Care Home: Maple Lodge Care Centre

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What the care home does well People have their needs assessed either by the home or by other professionals before they move in. In our surveys we asked if people had been given enough information to decide if the home was right for them before they moved in. Six said `yes`, One said `no` and two said `don`t know`. People`s care records contain up to date information about their needs and people receive the support they need with their personal care, health care and medication. Comments made by people we spoke to during our visit included `the staff are nice`, `well I don`t think they could do any better, they are all very nice the girls who work here` and `oh very good, they just look after you, all perfect`. All nine people who returned surveys said they `always` got the medical care they needed and we found that medication is generally stored and administered in a safe way. People have the opportunity to join in with activities and social events and are provided with a choice of meals, snacks and drinks. In our surveys we asked people if the home provided activities they could take part in if they wanted to. Five people said `always`, three said `usually` and one said `don`t know`. Comments made about the food included `you get what you want, you can see it`s alright, look at this (laughing and wobbling his stomach), oh yes, it`s lovely`, `the home gives me support as a diabetic and gives me a suitable diet` and `gives out lovely cooked food`. Information is made available to people about making complaints or raising concerns and people feel that they can approach staff if they have a problem. During our visit we asked people if felt able to raise concerns or complaints if they needed to. Their comments included `oh yes, it wouldn`t matter, I`d just speak to the manageress, it wouldn`t be a problem` and `my son just goes to see Sue (the manager) if we`ve any problems`. The home provides a clean and pleasant place for people to live. Staff are employed in sufficient numbers and are provided with the training they need to do their jobs. We asked people we spoke to during our visit if staff checked on them and responded to calls for assistance promptly. Comments from people included `I sometimes have to wait a few minutes, but I think they do it as quick as they can`, `oh yes, they are there` and `they are backwards and forwards all the time`. The home is run by an experienced and capable manager. Formal systems are in place to check that the home is being managed appropriately, including people`s finances and health and safety. What has improved since the last inspection? Since the last inspection improvements have been made by redecorating parts of Maple Lodge, installing new shower rooms and a new heating system. A new mini bus is also available, to help take people to appointments or out on outings. The manager has completed her Registered Manager`s Award. This is a management qualification specially designed for people who manager care homes. Staff training has continued and staff have been encouraged to undertake National Vocational Qualifications (NVQs) in care. A member of staff has completed training on dementia care mapping and is taking a lead on implementing this in the home, helping staff understand the needs of people with dementia more. What the care home could do better: Sometimes the assessment information that has been gathered by other professionals isn`t made fully available to the home before the person moves in. Wherever possible this information should be shared before people move into the home, especially for emergency admissions when the home hasn`t been able to complete their own assessment. This is important, because the information helps staff understand people`s needs and decide if Maple Lodge can meet them. We have made some good practice recommendations to help the home improve the way help provided with medication is recorded. The home needs to improve it`s recruitment records, so that it can show that staff do not work in the home until the required checks have been completed. This is important because the home needs to be able to demonstrate that people are being protected from unsuitable staff. Staff should be provided with the training they need to ensure that the Mental Capacity Act deprivation of liberty safeguards and authorisation conditions are being met at Maple Lodge. Key inspection report Care homes for older people Name: Address: Maple Lodge Care Centre (Scotton Gardens) Scotton Richmond North Yorkshire DL9 4LZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rachel Martin     Date: 2 1 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Maple Lodge Care Centre (Scotton Gardens) Scotton Richmond North Yorkshire DL9 4LZ 01748834029 01748831008 maple.lodge.richmond@fshc.co.uk www.fshc.co.uk Four Seasons (DFK) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) care home 60 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) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 60 The registered person may provide the following category of service only: Care Home with Nursing - Code N, To service users of the following gender: Either, Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places 50, Dementia - Code DE, maximum number of places 10, Mental Disorder, excluding Learning Disability or Dementia - Code MD, maximum number of places 2 Date of last inspection 10 2 0 Over 65 0 0 50 Care Homes for Older People Page 4 of 31 Brief description of the care home Maple Lodge is a purpose built care home, which was built in 1991. It provides nursing and social care for up to 60 older people, including a separate 10-bedded unit for people needing more specialist dementia care. The home is part of the Four Seasons Health Care group. The home is a single storey building, located in a pleasant rural location, near the garrison town of Catterick. It has extensive grounds to the rear, garden areas and car parking at the front of the building. At the time of this inspection the fees varied from £441- £500 per week. There are additional charges for chiropody, hairdressing, papers and toiletries. Up to date information about fees and terms and conditions should be sought from the home?s manager. Care Homes for Older People Page 5 of 31 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection of Maple Lodge Care Centre. The site visit was completed on 21st July and was completed by one inspector. We looked at a selection of records, observed care practice and meal times, looked around the building and talked to people who live at the home, the staff and management. Before our inspection visit we reviewed all of the information we had received about the service since the last inspection and we asked the home to complete a selfassessment. This was completed well and returned to us on time. It provided the information we had asked for and told us what the home did well and what could be improved. We also sent surveys to a selection of people who live at Maple Lodge, a selection of staff and some of the health care professionals (such as doctors and district nurses) who work with the home. Nine people who live at the home, six staff members and Care Homes for Older People Page 6 of 31 three health care professionals completed and returned surveys to us. The results from these surveys have been included in this report where appropriate. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Since the last inspection improvements have been made by redecorating parts of Maple Lodge, installing new shower rooms and a new heating system. A new mini bus is also available, to help take people to appointments or out on outings. The manager has completed her Registered Managers Award. This is a management qualification specially designed for people who manager care homes. Staff training has continued and staff have been encouraged to undertake National Vocational Care Homes for Older People Page 8 of 31 Qualifications (NVQs) in care. A member of staff has completed training on dementia care mapping and is taking a lead on implementing this in the home, helping staff understand the needs of people with dementia more. 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 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 Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. People have their needs assessed either by the home or by other professionals before they move in. However, sometimes the assessment information from other professionals isnt always made fully available to the home before the person moves in. Evidence: In their self assessment the homes manager told us that people who are moving into the home are visited and assessed before admission. These assessments are completed by the manager and are completed either at the persons home or in hospital, depending on the circumstances. Emergency admissions to the home are often made through the local authoritys intermediate care or rapid response services. In our surveys we asked if people had been given enough information to decide if the home was right for them before they moved in. Six said yes, One said no and two said dont know. When we asked if people had received a contract six said yes and one said no. Care Homes for Older People Page 11 of 31 Evidence: The care records we looked at contained assessments that had been completed by the homes staff, either before or when the person was admitted to the home. The manager told us that assessment information is also sought from other professionals, where this is appropriate. For example, emergency admissions through the intermediate care and rapid response team. However, sometimes this information is not made available to the home before people are admitted. Some of the care records we looked at contained assessment information that had been provided by the local authority in their care records, but others didnt. Someone was admitted to the home on the day of our visit. The manager had been and assessed this person while they were in hospital and the assessment paperwork was available in the office for staff to look at. We spoke to one of the care staff on duty. They were talking to the person and helping them settle in. They confirmed that they had met the persons relatives when they came to look around the home and said that they knew the basics about the persons needs, but also commented that they didnt know much about them and would learn more as they cared for him. Information in the homes self-assessment told us that Maple Lodge works closely with the local intermediate care team. The home will take people in emergencies for between 2 to 6 weeks, while they receive regular visits from the intermediate care team professionals. This support aims to enable people to regain their independent living skills and hopefully return home. Care Homes for Older People Page 12 of 31 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Peoples care records contain up to date information about their needs and people receive the support they need with their personal care, health care and medication. Evidence: In their self assessment the homes manager told us that everyone who lives at the home is registered with local doctor, who visits Maple Lodge every week for routine calls and responds to emergencies. They also told us that people living at the home have access to a dentist, visiting optician and chiropodist, that staff are trained to respect peoples privacy and to give choices. The homes mini bus is used to help people get to appointments if transport is needed. We looked at four peoples care records. These included assessments, risk assessments and care plans which provide staff with information about peoples care needs. The records were generally completed well and were being reviewed regularly. These reviews help to keep the records up to date and make sure that staff know what care people currently need. The records also included evidence that people saw other professionals if they needed too. For example, their doctor, chiropodist or mental Care Homes for Older People Page 13 of 31 Evidence: health nurse or consultant. Comments made by people we spoke to during our visit included the staff are nice, well I dont think they could do any better, they are all very nice the girls who work here and oh very good, they just look after you, all perfect. Nine people who live at Maple Lodge completed surveys about the home. When we asked people if they got the care and support they needed, seven said always and two said usually. Nine people said they always got the medical care they needed. When asked if staff listened and acted on what people said, five people said always, three said usually and one said sometimes. Comments when we asked what the home did well included personal care and looks after us properly. During our visit we saw staff talking to people in a friendly and pleasant way. People seemed comfortable with the staff and chatted and laughed with them. Staff were sensitive to peoples needs and personal care was carried out in private. In the dementia unit we noticed that one lady who was sat in a chair had pulled her skirt up, showing her underwear. This wasnt very dignified as there were other people in the room and there were no staff around to assist her at the time. However, as soon as staff did come back to the room they helped to rearrange her clothing and got a blanket to help keep her covered. The feedback we received from health care professionals who visit and work with the home was positive. Comments made to us in surveys that were completed by health professionals included holistic, personalised care and no concerns about admitting end of life patients to Maple Lodge under the fast track service. The homes staff look after and support relatives very well. We looked at how the home stores and administers medication. One of the nurses showed us where medication was stored and helped us check a selection of the homes medication records. The home used the Boots Monitored Dosage System, which supplies medication in blister packs on a monthly basis. Only the trained nursing staff administer medication at the home. Medication was being stored appropriately, with staff monitoring and recording the room temperatures and fridge temperatures regularly. This helps to make sure that medication is stored at safe temperatures. However, we did notice that the room temperature sometimes reached as high as 27 degrees Celsius during hot weather. We checked a number of medication administration records (MARs). The majority of these had been completed clearly and were up to date and accurate. However, we found two entries that had been crossed out and were illegible. This meant we didnt know if the person had taken their paracetamol or what dose they had taken if they had. We checked the Care Homes for Older People Page 14 of 31 Evidence: controlled drugs register. The records we checked were correct and accurately reflected the medication stock that was available. However, the use of oramorph solution is not currently being recorded in the controlled drugs register. It doesnt legally have to be treated as a controlled drug, but our guidance suggests that it is good practice to store all morphine products in a controlled drugs cupboard and to keep records of receipt, usage and disposal in the controlled drugs register. Care Homes for Older People Page 15 of 31 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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 have the opportunity to join in with activities and social events and are provided with a choice of meals, snacks and drinks. Evidence: In their self assessment the homes manager told us that the home still has an activities coordinator and that regular entertainment comes into the home. People receive a monthly activities calender and relatives are invited to social events. They told us that trips out are taking place in the homes new mini bus, church services are arranged regularly and that there are no visiting restrictions in place at the home. We talked to the activities coordinator about her role and the activities she arranges. Regular events include pampering sessions when people have hand massages and have their nails and makeup done, baking, knitting, trips out in the mini bus, visits from entertainers and games. The activities coordinator also sometimes brings in her dog and rabbit, so that people can pet them. During the morning of our visit the manager held an exercise class in the main lounge. This is a weekly event, with people from the dementia unit and nursing unit joining in together. Later in the afternoon we saw the regular knitting group taking place. One person we spoke to told us how she had been invited to join in with various activities, but didnt feel she had the energy. Care Homes for Older People Page 16 of 31 Evidence: In our surveys we asked people if the home provided activities they could take part in if they wanted to. Five people said always, three said usually and one said dont know. We spent time observing the lunch time meal in the dementia care unit and ate our lunch in the main dining room with two people who live at Maple Lodge. There was a choice of sausages or steak burger with mashed potatoes, beans, carrots and gravy for the main course, with chocolate fudge cake and ice cream for dessert. The food we tried was nice, although we found that the choice of sausages or steak burger didnt really offer much variety. The people we ate with told us that the food was usually nice and that they are asked what they want for each meal the day before. One of them was trying to eat healthily, so the kitchen staff had prepared her a salad. We also saw that people were offered fresh fruit or yogurts for pudding, as an alternative to the cake. Another person had a glass of milk, instead of tea after their meal and there was water on the tables for people to drink. Staff helped people with feeding on a one to one basis, sitting with the person and helping in a polite and friendly way. Staff we spoke to told us that the food is usually good and that they can always get alternatives if someone doesnt want or cant manage the main choices that are on the menu. They also told us that there are always snacks available if people are hungry between meals. One person told us how the staff tried hard to provide things that she fancied to eat, saying they are very obliging with sandwiches and things. Another person we asked about the meals commented you get what you want, you can see its alright, look at this (laughing and wobbling his stomach), oh yes, its lovely. In our surveys we asked people if they liked the meals provided at Maple Lodge. Eight people said always, one said usually and one said sometimes. Comments made about food in the surveys included the home gives me support as a diabetic and gives me a suitable diet and gives out lovely cooked food. People living at the home are offered choices about their daily lives. For example, choices of food, where to eat their meals and spend their time, and opportunities to join in with activities and social events. One person told us how he prefers a bath to a shower and that staff help him to have a bath twice a week. When we asked if he could have more baths if he wanted he said oh yes, if you want another theyll help you. Other comments made to us when we asked people what it was like living at the home included its like being at home you know. When we asked people if there were any restrictions placed on people visiting the home people told us oh no, he (son) can come anytime, has the code to the door and he comes straight in and I think they can come anytime, or at least they seem to. Care Homes for Older People Page 17 of 31 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Information is made available to people about making complaints or raising concerns and people feel that they can approach staff if they have a problem. Evidence: In their self assessment the manager told us that people are made aware of the procedure for complaints and are encouraged to raise any issues openly with the homes staff. They also told us that the induction training undertaken by all staff includes safeguarding adults. In our surveys we asked people if there was someone they could speak to informally if they were unhappy. All nine people answered yes. We also asked if they knew how to make a formal complaint. Seven said yes and two said no. During our visit we asked people if felt able to raise concerns or complaints if they needed to. Their comments included oh yes, it wouldnt matter, Id just speak to the manageress, it wouldnt be a problem and my son just goes to see Sue (the manager) if weve any problems. All six staff who returned surveys said that they knew what to do if someone had concerns about the home and when asked if the service responded appropriately if they or a person using the service had raised concerns, two health professionals said always and one said usually. Since the last inspection we have been made aware of two safeguarding incidents that have occurred at the home. One was a complaint that was investigated by the local Care Homes for Older People Page 18 of 31 Evidence: authority and the other was a staff disciplinary issue that was investigated and dealt with by the home. Both of these issues were reported and investigated appropriately. There have been no other formal complaints recently, made either to us of directly to the home. Care Homes for Older People Page 19 of 31 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, 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. 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 provides a clean and pleasant place for people to live. Evidence: Maple Lodge was purpose built as a care home in 1991. In their self assessment the manager told us about improvements that had been made since the last inspection. Corridors have had new floors put down and have been re-carpeted and bedrooms and communal areas have been redecorated. A new shower room has been installed in the main unit and a wet room, with a shower, has been provided in the dementia unit. A new boiler has been fitted, a new waste area built outside the home, trees have been trimmed and a window cleaner has been employed. In our surveys we asked people what the home does well. Comments included its situation - a quiet area over looking the countryside, but with equestrian and rural activities to watch outside. One storey with large windows giving a connection to the outside world (instead of often stuck away upstairs as most emi units tend to be). Rooms decorated in light and sunny colours without to much clutter and space for personal touches. However, one person also commented that they thought the home looks a bit worn and tired - could do with updating and freshening up the environment. During our visit someone also mentioned how uneven the car park and paved entrance to the home was, with puddles often forming. They were concerned that this could cause people to trip and fall. We discussed this with the manager, who Care Homes for Older People Page 20 of 31 Evidence: told us that the area was well lit at night and that salt was used in the winter to prevent the risk of slips. However, the area is uneven and improvements should be considered for safety. On the day of the inspection we looked around the home and made observations. The home was clean and tidy and there were no unpleasant smells. People had their own possessions in their bedrooms, which made them homely and pleasant places to spend time. One person told us how they had brought in their own bits and pieces when they moved in and had their own television and phone in their room. There are outside gardens for people to use, including a small enclosed garden with seating and sensory plants which is accessed from the dementia care unit. The communal areas had obviously been redecorated recently and overall the home provided people with a pleasant place to live. When we asked people in our surveys if the home was kept fresh and clean, seven people said always and two said usually. During our visit we saw cleaning staff on duty and completing cleaning tasks, such as washing floors. We found that the home was being kept clean and tidy. The manager told us that additional infection control training was being provided to staff, with six staff having completed the training and another six attending training in the next week. Care Homes for Older People Page 21 of 31 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. Staff are employed in sufficient numbers and are provided with the training they need to do their jobs. Evidence: We talked to the manager about staffing levels at Maple Lodge. On the main nursing unit there are usually four staff on duty during the day, with two staff on duty at night. An additional member of staff now works a twilight shift to help with the busy period when people are wanting to go to bed. The dementia care unit is staffed separately, with two staff usually being on duty during the day and night. The manager and activities coordinator work in addition to these staff numbers. In our surveys we asked people who live at Maple Lodge if staff were available when they needed them. Seven people said always and two said usually. Comments included from the bubbly matron, through the well informed nurses, to the wide variety of caring staff, it is a wonderful team that brings a lightness and brightness to a soul destroying situation and I only have experience of the dementia unit at Maple Lodge and there are times when an extra pair of hands would be very helpful there, as residents and their needs vary so much from person to person, time to time. We asked people we spoke to during our visit if staff checked on them and responded to calls for assistance promptly. Comments from people included I sometimes have to wait a few minutes, but I think they do it as quick as they can, oh yes, they are Care Homes for Older People Page 22 of 31 Evidence: there and they are backwards and forwards all the time. In our surveys we asked staff if there were enough staff to meet the individual needs of the people living at Maple Lodge. Three said always, two said usually and one said sometimes. In their self assessment the manager told us that all staff complete a comprehensive induction on employment and we have extensive ongoing training both internally and via the local hospital and authority. They also stated that 41.66 of permanent care staff working at the home had achieved an National Vocational Qualification (NVQ) in care. However, during our inspection the manager confirmed that more staff are currently undertaking this qualification and that 52 of care staff will have the qualification once they have completed the course. Records we looked at confirmed that a new staff member had started NVQ training within six months of employment. Staff we spoke to said that they were provided with the training they needed to do their jobs. For example, one staff member told us how she had recently completed a dementia care training course and received manual handling training every six months. We were also told that some staff were trained fire trainers, they go on courses for updates and then come back and update us. Staff told us that they could ask for training and that their ideas were listened to. For example, one person told us Ive requested more dementia training for more staff and this is being sorted out. This is important so that all staff working on the dementia care unit are aware of the special needs of people with dementia. When we asked staff about training in our surveys, all six said they were given training that was relevant to their work, five said they were given training that helps them understand peoples care and health needs and four said they were given training that keeps them up to date. They also told us that their induction had covered what they needed to know either very well or mostly. We saw checklists and the induction work book that a new staff member was completing. The training records we looked at showed that training in relevant subjects is regularly provided. All six staff who returned surveys confirmed that the required recruitment checks had been carried out by the home before they started work. In their self assessment the homes manager told us all staff prior to commencement have police checks and references obtained. We looked at the recruitment records for three staff who have recently started work at the home. The records showed that the home had obtained references and completed criminal records bureau checks on these staff. However, the records didnt always evidence that these checks had been completed before staff started work at the home. When we discussed this with the manager she told us that staff sometimes start their induction training while waiting for their references and Care Homes for Older People Page 23 of 31 Evidence: checks to be completed. This means that their contracted start date occurs before the date that their recruitment checks have been completed. The manager assured us that no staff member actually starts to work in the home until the required checks have been completed. However, staff recruitment records need to clearly demonstrate that staff do not work in the home or have access to vulnerable people until the required safety checks have been completed. Care Homes for Older People Page 24 of 31 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 run by an experienced and capable manager. Formal systems are in place to check that the home is being managed appropriately, including peoples finances and health and safety. Evidence: The manager of the home is registered with CQC and has managed the home for five years. She has completed the Registered Managers Award (RMA), which is a specialist training course for people who manage care homes. People we spoke to knew who the manager was and felt that they could speak to her if they wanted to. Comments included oh yes, it wouldnt matter, Id just speak to the manageress, it wouldnt be a problem, its a very friendly home and my son just goes to see Sue (the manager) if weve any problems. People we spoke to told us that they felt able to approach the staff and the manager to discuss things about their care. A formal quality assurance system is also in place and was described in the homes self assessment. This includes a system of audits, Care Homes for Older People Page 25 of 31 Evidence: checks and surveys that are completed regularly and help to make sure the home is providing people with a good and safe service. We looked at the records of some of these checks during the inspection and confirmed that they were taking place. A customer satisfaction survey had also been completed in February 2009 and the results of this were seen during our inspection. It showed that people experienced generally high levels of satisfaction with Maple Lodge. Regular residents meetings are not held at the home, because the manager found that they didnt work very well. Instead staff go around and talk to people about the home and then coordinate and discuss the comments. We saw records of these discussions, which included the suggestion that people would like to see a trolley bar service introduced. The home has in place a policy and procedure setting out how they support people with their finances and this has been agreed between Four Seasons and CQC. During our visit we talked to the office administrator and looked at a selection of records. All residents money is kept in an interest-free, pooled bank account and a cash float is available at the home, so that people can access money when they want. Individual records of all personal spending are kept, including receipts. These records are regularly checked to make sure that peoples money is being used appropriately and people are protected. For example, a financial audit was undertaken by the regional finance department in September 2008. There are systems in place to manage health and safety at Maple Lodge. The home employs a maintenance person, who undertakes and records regular maintenance and safety checks. We talked to the maintenance person and looked at a selection of the homes maintenance records, which were very organised and well kept. The homes self assessment told us that maintenance for important equipment is up to date and a random check of maintenance contracts and certificates confirmed this. A fire risk assessment of the home was completed in July 2008 by a specialist external company. Regular checks on fire equipment are carried out by the maintenance person and the records we looked at were up to date. The maintenance man is also a trained fire marshal and told us that he tries to undertake three fire drills a month, aiming to catch all of the homes staff at least once every three months. Safe door closure systems are in the process of being fitted where doors need to be propped open, but this work hasnt yet been completed. For example, we saw two bedroom doors in the dementia care unit that had been jammed open with tissues, by people living in the home. We talked to the manager about the policies, procedures and training that the home has in place to ensure that the Mental Capacity Act deprivation of liberty safeguards Care Homes for Older People Page 26 of 31 Evidence: and authorisation conditions are being met. We found that there are currently no people living at Maple Lodge who are subject to a deprivation of liberty authorisation. The home has had a visit from the local authority about these issues and has been informed how to gain authorisation if they ever need to deprive someone of their liberty. The manager had a basic understanding of these issues, but formal training for the manager and staff has not yet been provided by Four Seasons Health Care. Care Homes for Older People Page 27 of 31 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 Older People Page 28 of 31 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 1 29 19 Recruitment records must demonstrate clearly that all of the required information has been obtained about new staff before they start working in the care home. The homes recruitment records do not currently show that two writtenm referrences and a criminal records bureau disclosure are obtained before staff start work in the home. 30/09/2009 2 38 23 Bedroom doors should not 30/09/2009 be propped open unless a suitable door closure system is used. Appropriate door closure systems allow doors to be propped open, while ensuring that they automatically close if the fire alarm goes off. This helps to protect people in the event of a fire. Care Homes for Older People Page 29 of 31 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 2 Assessment information from other professionals should be provided before people are admitted to the home. This is particularly important for emergency admissions through the intermediate care or rapid response services when the home does not have time to complete their own assessments before admission. If the temperature in the drug storage room regularly exceeds the safe temperature parameters for storing medications during hot weather appropriate action should be taken. For example, the installation of air conditioning to maintain a safe constant temperature. The weak strength of Oramorph (10mg in 5ml) is legally not a controlled drug, but our guidance suggests that it is good practice to store all morphine products in a controlled drugs cupboard and to keep records of receipt, usage and disposal in the controlled drugs register. All entries written in the medication administration records (MARs) should be clear and legible. Where necessary dated notes should be made on the back of the MARs to clarify any entries that are unclear. Consideration should be given to improving the uneven parking area and entrance way. At the moment the paving is uneven, with large puddles forming when it is wet. All staff working in the dementia care unit should be provided with specialist dementia care training, to help them understand and cater for these peoples specialist needs. Staff should be provided with the training they need to ensure that the Mental Capacity Act deprivation of liberty safeguards and authorisation conditions are being met at Maple Lodge. 2 9 3 9 4 9 5 19 6 30 7 31 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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