Care Home: The Maples

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What the care home does well The service has produced good information about the home which they give to people who are thinking about moving in, and they have procedures in place for assessing their needs to make sure it is the right place for them to live. Staff showed good knowledge and understanding of the needs of the residents. During the inspection visit they were observed talking to residents in a polite manner and treating them with respect. Staff said: "I always talk to residents and tell them what I am going to do and talk to them in a respectful way" "I make sure curtains and doors are shut". "I never shout" The home had in place appropriate procedures for responding to concerns and complaints and for ensuring that residents are safe from abuse, harm or neglect. The Commission have not received any complaints about the home since the last inspection. Two complaints have been made directly to the home; records which were viewed showed that it was dealt with in accordance to the homes policies and procedures. Staff spoken with during the inspection said that they had been given information about how to make a complaint if they needed to. People were confident that their complaints would be listened to and dealt with in the correct way. What has improved since the last inspection? Residents` contracts have been developed and agreed by the relevant people to show that the company are acting in the their best interest and protecting their rights. The company have provided clear and accurate financial agreements, financial assessments and improved procedures for managing residents` finances which ensure their rights and best interests are safeguarded. Residents` care plans have been reviewed and updated so that staff have all the information they need to support residents to live independent and safe lives. Residents are able to enjoy a more varied lifestyle and take part in all the activities of their choice now that there is the right amount of permanent staff working at the home. Staff said: "Residents get out and about more and go further infield because there are always permanent staff on duty, the staff know the residents well and there is more consistency for them which is important because the residents like familiar faces. The staff team are a lot happier and they spend a lot of time explaining routines. They do more with the residents and spend more time with them." "We do lots of things with the residents, "They go shopping, for walks, the pictures and meals out. The things they do at home include footbaths, watching TV, listening to music, drawing and games".Menus have been reviewed following the advice of professional dieticians to ensure that residents are given a balanced and nutritious diet. There are plans in place to produce the complaints procedures in a more accessible format for example using pictures and symbols so that all the people who use the service can read and understand them better. Improvements made to the inside and the outside of the home have enhanced the comfort and safety of the residents that live there. The home was better maintained and free from hazards making it a pleasant and safe place for people to live in. Residents are better protected by the strict procedures that are now in place for recruiting and selecting new staff. The procedures include carrying out police checks before a person is allowed to start work at the home. A training plan has been produced for each member of staff to help to ensure that they have the skills to meet people`s support needs and that they are up to date with current good practice and make sure residents are safe at all times. Staff have undertaken or are planning to undertake both mandatory and specialist training so that they have the skills and knowledge to meet the needs of the residents and the aims and objectives of the home. The home now has a registered manager who has reviewed and updated existing management systems as well as implementing new ones all which have contributed to the overall improvement of the service. Comments about the manager included: "Things have changed dramatically, Lorraine is the best manager we have ever had". "She is extremely efficient". "She works hard and we have a lot of respect for her". "She is very professional". "The manager is much organised and gets a lot done". "The manager understands, approachable, caring and fair". "The manager is very good to the residents". The health safety and welfare of the residents is better protected now that the required health and safety checks to the environment and equipment are being carried out and appropriately recorded. CARE HOME ADULTS 18-65 The Maples 327 Hoylake Road Moreton Wirral CH46 0RN Lead Inspector Janet Marshall Key Unannounced Inspection 16th May 2008 09:30 The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Maples Address 327 Hoylake Road Moreton Wirral CH46 0RN 0151 678 6956 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) No email www.c-i-c.co.uk. Community Integrated Care Lorraine Anna Marie Pattern Care Home 5 Category(ies) of Learning disability (5) registration, with number of places The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user over 65 years of age may be accommodated Date of last inspection 18th October 2007 Brief Description of the Service: The Maples is situated by Moreton Cross on the Wirral and is close to the main shopping area. The home is a dormer bungalow with single bedroom accommodation being provided on both the ground and first floor. A bathroom with toilet and a separate shower room is provided on the ground floor with a further toilet situated on the first floor. There is a separate dining room that is also used as a seating area at the rear of the building and a lounge situated at the front of the home. The home has some equipment and some adaptations in place to meet the assessed needs of the residents that live there. There is off-road parking available to the front of the home and a large garden to the rear. The fees for the home are from £60.16 to £81.35 each week; Social services pay £330.50 per week. The Company agree to pay £500 each per year for a holiday. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good outcomes. This was a Key Inspection. The Commission considers 22 standards for Care Homes for Adults (18–65) as Key Standards, which have to be inspected during a Key Inspection. All key standards for this type of service are highlighted in bold in the relevant sections of this report. The report has been put together using information gathered from a number of sources including information that the Commission have received about the service since the last inspection which took place in October 2007 and details provided in the Annual Quality Assurance Assessment (AQAA). The AQAA, which is in two parts, a self-assessment and data-set, provides the Commission with important information about the service and the people that live and work there. The document, which was sent out to the service was completed in good detail and returned to the Commission before the site visit took place. The inspection also involved an unannounced visit to the home (site visit). This was carried out with the help of the registered manager and support staff that were on duty at the time. Records that were examined, staff comments and observations made during the visit have also been used as evidence for the report. Residents were unable to give their views and opinions about the service, however two residents were case tracked. This process involved observing and talking to staff, looking at the environment and a selection of residents’ records such as assessments, care plans and daily notes to get an idea about people’s experiences and to find out if they are receiving the care and support that they need and which they have agreed. What the service does well: The service has produced good information about the home which they give to people who are thinking about moving in, and they have procedures in place for assessing their needs to make sure it is the right place for them to live. Staff showed good knowledge and understanding of the needs of the residents. During the inspection visit they were observed talking to residents in a polite manner and treating them with respect. Staff said: The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 6 “I always talk to residents and tell them what I am going to do and talk to them in a respectful way” “I make sure curtains and doors are shut”. “I never shout” The home had in place appropriate procedures for responding to concerns and complaints and for ensuring that residents are safe from abuse, harm or neglect. The Commission have not received any complaints about the home since the last inspection. Two complaints have been made directly to the home; records which were viewed showed that it was dealt with in accordance to the homes policies and procedures. Staff spoken with during the inspection said that they had been given information about how to make a complaint if they needed to. People were confident that their complaints would be listened to and dealt with in the correct way. What has improved since the last inspection? Residents’ contracts have been developed and agreed by the relevant people to show that the company are acting in the their best interest and protecting their rights. The company have provided clear and accurate financial agreements, financial assessments and improved procedures for managing residents’ finances which ensure their rights and best interests are safeguarded. Residents’ care plans have been reviewed and updated so that staff have all the information they need to support residents to live independent and safe lives. Residents are able to enjoy a more varied lifestyle and take part in all the activities of their choice now that there is the right amount of permanent staff working at the home. Staff said: “Residents get out and about more and go further infield because there are always permanent staff on duty, the staff know the residents well and there is more consistency for them which is important because the residents like familiar faces. The staff team are a lot happier and they spend a lot of time explaining routines. They do more with the residents and spend more time with them.” “We do lots of things with the residents, “They go shopping, for walks, the pictures and meals out. The things they do at home include footbaths, watching TV, listening to music, drawing and games”. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 7 Menus have been reviewed following the advice of professional dieticians to ensure that residents are given a balanced and nutritious diet. There are plans in place to produce the complaints procedures in a more accessible format for example using pictures and symbols so that all the people who use the service can read and understand them better. Improvements made to the inside and the outside of the home have enhanced the comfort and safety of the residents that live there. The home was better maintained and free from hazards making it a pleasant and safe place for people to live in. Residents are better protected by the strict procedures that are now in place for recruiting and selecting new staff. The procedures include carrying out police checks before a person is allowed to start work at the home. A training plan has been produced for each member of staff to help to ensure that they have the skills to meet people’s support needs and that they are up to date with current good practice and make sure residents are safe at all times. Staff have undertaken or are planning to undertake both mandatory and specialist training so that they have the skills and knowledge to meet the needs of the residents and the aims and objectives of the home. The home now has a registered manager who has reviewed and updated existing management systems as well as implementing new ones all which have contributed to the overall improvement of the service. Comments about the manager included: “Things have changed dramatically, Lorraine is the best manager we have ever had”. “She is extremely efficient”. “She works hard and we have a lot of respect for her”. “She is very professional”. “The manager is much organised and gets a lot done”. “The manager understands, approachable, caring and fair”. “The manager is very good to the residents”. The health safety and welfare of the residents is better protected now that the required health and safety checks to the environment and equipment are being carried out and appropriately recorded. What they could do better: The main bathroom could be made more comfortable and homely to enhance the comfort and dignity of the residents. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 8 The garden could be tidied up and the broken fence repaired or replaced so that the residents have the opportunity to sit outside in a private, safe and pleasant space during the warmer weather. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has in place procedures which aim to ensure that people choose a home which is right for them and residents’ rights and best interests are protected by contracts which are detailed and up to date. EVIDENCE: A requirement was given as part of the last two inspections to ensure that residents have up to date and clear contracts in place. This was because residents’ rights and best interests particularly with regard to transport needs were not fully protected as contracts were unclear, out of date or unavailable during those inspection visits. The AQAA told us that each of the residents have in place an up to date financial support plan and Care contracts. During this inspection visit a contract was seen for each of the residents living at the home. The contracts were looked at in detail this showed that they have been reviewed and updated since the last inspection. All the contracts were dated and signed by the resident’s family or an advocate and Community Integrated Care (CIC) representative. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 11 Financial support plans were included in the contracts. The person’s benefit entitlements and financial arrangements were detailed in this section. CIC acts as appointee for several residents there was available information relating to the decision-making process as to why this decision was made; it showed that the relevant people were involved in this process and agreed to the decision. The Homes Statement of Purpose and Service User Guide, which were looked at, have been updated since the last inspection. They were available in written and audio format. The documents included all the required information about the service. An example of a care/support agreement is placed a the back of the Statement of Purpose and Service User Guide so that the prospective service user and/or their family or representative can see what a contract of terms and conditions looks like. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have the information they need to support residents to live independent and safe lives. EVIDENCE: Three residents’ care files were looked at in detail during the inspection visit. The manager explained that she is in the process of renewing all the residents’ care plans using standard CIC documentation. Each of the residents had a care/support package which was made up of essential health and lifestyle plans, financial support plans and risk assessments. Records of reviews showed that the plans have been reviewed and updated at regular intervals. The care/support plans which were looked at were personcentred and provided the staff team with detailed information and clear guidance as to the type and level of support residents need regarding their emotional, social and personal care needs. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 13 Risk assessments were part of each person’s plan of care. These provided staff with clear guidance and where appropriate instructions as to the support and supervision residents require in a range of environments and situations. Records showed that risk assessments have been regularly reviewed and updated. There was also evidence to show that the staff team have completed specialist training which helps them support residents in potential high-risk situations such as moving and handling and with challenging behaviours. All residents’ care/support plans were kept securely at the home. A requirement was given as part of the last inspection to ensure that residents’ rights and best interests are fully protected with regards to managing their finances. This was because there was little evidence at the time to show this was being done. Since the last inspection and with the involvement of the relevant people the service has put together a financial support plan for each of the residents. These were looked at for three residents. The plans provided staff with the information they need about the help and support residents need with their finances. A member of staff said the system for handling and recording residents’ finances has changed since the last inspection. New procedures require staff to carry out daily checks of residents’ personal money and records. Money and records which were checked for two residents were in good order. The procedures which the service now have in place for managing residents’ money are clear and help safeguard people from financial abuse as well as promoting their rights. The opportunity for residents to make decisions and their needs known relies a lot on the staff team understanding and responding to their non-verbal communications. This was observed during this visit and care plans reflected the staffs understanding, knowledge and rapport with the residents. The last inspection visit evidenced that the home relied heavily on the use of regular agency staff and have had long-term recruitment problems in keeping the stability of a staff team. This led to residents being managed and supported on occasions by staff that had not been trained or assessed as competent to support them, which had the potential to put residents at risk and impinge on their daily routines. This inspection evidenced that the use of agency staff has reduced significantly due to the recruitment of permanent staff and the use of familiar bank staff. Residents have benefited from this because they are now receiving a consistent service with support from a staff group they are familiar with and who have a good understanding of their needs. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy active and healthy lifestyles. EVIDENCE: As previously stated it was noted at the last inspection that the home relied heavily on the use of regular agency staff. This meant that there wasn’t always enough of the right staff on duty to support the lifestyle needs of the residents. The AQAA showed that this situation has improved since the last inspection because a number of new permanent staff have been recruited. Examination of daily records and discussion with the manager and staff showed that residents are now supported to take part in a variety of activities which they enjoy both at home and in the local community. Activities which residents have recently taken part in include shopping, visits to the cinema, country walks, meals out, and regular hydrotherapy sessions. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 15 One resident particularly enjoys pop music and has recently been to several pop concerts and is looking forward to going to another one in the near future. At the time of this inspection there were enough staff on duty to support the residents to do the things that they wanted to do. Staff spoken with said that residents take part in most planned activities both at home and in the community. The staff also reported that residents’ activity programmes and daily routines are much better followed because staffing levels are much more consistent and the use of agency staff is much lower than it has been in the past. One member of staff said, “Residents get out and about more and go further afield because there is always permanent staff on duty, the staff know the residents well and there is more consistency for them, which is important because the residents like familiar faces. The staff team are a lot happier and they spend a lot of time explaining routines. They do more with the residents and spend more time with them”. Another member of staff said, “We do lots of things with the residents. They go shopping, for walks, the pictures and meals out. The things they do at home include footbaths, watching TV, listening to music, drawing and games.” Each persons care/support plans detailed their hobbies and interests and included risk assessments for all the activities which they take part in. The communal minibus is no longer available. The bus that was paid for by the residents has been returned to the hire company. This was because there were only two staff able to drive, which meant the residents were not getting much use out of it. Residents now get about using public transport which increases their independence and confidence and as well as saving them money. Mobility arrangements, which were part of each person’s care package, detailed the person’s preferred way and the most suitable way of travelling. The plans also detailed the decision-making process. Menus which were looked at showed that residents are offered balanced and nutritious meals. The menus, which have been reviewed and changed since the last inspection, also showed a choice of meals. The home has a good sized kitchen and a separate dining room. Residents are encouraged to sit and eat together at the family sized dining table in the dining room, although if they wish they can eat their meals into the lounge or their own rooms. Meal times are flexible to fit in with routines and/or activities as well as any particular needs of the individual. The AQAA told us that community health professionals have given advice about healthy eating and specialist eating plans. It also told us that relevant health The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 16 professionals have looked at the menus and were satisfied and assured that the menus were well balanced and appropriate to the needs of each person. Residents’ food likes and dislikes were detailed in their care plans. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are treated well and their personal and healthcare needs are well monitored and supported to ensure they stay well. EVIDENCE: Each person’s care plan provided staff with a good amount of information about the best way to support residents with their health and personal care. During the inspection visit staff were seen treating residents well. They spoke to them in a respectful way and listened patiently to what they had to say. During discussion staff showed a good awareness of the main principles of care and gave a number of examples of how they ensure that residents are treated with dignity and respect. Examples they gave included: “I always talk to residents and tell them what I am going to do and talk to them in a respectful way” “I make sure curtains and doors are shut”. “I never shout” The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 18 Records which were looked at for two residents showed that they are supported to access healthcare services and attend appointments. Records of appointments to doctors, dentists, chiropodists and opticians were kept. Other more specialist appointments such as visits to hospital were also recorded. Staff have received training in specialist topics such as epilepsy awareness and mental health awareness to help them understand and deal with these conditions. Daily records showed that staff have encouraged and where necessary provided residents with the right kind of personal support. On the day of the inspection visit all residents were clean and smartly dressed. Staff at the home are responsible for managing medication for all the residents. This included ordering, storing, recording and administering. The AQAA showed that in place at the home are the required policies and procedures for the safe handling of medication and staff who are involved in the management of medication have completed medication training. Certificates viewed and discussion with staff during the inspection visit also supported this. A monitored dosage system in the form of blister packs was being used at the home. Medication and Medication Administration Records (MAR) are prepared by a local pharmacist. On the day of the inspection visit all medication was stored correctly and records were accurate and up to date. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures followed at the home ensure that people are protected from abuse, harm and neglect. EVIDENCE: The AQAA told us that two complaints have been made to the home in the last twelve months and that they were resolved within twenty-eight days. The AQAA showed that the service has in place a number of written policies, procedures and code of conducts which aim to protect both residents and staff. These included complaints, whistle blowing and protection of vulnerable adults procedures. The AQAA also told us that there are plans in place to produce these procedures in a more accessible format for example using pictures and symbols so that all the people who use the service can read and understand them better. A visitors’ book was available close to the front door for visitors to sign in and out of the home and no visitor is allowed to gain entry unless they produce some form of identification. Staff spoken with were familiar with the home’s complaints procedure and said they would be confident about making a complaint if they needed to. Staff spoken with made the following comments: “Yes I would complain if I needed to”. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 20 “I know how to make a complaint” There were a number of procedures relating to the Protection of Vulnerable Adults (POVA). They included the company’s own version and a copy of Wirrals Local Authority’s procedures. Staff training records which were looked at and discussion with staff showed that they have completed POVA training. Staff spoken with during the inspection visit all said they had attended POVA training. Induction records for a new member of staff showed that the topic was covered as part of their induction. All the staff correctly described the steps they would take if they witnessed or suspected abuse taking place. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ safety and comfort has been enhanced by the improvements made to the environment. EVIDENCE: The home is a detached property located in a popular residential road in Hoylake, Wirral Merseyside. It is located close to shops, cafes, pubs, healthcare centres and public transport links. There is a large driveway at the front of the house which is big enough for several cars and there is off-road parking available directly outside the house. Since the last inspection the front driveway has been cleared of all weeds and moss and risk assessments for the uneven path have been carried out making the area safer and more attractive. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 22 The home has a large back garden which is in need of attention. The lawn and borders were covered in weeds making it look untidy and unattractive and some parts of the fencing were in poor condition. The AQAA showed that plans are in place to tidy up the garden and replace the fencing. This should be done so that the residents have the opportunity to sit outside in a private, safe and pleasant space during the warmer weather. The inside of the home has undergone a number of improvements since the last inspection. They include: • The redecoration of all residents’ bedrooms and replacement of furniture and fittings improving their comfort and dignity. • The removal of a sink from a resident’s bedroom which has provided more space and reduced health and safety hazards. • Residents have been provided with new specialist beds which have improved their comfort. • The outside of the house has been repainted making it look more attractive. The company recently had a survey carried out on the property which highlighted a number of other general repairs and refurbishments. In response to this the company have made the necessary plans for the works to be carried out. A decorating schedule which was viewed as part of this inspection showed that parts of the home will soon be redecorated. The home has a bathroom and shower room which are situated on the ground floor. Both rooms were fitted with specialist equipment such as a bath hoist and handrails for use by those residents with physical disabilities. The main bathroom was quite bare making it look clinical. Items such as plants, pictures and ornaments would make it look more homely and comfortable for the residents. It was also noted that there were no mirrors in the bathroom, the manager did however say that she has made plans for mirrors to be fitted. All the residents’ bedrooms have been decorated since the last inspection. They were attractive and personalised with items such as pictures, family photographs, ornaments, TVs and music centres. One resident was enjoying watching DVDs in his room at the time of the inspection visit. New specialist beds have been provided for residents since the last inspection. They were fitted with special mattresses and remote controls to meet the particular needs of the person. The AQAA detailed a number of Policies and procedures relating to the environment including disposal of clinical waste, health and safety and hygiene and food safety. All parts of the home were clean, pleasant and hygienic and there were no hazards identified at the time of the inspection. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 23 The laundry, which is located in an outhouse at the back of the house, was equipped with sufficient washing and drying machines and ironing facilities. The laundry was clean and well organised. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by an effective staff team. EVIDENCE: There were serious concerns highlighted in relation to staffing as part of the last inspection. This was because there was a lack of permanent staff and high use of agency staff which impacted on residents’ lifestyles and choices. Information provided in the AQAA and examination of the rota showed that staffing arrangements have improved a lot. This was also supported by the following comments made by staff: “At least three new staff have been recruited recently, and we also have our own bank staff who know the residents”. “The use of agency staff has reduced significantly”. “Residents’ lives have improved because of this, they get out more and the staffing is more consistent which is very important for the residents”. “We spend more time with the residents and do a lot more with them”. “Staff sickness is low” The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 25 “There is always enough staff on duty the levels have dramatically improved” All staff spoken with reported that the use of agency staff has reduced significantly and residents are supported by permanent staff and regular bank staff. The AQAA showed that there are three full time care staff and four part time care staff currently working at the home. There were three care staff on duty at the time of this inspection visit. The rota showed three (sometimes four) staff on duty during the day and two staff at night. Staff were observed to have a good rapport with residents and through discussion showed a good understanding of each person’s needs. Staff records were looked at for three staff that have started work since the last inspection. Each of the files contained information to show that all the required checks were obtained before the people were allowed to start work at the home. Training and induction records viewed at the last inspection were poorly maintained and showed that staff had not received updates in basic training. This was of concern as there was little evidence to show that the staff were up to date with current good practices and of how to deal with unsafe or difficult situations. The AQAA showed that staff have received both mandatory and specialist training. It also showed that all new staff take part in detailed induction training when they first start work at the home. Training and development records which were looked at during the inspection visit also evidenced this. Staff spoken with confirmed that they have completed the following training: POVA, medication awareness, Fire training, moving and handling and First aid. The AQAA told us that more than half of the staff team have completed or are working towards an NVQ in Care Level 2 or above. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is better managed to the benefit of the residents and staff. EVIDENCE: The last inspection carried out in October 2007 highlighted a number of concerns regarding the management of the home. This was because records which are required by law could not be found and others which were checked were poorly maintained, putting the health, safety and welfare of residents and staff at risk. There has been a change of manager since the last inspection. In December 2007 Lorraine Pattern was appointed as the manager of the home. In March 2008 she put forward to the Commission an application to The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 27 become the registered manager of the home. Her application was successful and Lorraine was approved by the Commission in May 2008 as the registered Manager of the home. Lorraine has worked with younger adults who have a learning disability for approximately 20 years and has held a management position in this field of care for 7 years. During this time she has developed a range of care skills, managerial knowledge and expertise. She has obtained NVQ level 3 in continuing care, level 2 in both developmental care and direct care. In addition she has completed the Registered Managers Award and is currently completing an NVQ level 5 in management. She keeps up to date with current good practice by attending regular training sessions both in-house and externally, reading articles and carrying out research. Staff spoken with during the inspection visit were very complimentary of the manager and the way she runs the home. They all reported that the management of the home has improved a lot since the last inspection. The following comments, which were made by staff during the inspection visit, supported this: “Things have changed dramatically, Lorraine is the best manager we have ever had”. “She is extremely efficient”. “She works hard and we have a lot of respect for her”. “She is very professional”. “The manager is much organised and gets a lot done”. “The manager is understanding, approachable, caring and fair”. “The manager is very good to the residents”. Information provided in the AQAA and examination of records looked at during the inspection visit showed that all the records required by regulation are in place at the home and appropriately maintained. Residents’ care plans, risk assessments and staff records have all been reviewed and updated ensuring that they are up to date and accurate. Discussion with the manager and records which were examined showed that the home has in place a number of quality monitoring systems, which aim to ensure that the home is run in the best interests of the residents. Satisfaction questionnaires are given out to residents and their representatives as a way of seeking people’s views about the home and the results of them are used to plan to make the necessary improvements and to plan for the future. The health safety and welfare of residents are better protected. This was supported by a set of policies and procedures, which were detailed in the AQAA and available at the home. All the home’s policies and procedures have been reviewed and updated since the last inspection. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 28 The AQAA told us that the required health and safety checks have been carried out on the environment and equipment used at the home, at the required intervals, for example fire system checks, gas and electricity checks and environmental risk assessments. This was also supported by a selection of records which were looked at during the inspection visit. Staff spoken with confirmed that they hear the fire alarm system regularly being tested. The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X 3 3 X 3 X X 3 X The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 30 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA24 Good Practice Recommendations It is recommended that the main bathroom be made more comfortable and homely to enhance the comfort and dignity of the residents. The garden should be tidied up and the broken fence repaired or replaced so that the residents have the opportunity to sit outside in a private, safe and pleasant space during the warmer weather. 2. YA24 The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Maples DS0000018946.V358656.R01.S.doc Version 5.2 Page 32 - 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. 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