Inspection on 20/11/07 for Appleby House

This is the latest available inspection report for this service, carried out on 20th November 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Appleby House 19/10/05

Appleby House 20/05/05

Appleby House 07/10/04

Appleby House 28/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Appleby House Appleby House Longmead Road Epsom Surrey KT19 9RX Lead Inspector Sarah MacLennan Unannounced Inspection 20th November 2007 10:00 X10015.doc Version 1.40 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 Appleby House DS0000013891.V352143.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 Older People. 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. Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Appleby House Address Appleby House Longmead Road Epsom Surrey KT19 9RX 01372 739933 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) manager.burroughs@careuk.com Care UK Community Partnerships Ltd Vacant post Care Home 75 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (75) of places Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 10 service users may be admitted from the age of 50 within the category of DE (Dementia) 26th September 2006 Date of last inspection Brief Description of the Service: Appleby House is a purpose built home providing care and accommodation for up to 75 older people who have dementia. The home is owned and managed by Care UK, a private healthcare organisation. The building is single storey and accommodation is arranged in five units. Each unit has its own communal facilities including a lounge, dining room, kitchen, toilets and assisted bathrooms. All bedrooms are single occupancy, 35 of which have en-suite facilities. There is a large activities room central to the building. The home also has a hairdressing room and a day centre that is accessed by service users in the home and from the community. The home is a short distance from Epsom town centre and has ample parking to the front of the property. Fees at this home are in the range of £500 to £760 per week. Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit formed part of the key inspection process and took place over 7½ hours commencing at 10:00 and ending at 17:30. Sarah MacLennan, Regulation Inspector, carried out the visit. The manager was present throughout the inspection. As part of the inspection process a tour of the premises took place. Various written records were examined, including seven care plans and service user assessments, five staff personnel files, samples of staff training records, the complaints record, the medication storage facilities and a sample of the medication administration records. The inspector spoke to a number of service users and some staff members. Some of the comments made to the inspector are quoted within this report. The inspector would like to thank the staff and service users for their time, assistance, and hospitality during the visit. What the service does well: Service users spoken with were complimentary regarding the care that they received in the home. Comments included; ‘I love it here’ and ‘it’s very nice’. Service users are encouraged to be as independent as possible and to make their own choices, such interactions were observed. When asked if they received the support they required service user comments included ‘yes, the staff are great’. All appropriate safeguarding adults policies and procedures were in place and readily available to staff. Staff spoken to were aware of these policies and procedures and their whistle blowing responsibilities. A recent safeguarding referral evidenced that staff respond promptly and appropriately to concerns, complaints and allegations. Various quality audit systems were in place to ensure the staff, service users and their relatives had a forum for airing their views. These included staff meetings, service users meetings, service user and relative surveys, staff supervision and a suggestion box was available in reception. The minutes of the meetings were randomly sampled and evidenced that action is taken following comments made. All service users spoken to felt that their views were listened to and taken seriously. The inspector was informed that Care UK has recently appointed a Complaints and Customer Experience Manager who will be collating the results of the recent service users surveys. Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are not being fully assessed prior to admission to the home to ensure that the home can meet the service users identified needs. The home does not offer intermediate care. EVIDENCE: The inspector was advised that, following the home’s receipt of the social services assessment, pre-admission days take place for prospective service users. This enables the Team Leader to carry out pre-admission assessment on all prospective service users. Seven service user care plans were seen, four of the pre-admission assessments had not been fully completed and one service user’s file did not contain any evidence of a pre-admission assessment having been completed. Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies, procedures and practices are in place to ensure the service users health care needs are met; however the service users care plans are not person specific and the use of ‘bed-rails’ requires review. Care was seen to be provided in a respectful and sensitive manner. EVIDENCE: The home uses a computerised system of care plans, risk assessments and daily notes. These records were randomly sampled; seven service user care plans, risk assessments and daily statements were looked at in detail. The care plans did not contain specific instructions to staff and were not appropriately personalised. The home’s manager and deputy stated that they were aware of this shortfall and were currently in the process of personalising all the care plans; this will be monitored as part of the subsequent inspection processes. Two service users had ‘bed-rails’ in situ, risk assessments had been completed; however these risk assessments did not identify a need for Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 10 ‘bed-rails’, and there was no evidence of consent for their use. Discussion with staff evidenced that they were being used appropriately. It is required that the risk assessments are updated and ‘bed-rails’ are only used following appropriate consent. The service users daily statements evidenced that the care plans were followed and provided details of the service users 24hr day. Service users spoken with were complimentary regarding the care that they received in the home. Comments included; ‘I love it here’ and ‘it’s very nice’. Service users were registered with a local GP and had access to other health care services including district nurses, optician, dentist, chiropody and dietician. The home’s storage and recording of medication were seen and found to be in order. The home had a suitable policy for the administration of medication. Conversation with staff and service users evidenced that the service users are encouraged to be as independent as possible and to make their own choices, such interactions were observed. When asked if they received the support they required service user comments included ‘yes, the staff are great’. Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provision of activities and food are suitable for the needs of the service users. EVIDENCE: From examination of the service user records and discussion with staff and service users it was apparent that service users are encouraged and enabled to live a full life and to participate in age related activities such as bingo, musical quizzes, word games, ‘sing-a-long’, cooking, exercises and reminiscence. Service users spoken to gave examples of activities they had recently enjoyed and stated that the provision of activities was suitable for their needs. Comments from service users included ‘it’s very good and lots of fun’, ‘it’s lively and fun’ and ‘I’m not bored’. The home has links with various religious establishments in the local community. Church of England and Catholic services take place regularly. Due to the needs of the current service users, representatives of other denominations do not currently visit the home. Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 12 The home is located on the same site as the ‘Orchard Centre’, a day care facility run by Care UK that service users access as well as the wider community. The inspector was informed that they are planning to introduce ‘Activity Based Care’ within the next six months as this is a proven method of providing activities to service users with dementia. All service users spoken to stated that they were happy with the food provision within the home. Service users were observed to eat supper during the inspection. The meal was met with a positive reaction from service users. The menu was on a four weekly rota and alternatives were available on request. No cultural diets are currently provided, but could be upon request. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural groups. Conversation with staff and service users evidenced that the service users are encouraged to be as independent as possible and to make their own choices, such interactions were observed. Staff were observed to treat the service users with respect and care was provided in an unobtrusive and dignified manner. Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a simple and accessible complaints procedure; service users stated that they felt safe at the home. EVIDENCE: The home had a simple and accessible complaints procedure. The complaints procedure is clearly displayed in the hallway and a copy is given to all service users and their relatives in the home’s welcome pack. Service users spoken to during the inspection were aware of who to speak to should they have any complaints and felt confident that they would be listened to. There had been no complaints since the last inspection. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. All appropriate safeguarding adults policies and procedures were in place and readily available to staff. Staff spoken to were aware of these policies and procedures and their whistle blowing responsibilities. A recent safeguarding referral evidenced that staff respond promptly and appropriately to concerns, complaints and allegations. All service users spoken with stated that they felt safe at the home. Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was found to be clean, tidy and suitable in layout for its purpose. EVIDENCE: The inspector toured areas of the home. The premises were seen to be well maintained with service users able to access all areas of the home and grounds. The home was suitable for the needs of the service users. The décor was domestic in nature and general standards of maintenance were good. It was seen to be clean, tidy and free from offensive odours. Service users spoken to stated that the home is always clean, other service user comments included ‘I have a lovely room’. Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staffing arrangements in place on the day of the inspection were sufficient to meet the needs of the service users. EVIDENCE: The inspector was informed that the home currently maintains staffing number of 11 carers in the morning, 10 during the afternoon and 7 at night. Discussion had recently taken place at a staff meeting regarding these staffing numbers; following this the manager was planning to increase the morning number to 12 carers. One staff member spoken to during the inspection stated that the staffing numbers were not sufficient to meet the needs of the service users. The manager informed the inspector that she thought that this shortfall would be rectified by the planned increase. This will be monitored as part of the subsequent inspection processes. Five staff files were seen during the visit and found to contain the required information and documents specified in paragraphs 1 – 9 of Schedule 2 of The Care Homes Regulations 2001 (as amended by The Care Standards Act 2000(Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004). Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 16 Staff training was discussed with the home’s manager and deputy. The inspector was informed that a training plan for all staff is currently being completed. The home’s deputy manager is a manual handling trainer and all staff have received manual handling, safeguarding adults and fire training. The deputy had recently completed computerised training that included common induction standards, food hygiene, safeguarding adults, health and safety, COSHH and customer care, the certificates for this training were seen during the inspection. Service users spoken with were complimentary about the staff at the home. Comments included ‘they listen to me’, ‘they are nice’ and ‘I love it here’. All interactions observed between the staff and service users were caring and respectful. Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users benefit from the management approach at the home, which provided an open, positive and inclusive atmosphere. EVIDENCE: The home’s manager demonstrated a good knowledge and awareness of the service users needs. Her application with the Commission For Social Care Inspection to become registered manager is currently in progress. Service users were seen to interact readily with the manager and an open and inclusive atmosphere was evident within the home. All service users and staff spoken to spoke very highly of her. Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 18 Staff and service users appeared happy, contented and relaxed with the inspection process. The atmosphere within the home during the inspection was lively and cheerful. The manager stated that various quality audit systems were in place to ensure the staff, service users and their relatives had a forum for airing their views. These included staff meetings, service users meetings, service user and relative surveys, staff supervision and a suggestion box was available in reception. The minutes of these meetings were randomly sampled and evidenced that action is taken following comments made. All service users spoken to felt that their views were listened to and taken seriously. The inspector was informed that Care UK has recently appointed a Complaints and Customer Experience Manager who will be collating the results of the recent service users surveys. Procedures were in place to safeguard the financial interests of service users. No staff members are appointees for service users. The manager is aware of the need to maintain a safe environment for service users and staff. Required policies, procedures and safety checks were in place; samples of which were seen. Staff were observed to be following appropriate health and safety practices as they went about their work. Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement The registered person must ensure that all service users are fully assessed prior to their admission to ensure that the service users identified needs are met. The registered person must ensure that the risk assessments for the use of ‘bed-rails’ are updated and ‘bed-rails’ are only used following appropriate consent to ensure that their use is appropriate to the service users needs. Timescale for action 20/11/07 2 OP8 12 (1)(2)(3) 20/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Appleby House DS0000013891.V352143.R01.S.doc Version 5.2 Page 22 - 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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