Inspection on 22/12/05 for Apple Court Care Home

This inspection was carried out on 22nd December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Apple Court Care Home 03/10/06

Apple Court Care Home 25/04/06

Apple Court Care Home 29/07/05

Apple Court Care Home 16/12/04

Apple Court Care Home 21/05/04

Apple Court Care Home 13/02/04

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

CARE HOMES FOR OLDER PEOPLE Apple Court Care Home Apple Court Mental Nursing Home 76 Church Street Warrington Cheshire WA1 2TH Lead Inspector Anthony Cliffe Unannounced Inspection 09:00 22 December 2005 nd 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 Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 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. Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Apple Court Care Home Address Apple Court Mental Nursing Home 76 Church Street Warrington Cheshire WA1 2TH 01925 240245 01925 240123 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) Hallmark Healthcare (Warrington) Limited Mr Ian Smallwood Care Home 67 Category(ies) of Dementia - over 65 years of age (67), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1) Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 67 service users to include: * Up to 67 service users in the category of DE(E) (dementia over the age of 65). * Up to 1 named service user may be MD(E) (mental disorder over the age of 65). Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commision for Social Care Inspection. The registered provider, must at all times, employ a suitably qualified and experienced manager who is registered with the Commissiion for Social Care Inspection. The registered manager has a qualification at level 4 NVQ in management and care or equivalent by 1st April 2005. 30th August 2005 2. 3. 4. Date of last inspection Brief Description of the Service: Apple Court is a 67-bedded care home providing nursing and personal care to older people diagnosed with dementia and is operated by Hallmark Healthcare. The home is located in Warrington town centre and is on a main bus route and close to all local amenities and facilities.The home is a purpose built two-storey building. Each floor has two living areas that have been combined to provide one larger living group and facilitate the support of a larger group of staff, with a minimum of two registered nurses on duty at any one time.Each floor has two lounges, two dining rooms and recreational areas. Each resident has their own single bedroom with en-suite facilities. Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two regulatory inspectors undertook this unannounced inspection. The full inspection was triggered by two recent unexplained fractures to two residents, which were referred under the local authority adult protection procedures. The regional manager has been providing managerial cover while a full time registered manager is recruited. The inspection took place over eight hours. Feedback was given to the clinical managers. Records were inspected and staff practice was observed. Discussion took place with residents and staff. One requirement remained outstanding from the last inspection visit. What the service does well: What has improved since the last inspection? The statement of purpose has been revised to reflect the resident population accommodated at Apple Court and changes in the management structure. Management and administration of medication has improved but further improvement is needed. The management and approach to managing challenging behaviour has improved with staff receiving training on the techniques employed at Apple Court. Complaints are appropriately acted upon. Management of the home has improved with the regional manager working at Apple Court supported by two clinical managers until a suitable competent and experienced manager is recruited. Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 6 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. Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 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 Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. The statement of purpose has been amended to reflect that residents with severe challenging behaviour are not accepted. Residents’ needs were assessed prior to moving into the home to ensure their needs could be met. EVIDENCE: The statement of purpose has been revised to confirm that Apple Court does not accommodate residents with a history of aggressive challenging behaviour. Care documents were examined for a number of residents showed that the people most recently moved into Apple Court had pre-admission assessment documentation completed. Pre admission documents were signed and dated by the person that completed them. The pre admission document is very detailed; from this a care plan can be developed. The pre admission assessments were supported by assessments and care plans from care managers and NHS facilities. Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9 and 10. Residents’ plans ensure that health and social care needs are identified and met but improvement in the monitoring of the causes of challenging behaviour would further enhance residents’ quality of life. Residents’ health is at risk from staff not adhering to moving and handling procedures and not using the equipment identified. Improvement in the administration and recording of medicines has been made but further improvement is required to ensure residents receive prescribed medicines. Residents are treated with dignity and respect but staff need to be informed about antisocial behaviour that may place residents at risk of abuse or exploitation. EVIDENCE: The care plans of several residents were examined. All plans had a wide range of assessment documents fully completed; with a care plan to address residents’ identified needs. From looking at care plans, and talking with residents, the health needs of residents were generally met. Two residents were identified as presenting challenging behaviour. One of the resident’s behaviour was associated with diabetes. The resident was identified as becoming aggressive at times and taking other residents food. There were records that the resident was reviewed regularly by his general practitioner and had gained 7.5 Kilogram’s since moving into Apple Court. Staff had been Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 10 concerned about the resident’s physical and mental health. The resident’s medication had been reviewed due to drowsiness and a general practitioner visited due to a urinary tract infection. The chiropodist had seen the resident due to his diabetic condition. The resident’s blood glucose levels were monitored daily and recorded ‘within normal range’ on most days. There was no indication of what the normal range was. In reviewing the days when aggressive behaviour or taking residents’ food was recorded. It was noted that the resident had a low blood sugar. Staff clarified that if the resident’s blood sugar was low they would provide a sugary drink or food item. This information was not recorded in the care plan to manage his challenging behaviour. Another resident identified as being verbally abusive and aggressive had an action plan to manage this behaviour. The care plan did not identify any triggers or antecedents to the behaviour. The manager confirmed that there was a monitoring chart in place but this was not in use. A resident’s pre admission assessment and local authority assessment identified the resident as displaying inappropriate sexual behaviour to females. The resident had been accommodated for less than 24 hours and a care plan; risk assessment and risk management had not been drawn up. Despite the risk to females this information had not been passed onto staff to be aware of. When asked about the resident’s needs a carer said ‘no I was not aware but he has made some comments to me. He asked if I wanted to go upstairs. We were told at handover about his health and diet but not about him making those types of comments’. A resident with a pressure ulcer had her care reviewed regularly with a wound management plan in place to advise how often the dressing used should be replaced. The GP liaison nurse had reviewed the resident and records recorded an improvement in the pressure ulcer. A resident who had recently moved into the home had a comprehensive range of care plans, risk assessments and risk management plans to meet her needs. The resident was identified as being at risk of falling. The manual handling assessment identified that a transfer belt and turning circle were to be used at all times when transferring the resident from a chair or wheel chair. Two care assistants were seen on two occasions to transfer the resident without the use of a transfer belt or turning circle. The resident was positioned over three feet away from a dining room chair during the transfer and was heard to complaint to staff that they were hurting her back. The medicine room was very untidy because of large quantities of waste and empty containers waiting to be processed and there was a substantial amount of residents’ prescribed food supplements on the floor with the waste labelled “out of date”. The beaker used for storing oral dose syringes was dirty. The sharps box had been overfilled and syringes were sticking through the top opening. There was a linen towel by the hand washbasin in addition to the paper towels. One medicine prescribed, as a variable dose did not recorded the does given. Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 11 There were nineteen omitted records of administration of medicines. The majority of these were spread over two dose times. One resident’s course of antibiotics did not account for two doses. See requirement 1 and 2 and recommendations 1 and 2. Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Residents are supported in making choices in their lifestyle and in meeting their social needs, but the training of staff providing social activities needs to improve. Families and friends are welcomed into Apple Court at any reasonable time. Residents have a choice of meals in pleasing surroundings but choice and presentation of meals needs to improve. EVIDENCE: The environment on the units was relaxed and sociable. Residents were seen listening to and enjoying Christmas songs on the radio. The radio was tuned into an appropriate radio station. A resident spoken with said ‘I feel safe here. Staff are okay and they work together. They are kind and nice to me. I heard Stephanie call you Mr. That shows respect. I don’t want to be called Mrs that is not what you want at home. The main thing is that I feel okay here’. Another resident said ‘ I have settled in the home very well and my wife visits me on a regular basis’. A resident who had just moved into Apple Court said ‘ I moved in yesterday from another home where I lived for seven years. I have lived in care homes for twenty years. I have a nice bedroom with an en suite toilet. I have been introduced to everyone. That nurse is from India and he is a nice chap. Staff have showed me around and I can ask if I need the toilet. For breakfast I had cornflakes and toast. When in arrived yesterday I had sandwiches. I have told staff that I don’t like cheese, gravy or yoghurt. She said yes I know that. People here are very friendly. I originate from Liverpool and they call me by my first name, which is all right’. In passing the resident Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 13 asked a care staff about the food he disliked and she clarified what he had said and added that he was diabetic and needed reminding of this. Residents sat in the dining room were seen to assisted by staff prompting them to eat their mid day meal. Staff were seen to be skilled in their interactions with residents offering timely prompts to residents eating. They did not intervene by helping residents to eat but promoted their independence by drawing their attention back to eating their meal and reminding them to eat their meal. The activities organiser was seen on two of the four units in the morning. She was displaying the activities programme and had led a small group of residents in a gentle exercise session. The activities programme was for a three-week period. The organiser said ‘the programme is based on what residents can do and we take residents out weather permitting. Some families gave us information on residents’ likes and dislikes but we devised the programme. A new resident’s family have asked if her husband can do some painting which he enjoys, but I need to see her about this. He cannot paint but maybe has some other interests’. The activities organiser said she did not think the resident could hold a paintbrush. She verified that she and the other activity organiser had no formal training in providing activities or assessing residents’ suitability to join in them. The mid day meal was served at 12.30pm. Residents were prompted or assisted into the dining rooms. Residents were served drinks before lunch. Staff were unaware of the choice of meal on all four units. Staff on each unit stated that the menus were displayed on the dining room door, but no menus were seen. Staff clarified that there were alternative meals available if residents did not wish to have the main meal. Kitchen staff that served the meals said the alternative was soup or sandwiches. Alternative choices were not seen to be offered to any residents. Staff served meals to residents and asked if the meal was okay, this was positive but did constitute choice. Meals were generally seen to be well presented, including pureed meals. However some meals were served in a bowl with the portions served on top of one another. Two care assistants on one unit assisted residents to eat by standing next to them when the residents were seated. These staff then mashed the residents’ food together before assisting them to eat. This matter was addressed to the two clinical managers. See recommendations 3 and 4. Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Complaints are acted on appropriately. The management of physical intervention has improved and staff are clear about the techniques used at Apple Court to manage challenging behaviour. EVIDENCE: A new complaints recording format has been introduced. The format records the details of the complainant, nature of the complaint, date and time of complaint and who took the complaint. The format records when an acknowledgement of the complaint is sent and when the complaint is finalised the outcome of the investigation of it. One complaint had been recorded since the previous visit regarding the competence of a qualified staff member. The complaint was regarding a family not being informed about the deteriorating health of a resident and the language skills of the staff member. The complaint was recorded as being partially upheld as information was not given in a timely way. Training records provided recorded that staff had undertaken training on aggression and de-escalation in September 2005 and abuse awareness in November 2005. Staff spoke about the training and said ’the training on dementia and challenging behaviour has been useful. It helps you understand why people are confused and helps you to approach people and calm them down’. Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Residents live in a safe and well-maintained home, which is clean and hygienic. There is a commitment to improving the standard of accommodation for the benefit of residents. EVIDENCE: All communal areas and some bedrooms were seen. The interior and exterior of the building was well maintained. The home was free from odours. Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The numbers and skill mix of staff are adequate to meet residents’ needs. The training programme has provided a more informed and skilled staff group. Staff recruitment needs to improve to ensure that residents are protected. EVIDENCE: The staffing on the units was adequate with a qualified staff member and two care assistants on duty. The manager stated that he has been set a target for 75 of staff achieve an NVQ level 2 qualification by December 2006. Training records provided recorded that two care staff had an NVQ level 3 and 17 staff have an NVQ level 2 qualification out of the 32 care staff employed. Records of three recently appointed members of staff were looked at. The home’s receptionist maintains these records in good order. All files contained an application form, a medical declaration, and record of interview. A POVA first check, and a Criminal Records Bureau disclosure had been received. A PIN check had been carried out for qualified nurses. One file contained only one reference, and did not all have an employer’s reference. The manager on Rylands unit stated that the positive practice observed was due to in house training on the unit. She stated that staff had been given guidance on the promotion of independence in prompting residents to eat independently and interact more with them when providing assistance. She said staff were advised to use timely prompts during meal times to promote residents eating skills. Staff were seen to be skilled in prompting residents to eat independently. Training records provided recorded that staff had completed Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 17 training on aggression and de-escalation on 7th September 2005. Moving and handling on 9th December 2005. Fire safety training in November 2005. Abuse awareness in November 2005. Emergency first aid in November 2005. Communication skills in November 2005. End of life pathways in November 2005. Two staff talked about the training they had undertaken and said ‘ We have had a lot of training on COSHH, moving and handling, adult protection, challenging behaviour, health and safety, end of life pathways, dementia care and basic food hygiene’. A staff member verified that the clinical manager had completed the TOPPS induction training with her and she was now registered for an NVQ level 2 qualification. A senior carer said ‘ I have now applied to the Nursing and Midwifery Council for adaptation training. They have offered me a placement here. I am hoping to start next year’. See requirement 3. Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. The management of Apple Court has improved but the appointment of a suitably competent and experienced manager would ensure residents receive consistent quality care. The quality assurance system in use needs to improve to ensure that care plans are audited on a regular basis. The maintenance procedures at Apple Court do not promote and safeguard the health and safety of people living there. EVIDENCE: Since the last visit the registered manager has been promoted to the regional manager for Hallmark Healthcare and is still acting as the registered manager until a suitable experienced manager is appointed. The manager was able to demonstrate that Hallmark Healthcare commissioned an agency to undertake a robust recruitment process for a suitable candidate. Potential candidates were being shown around Apple Court and interviewed during the visit. The manager verified that the second part of the interview was psychometric testing and interview at Hallmark Healthcare’s head offices. The manager clarified the new management structure detailed in the statement of purpose. There are now two clinical managers one on each floor. They are based on a unit but have Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 19 supernumerary hours to supervise qualified and care staff and coordinate the care of residents. Staff commented that the clinical managers were facilitators of care and provided supervision and guidance to them. A senior carer said ‘ I like working here the teamwork is excellent and I enjoy good relationships with the management team. Stephanie is excellent and she is proud of the standard of care provided. Communication and support is very good’. Another senior carer said ‘there has been an improvement in the organisation of things. We have Karen as the clinical manager. We have regular training and supervision. Karen is very good, very approachable. If you want to ask her something she will advise you. If she is not satisfied with your practice she will tell you. There has been a definite improvement in the supervision of us’. Hallmark healthcare have introduced a ‘ quality audit tool’’ which was completed at Apple Court between the 24th to 26th October 2005. This uses a comprehensive audit tool covering the operation, management and administration of Apple Court using performance indicators against set standards. Apple Court uses a formal quality assurance system that seeks feedback from the families of residents. Satisfaction questionnaires are sent directly to residents’ families from the head office. Replies of these had not been sent to the manager. The manager completes a clinical audit on a monthly basis. This includes such areas as falls, accidents, complaints, tissue viability, continence and medication. The care plan audit tool is not currently in use and the clinical managers do not routinely audit care plans and provide feedback to staff on the standard of record keeping. Staff said they had received supervision from the clinical managers. Training records provided recorded that a number of both qualified and care staff had received supervision in November 2005 but not all staff. One of the clinical managers verified she had not completed supervision of staff for two months and care staff verified this. Other staff recalled having supervision in November a carer said ‘I had a one to one with Karen. We talked about training and how I do my job. Karen is very good she is the clinical manager and is approachable and offers you advice on care. If she did not think you were pulling your weight or doing things right she would tell you’. Another carer said ‘I completed the TOPPS induction day and in my one to one registered for an NVQ level 2’. No residents’ money is kept on the units. Residents are usually advised not to keep large amounts of money. Personal money can be given to the administrator for safekeeping and accessed for the resident by request. The administrator said that the majority of resident’s families deal with their finances and that Apple Court does not act as appointee. Two records were examined and showed appropriate receipts for purchases and invoices. Some resident’s finances are handled by Social Services; therefore the administrator makes requests for their personal allowances. Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 20 The maintenance man kept comprehensive records. Weekly fire alarm tests were evidenced. The last alarm service was recorded as 25th November 2005 Emergency lighting is tested monthly and a monthly maintenance plan completed. Mobile and static hoists and water service records were completed. Portable appliance testing had not been completed in June 2005 as required. On the ground floor a sluice room was not locked and residents had access to this. There was a hot water outlet distributing water at 62.9 degrees centigrade. This matter was attended to immediately. The water temperature was reduced and an alternative door fastening fitted to secure the entrance door to the sluice. See requirements 4 and 5 and recommendation 5. Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 21 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 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 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 3 3 3 X 1 Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13(2) Requirement The registered person must ensure that medicines are given and recorded reliably, safely and appropriately. The registered person must ensure there is a safe system for the moving and handling of residents. The registered person must not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2. The registered person must ensure that an application for a suitably qualified and experienced manager is submitted to the Commission for Social Care Inspection. The registered person must ensure that portable electrical appliances are tested as required. Timescale for action 22/12/05 2 OP8 13(5) 01/02/06 3 OP29 19(1)(a)( b)(c) 01/02/06 4 OP31 8(1)(a) 01/03/06 5 OP38 23(2)(c) 01/03/06 Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 23 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 2 3 4 5 Refer to Standard OP7 OP10 OP12 OP15 OP33 Good Practice Recommendations Staff should monitor the triggers and antecedents to challenging behaviour to verify if there is a biological or sociological basis for it. Staff should be made aware of any antisocial behaviour displayed by a resident in order to protect other residents from abuse and exploitation. The activities coordinators should be provided with training on assessing the suitability of residents for activities and the suitability of activities provided for residents. Meals should be presented in an appealing style and a greater variety of meal choices available to residents. The quality assurance system should be reviewed to incorporate the auditing of care plans. Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 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 Apple Court Care Home DS0000046209.V261795.R01.S.doc Version 5.0 Page 25 - 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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