Care Home: Maple Lodge

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What the care home does well People who use the service told us `staff help`, `they look after me`, `I like the activities`, `they support me well` and they said that they are happy living here. Relatives or representatives of people who use the service made positive comments about the care and support, with comments including `they appear to do things well`, `they are always there for everyone`, `it`s a happy home with a positive family atmosphere` and `I appreciate all the effort made to look after all the people at Maple Lodge`. Staff told us they provide a positive environment for people, they empower people and promote independence. Staff feel they have good training opportunities, good support, regular meetings and `get on and work well as a team`. Maple Lodge provides a homely environment where people can continue to develop their independent living skills, do the things they want to do and see the people they want to see. What has improved since the last inspection? Staff have completed training in the protection of vulnerable adults and new staff complete core training following the Skills for Care package. The procedures around individuals finances have been updated to ensure all staff are aware of appropriate use of people`s money. The hot water temperature was seen to be maintained at 43 degrees. These issues were raised at the last inspection in August 2007. What the care home could do better: The service should consider the storage of `life story books` and `personal passports`, to ensure people who use the service and staff have easy access to these documents. Consideration should be given to the analysis of surveys being made avaialble to people who use the service and their representatives. Plans for the future of the service should continue to be discussed with the people who use the service and their representatives. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Maple Lodge 10 Southborough Road Surbiton Surrey KT6 6JN     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: Emma Dove     Date: 2 6 0 6 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 26 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 26 Information about the care home Name of care home: Address: Maple Lodge 10 Southborough Road Surbiton Surrey KT6 6JN 02083994356 02082871950 richard@thefircrofttrust.org www.thefircrofttrust Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Fircroft Trust care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: A variation has been agreed to allow one specified service user over the age of 65 to be accommodated. Date of last inspection Brief description of the care home Maple Lodge is a care home which provides accommodation for thirteen adults with learning disabilities. It is located in a quiet residential street close to Surbiton. Local bus routes are accessible nearby. Trains, shops and facilities are available in Surbiton itself. The service is managed by The Fircroft Trust. Information about Maple Lodge is available in a detailed Statement of Purpose and easy to read Service User Guide. Fees are from £592.27 per week. 13 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 26 Care Homes for Adults (18-65 years) Page 5 of 26 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 key unannounced inspection was carried out over six hours on the 19th June and 26th June 2009, by one regulation inspector. We spoke with people who use the service, staff and the manager and we looked at records. Surveys were sent to people who use the service and their relatives or representatives and staff. We received twenty four completed surveys, comments from which are included throughout this report. We received an annual quality assurance assessment from the manager when we asked for it. This gave us good information about the service, what it does well and areas they plan to develop over the next year. We looked at information we received since the last inspection in August 2007. Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 26 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 8 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service understands the importance of having sufficient information when choosing a care home. Assessments are completed before admission, to ensure the service is appropriate for the individual. People have a contract of residence. Evidence: The manager told us they have good information for people looking at moving into the home. We saw a Statement of Purpose and Service Users Guide, in written and pictorial format, making them accessible to the people who use the service. People who use the service told us they had been asked if they wanted to move in and had enough information to help them make the decision. We saw case files contain assessments of individuals needs, ensuring the service is able to offer people appropriate care and support. The manager told us all people who use the service have a contract of residence. We saw contracts in case files, which detail the fees, what the service provides, reviews, medication, finances and care plans. These documents are signed by the individual Care Homes for Adults (18-65 years) Page 9 of 26 Evidence: and the manager. We saw that one individual needs to sign their contract. Care Homes for Adults (18-65 years) Page 10 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service develops detailed care and support plans with each person who uses the service. These plans are person centred. Risk assessments are in place and kept up to date. Evidence: The manager told us each person who uses the service has a care plan which is in a user friendly format. We saw very detailed information, in pictorial and written format in care and support plans, ensuring staff are able to meet individuals needs. We saw a personal passport for communication for one person. This contained very good, descriptive information about what how the person communicates, what they like and dont like, words and gestures they use and what they mean. We also saw a photo album to contain information, like a life story book. Again this information provides staff with information about individuals likes and dislikes, what they have achieved and pictures of special events. The service should consider whether these books are best kept in the office or in individuals rooms. Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: We saw that people have developed goals they wish to achieve and a list of things they want to change. These are reviewed every year. The manager told us peoples religious and cultural needs are met. One person told us they do not have any religious needs. One person told us staff respect their religious wishes. The service operates a key worker system. People who use the service were aware of who their key worker is and said they meet with them regularly. We saw monthly reports written by key workers, which review health; personal care and support; communication; leisure; day placement; personal goals and any feedback from the individiual. The deputy manager said she checks these are completed every month. Five relatives or friends feel the service always and one said they usually meet the needs of their friend or relative. Five relatives or friends feel the service always and one said they are usually kept up to date with important issues. Five relatives or friends say the service gives the support agreed and expected. Eight members of staff said they always and one said usually have up to date information on the needs of the people they support. The manager told us there are generic risk assessments in place for all people who use the service. We saw risk assessments for personal care, accessing the community, using kitchen appliances, completing domestic tasks and answering the front door in individuals case files. Other risk assessments are completed for individuals as required. These assessments are reviewed every year or more often if necessary. People who use the service told us they understand why risk assessments are completed and feel these are apporpriate. Care Homes for Adults (18-65 years) Page 12 of 26 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. The service has a commitment to enabling people who use the service to maintain and develop their social, emotional, communication and independent living skills. People go out and do what they want to. The service provides a varied diet to meet peoples medical and cultural needs. Evidence: The manager told us the home has a weekly activity programme, with an emphasis on accessing community facilities. People who use the service told us they go to day centres during the week and go out to clubs and groups some evenings. We saw people return from day centres, shopping, a day trip and seeing relatives during our visits. People said they enjoy going out for meals, going out on day trips and holidays. Five people said they always decide what they do, two people said they usually and two people said they sometimes decide what they do. Eight people said they decide Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: what they do during the day, evening and at the weekend. One person told us the best thing about the home is the activities, especially cycling. Four relatives feel the service always and one said usually helps people to live the life they choose. People who use the service told us they can have visitors and go to see family and friends. Five relatives or friends said the service always and one said usually helps them keep in touch. We saw the service provides a varied menu, which takes into account individuals health and medical needs and preferences. The manager told us people can sit together in the dining room for meals and if they want to eat on their own, this can be arranged. Peoples comments about the food included I like the food, I enjoy the food and the food is good. People told us they make drinks when they want. We saw a weekly planner of household tasks people who use the service do. People told us they are happy to do these tasks. Care Homes for Adults (18-65 years) Page 14 of 26 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 receive appropriate support with personal and health care, using a person centred approach. Medication is well managed. Evidence: The manager told us they deal with peoples health needs appropriately, ensuring that each person has access to health care professionals as required. We saw case files contain separate details of health and medical appointments with any actions needed. The manager told us that people who use the service are taking part in a national health screening programme through the GP. One person confirmed that they are seeing the GP. Medication is appropriately stored, labelled and records are up to date and signed by staff. Good systems are in place to check medication has been administered daily and weekly. People told us staff help with medication, staff come to the doctors with me and staff help me. The manager told us they have recorded the wishes of people who use the service Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: around end of life care. We saw case files contain peoples wishes regarding end of life care. Some files contained clear details, while others stated that the family would arrange, with details of who to contact to make arangements. Care Homes for Adults (18-65 years) Page 16 of 26 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. The service has a clear complaints procedure which is accessible to the people who live there. Appropriate policies are in place for safeguarding and staff complete training in safeguarding. Evidence: The manager told us the organisation has an accessible complaints policy in place. People we spoke with were aware of how to make a complaint and told us they would speak to the manager, the deputy, my key worker or my relatives if they had any worries or concerns. Five relatives or friends said they know how to make a complaint and feel the service always responds appropriately. The manager told us they have not recieved any complaints. No complaints have been received by the Commission. The manager told us they use the local authorities safeguarding procedure and all staff completed training in the protection of vulnerable adults in December 2008. Staff confirmed that they have completed training in safeguarding and are aware of their responsibilities. Care Homes for Adults (18-65 years) Page 17 of 26 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. People who use the service benefit from a well maintained and homely environment which is kept clean. Seven bedrooms are single and three bedrooms are shared. There are enough bathrooms and toilets for the people who live there. Evidence: Maple Lodge is a large detached house in a quiet residential road in Surbiton. It is a good walk to local shops and a bus journey to Tolworth, Surbiton and Kingston shops and leisure facilities. The house was not designed to be a care home and does not fully meet the needs of the people who live there. There are three shared and seven single bedrooms. People can access a lounge, dining room and kitchen on the ground floor. The garden is accessed through the dining room and has chairs and tables for use during good weather. There are sufficient bathrooms and toilets and people have the choice of a bath or a shower. All areas were clean and fresh. Seven people told us that the home is always and two people said it is usually clean and fresh. The manager told us the organisation has purchased a site in the local area which they Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: plan to develop into purpose built accommodation for people who use this service and two other similar services. Care Homes for Adults (18-65 years) Page 19 of 26 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. People who use the service have confidence in the staff who support them. Staff levels are sufficient to meet peoples needs. Staff recruitment is in line with regulations to keep people safe. Staff have access to relevant training and have regular supervision. Evidence: We saw enough staff to meet peoples needs, with four staff on duty in the morning, three staff in the afternoon and one staff awake and one member of staff asleep but on call at the home at night. The manager is available in addition to these hours on weekdays. We saw the staff levels to be sufficient to meet peoples needs. Three members of staff said there are always and six staff said usually enough staff to meet peoples needs. Nine people said staff always treat them well. Seven people said staff always listen and act on what they say. Peoples comments about the staff included staff help, they look after me and staff help me. Staff told us they had the appropriate checks before they started work. We looked at one staff file which contained confirmation that two written references were received and that a Criminal Records Bureau (CRB) check was completed before the person started work. It is recommended that the date references were received and the date Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: the CRB check was completed are included. The original recruitment documents are kept at the organisations head office. We saw a completed Skills for Care induction booklet for new staff. Staff told us their induction covered everything they needed to know very well. The manager told us staff have access to training to help them do their job. Staff told us they get appropriate training. We saw records of staff training to include first aid, medication administration, health and safety, fire safety, protection of vulnerable adults, manual handling, food hygiene, end of life care and dementia care. The manager and deputy have completed training on the Deprivation of Liberties Safeguarding and will be passing this information on to the staff team. Staff told us they see the manager regularly and get enough support. Staff told us they have a handover of information at the beginning of every shift and tasks are allocated for each shift. Care Homes for Adults (18-65 years) Page 21 of 26 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 manager has the required experience to run the home and is aware of the organisations systems and plans. Quality Assurance systems are in place to seek the views and opinions of people who use the service and their representatives. The Annual Quality Assurance Assessment contains clear information and shows us how the service meets the required standards and areas they plan to improve. Health and safety is well managed. Evidence: The manager has been at the home for a number of years and has experience in other similar care services. The manager has the knowledge and experience to run the service. He is registered with the Commission. Systems for quality assurance are in place with annual surveys sent to people who use the service and their representatives and a monthly visit carried out by one of the organisations trustees. We saw the reports from these monthly visits. The analysis from surveys could be used more formally to show people what their comments are and detail any actions taken to improve or change the service. We saw an Annual Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: Development Plan for the current year which is being worked through. We saw records of health and safety checks to be up to date. There are good systems to check the premises on a weekly basis. Care Homes for Adults (18-65 years) Page 23 of 26 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 24 of 26 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 6 Consideration should be given to where the personal passports and life story books are stored, to ensure that people who use the service have full access to them. The staff recruitment records should include the date checks were completed. Consideration should be given to making the comments people who use the service in annual service surveys. 2 3 34 39 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!