: We found that there is a complaints procedure. This is produced in large text with symbols. The manager agreed that this version may not be meaningful to everyone and so not everyone can use it. The manager talked about ways this could be improved to make it more meaningful to everyone.We found that the home has had two complaints in the past year. The manager dealt with both complaints as per the company procedure. We have received a complaint since the last key inspection about staffing hours and the length of shifts. The manager has addressed this. For more information please contact the manager. We found that there is a policy and procedures in place to safeguard people from harm and abuse.Staff told us what abuse is, how they would recognise it and who they would report to.One staff said they have had training recently in how to safeguard people from harm. The manager said all staff have had this training so can recognise and respond to possible abuse. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and safe. Improvements to some parts will enhance peoples lives and make the home a more attractive place to live. Evidence: We found that the home is safe and generally well maintained. Some parts of the home need attention including some windows need replacing or repairing as there is flaking paint and some rotten looking wood.The manager said he has obtained quotes for this work and hopes it will be addressed soon. We found that the doors on the first floor landing do not match and some are in need of repair. We found that not all of these doors, including the bathroom door, have suitable safe locking devices so people cannot have privacy and keep their valuables safe. The manager said there are plans to replace the doors so they match and then fit suitable locking devices that people can operate safely.To ensure this work is done and the environment is improved to enhance peoples lives we made a requirement that they send in a plan of when the work will be done. Two people showed us their bedrooms. People said they are happy with their rooms which are personalised so are individual. All bedrooms are single room and no room Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: has en suite facilities but most have a wash hand basin. There is a communal bathroom and WC on the first floor and one on the ground floor. The manager said there are plans to convert the ground floor bathroom to a wet room, as some people prefer a shower to a bath.The kitchen is new and spacious. There is no restriction on the kitchen so people have free access and get drinks and snacks when they want to. This is also the case for the garden so people can get out and get fresh air when they want to. The garden at the rear is large and safe and service users spend time here on their bikes and playing football. The garden is well kept with a seating and patio area.There is a spacious dining room and separate lounge so people have space to relax in. There is a new sensory room where people can relax. We found that people have support to keep the home clean and the home was clean on the days of the visits.People have support to do their laundry and we found a photo step by step guide about washing clothes in the machines. This means that people can follow this and do as much for themselves as possible. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough trained staff to meet peoples needs. Recruitment checks are robust protecting service users Evidence: We found that there is usually three staff on duty during the day including a team leader. There is a sleep in staff at night. We found that there are enough staff on duty to meet peoples needs. The manager has reduced the length of shift that staff work. Some staff use to work long days of up to fourteen hours. Now staff work early and late shifts. This means that staff are less tired and stressed so improves support for people who use the service. The home has a full staff team and do not use agency staff. This means that people know who will be supporting them and get continuity in their support.We found that staff are patient and calm and support people positively and respectfully. On both days we observed staff supporting people in a supportive positive manner. Staff have access to regular training and some have attended training in person centred thinking. One staff said they enjoyed this day course. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: A new staff said they are working through their induction folder with support from other staff and the manager. We found that the induction is in line with the Minimum Standard. Staff said they have the opportunity to attend regular staff meetings and have one to one meetings with the manager. This gives them support, coaching and mentoring and an opportunity to talk about any issues they might have. We found that service users are involved in recruiting staff. They meet prospective staff when they have a look around and the manager talks to people and completes an opinion sheet. This means that people get to have a say about who may potentially support them.We found that people fill out an application form and have an interview with the manager. We found that recruitment checks are carried out before a person starts work at the home like references and a Criminal Records Bureau check. This protects service users. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and managed in peoples best interests. There are quality monitoring systems in place to ensure good practice. People know their health and safety will be protected. Evidence: The management of the home is stable with the same manager in post for the past year. The manager is registered with us, which means he has passed the fit person process and is a fit person to manage the service.The manager has a National Vocational Qualification in care at level 2 and 3 and has a Registered Managers Award. These qualifications meet the Minimum Standard. The manager has no qualification relating to peoples specific needs, that is learning disabilities. This means that he is not up to date with the latest research and best practice.The manager said he is keen to gain a qualification in learning disabilities. Staff said the manager is approachable and supportive and is always on call for advice. One staff said the manager is a very genuine person and they feel the service has Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: improved under his leadership. The manager completed the Annual Quality Assurance Assessment. This was generally well completed and gives information about what the service does well, what could be better and how they intend to improve. The AQAA shows the manager has an awareness of equality and diversity however there are no further improvements planned to further promote equality and diversity. This means that without plans to improve, outcomes for people who use the service may not improve.The AQAA shows that no barriers to improvement have been identified. However we found that some barriers to improvement are present for example, delays with funding for replacement windows and first floor doors. If barriers are not identified then there will be no plans in place to overcome them and the service may not improve for people. We found that there are systems in place to get the views of people who use the service. There are weekly service user meetings and people have yearly reviews when family and friends may be invited to attend.Staff said they look out for clues from people who may not be able to tell them something is wrong. They said they look for changes in mood and facial expressions that may show people are not happy about something.One person attends an area forum meeting so they can feedback any issues from Maple House and have a say about the service. The company carries out audits of the service. The manager said they have recently had a financial audit and are due to have a full audit. An area manager visits the home and carries out monitoring checks. The AQAA shows that the required health and safety checks of premises and equipment are carried out.Staff have training in areas related to health and safety like food safety and first aid. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 37 So the manager is up to date with latest research and best practice he should obtain a qualification relating to peoples needs, learning disability. Increasing the managers skills and competencies will also improve outcomes for people. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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