Inspection on 06/09/07 for Appleby Care Home

This inspection was carried out on 6th September 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 Care Home 30/06/09

Appleby Care Home 29/09/08

Appleby Care Home 02/10/06

Appleby Care Home 20/02/06

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

CARE HOMES FOR OLDER PEOPLE Appleby Care Home Military Road North Shields Tyne And Wear NE30 2AB Lead Inspector Suzanne McKean Key Unannounced Inspection 10:00 6 September 2007 th 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 Care Home DS0000065828.V346530.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 Care Home DS0000065828.V346530.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Appleby Care Home Address Military Road North Shields Tyne And Wear NE30 2AB 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) 0191 257 9444 0191 270 8226 Appleby@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Position Vacant Care Home 55 Category(ies) of Dementia (55) registration, with number of places Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: 2. Dementia - Code DE, maximum number of places: 55 The maximum number of service users who can be accommodated is 55. 2nd October 2006 Date of last inspection Brief Description of the Service: Appleby is a 55 bed care home with nursing. It provides care for older people with enduring mental health problems. The home is owned and managed by Southern Cross Healthcare Limited a large national provider of services for vulnerable client groups. Care in the home is provided by Registered Mental Nurses supported by care staff. The home is situated in North Shields in North Tyneside close to local shops and good public transport links. The building is comprised of two floors with 55 single bedrooms all with en-suite facilities. Each floor has separate lounge, dining areas, bathrooms and additional toilet facilities. The home also has a kitchen and laundry room. There is a garden and patio area to the rear of the home. The philosophy of care is to support the residents in their activities of daily living, also to provide for their physical and mental health needs. Information about the homes services, philosophy of care, service brochures and Inspection reports are displayed in the homes entrance area. Fees in the home are from £376 to £563 the nursing care element of the care is provided through health authority contributions. Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the visit: We looked at: • Information we have received since the last visit on 25th September 2006. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on 6th September 2007. During the visit we: • Talked with people who use the service, relatives, staff, the manager & visitors. • Looked at information about the people who use the service & how well their needs are met, • Looked at other records which must be kept, • Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, • Looked around the building/parts of the building to make sure it was clean, safe & comfortable. We told the manager what we found. What the service does well: What has improved since the last inspection? Work has been carried out to identify resident’s previous lifestyles, interests and hobbies so that better social care plans can be written. Menus have been improved to include supper options and to show what the ingredients of sandwiches are. This allows residents to make real choices about the food that they eat. Client centred training has been provided for all care staff employed in the home to improve the individualised care given. The homes aspirator is checked regularly to ensure its safe working, and records of these being carried out are being kept. More needs to be done to make bathrooms and toilets more homely. Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Appleby Care Home DS0000065828.V346530.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 Care Home DS0000065828.V346530.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 & 6 (Intermediate care is not provided) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. No service user moves into the home without having his/her needs assessed. Residents and relatives are given good information about the home so that they can be confident about what the home can provide. EVIDENCE: The care plans contain good comprehensive pre-admission assessments, carried out by the Manager or the senior staff before the resident is offered a place in the home. Relatives said they were given good information about the home services prior to the admission and had the opportunity to visit the home. Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 Page 9 The are also care management assessments carried out by Social Workers/Care Managers where the funding is being provided by Social Services through their contract system. These are given to the home before the resident is admitted and from these documents an individual care plan is produced. All of the care plans looked at had these in place. Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 Page 10 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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All people living in the home have a detailed care plans. The residents have their care given as these describe. They are given their care with respect and in privacy. The residents receive their prescribed medication according to safe working practices. Medicines are well managed and are safely disposed of as necessary. EVIDENCE: The care plans were looked at closely as part of the case tracking process and they were completed to a good standard. Relevant risk assessments are completed for, prevention of falls, wound care, moving and assisting, and continence promotion. There is an assessment to look at the resident’s food and fluid intake and if needed a plan is then drawn up to prevent any further weight loss. Care plans show that when necessary advice is sought from a Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 Page 11 dietician and speech therapist. There is an agreement with the local General Practitioners who have the majority of the residents on their list to visit the home weekly for a “clinic” to see residents identified by the staff. This works well and gives the staff confidence that even small issues can be discussed and advice sought without calling them out. There is good information for the staff to make sure that they know how to meet the individual’s needs. The care plans are regularly looked at make sure they are still accurate. They are also brought up to date by checking them with the residents and or their relatives or representatives. The care plans showed that the home staff make sure that the residents use NHS services and facilities if they need to. There is a good range of pressure relieving mattresses to reduce the risk of resident getting pressure sores. Records of what the nurses are doing to treat wounds were good with evaluations being dated and signed. Staff get expert advice for wound care for individual residents. The home also gets specialist advice for residents with different conditions for example physiotherapist or occupational therapist. Medicines management was appropriate. The staff record the medicines correctly when they are ordered. The prescriptions are then checked when they are received in the home from the General Practitioners and are then sent to the Chemist for dispensing, a copy is not kept. The medicines that are sent from the pharmacy are then again checked against the record of what was ordered and prescribed so that any errors can be picked up. There are no residents who manage their own medication. Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are given the opportunity to take part in a range of social activities according to their choices and abilities. Residents have choice about their lifestyle in the way they live. Residents are supported to maintain contact with family, friends, representatives and the local community as they wish. The residents get a balanced, nutritious diet at appropriate times in a pleasant environment. The home has an effective way of giving residents support to make choices about the food they eat. EVIDENCE: There have been a number of activities arranged for the residents; these are recorded separately for individual residents. Both records and the residents confirmed that they had been enjoyed. A variety of entertainers visit the home each month. Records showed the residents also enjoyed these events. Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 Page 13 Daily newspapers are provided to keep residents up to date on current events and although not all of them can read them staff help and talk about the articles or show them the photographs. There is an afternoon knitting group. Residents commented that they enjoyed this activity. Some residents participate in a gardening club. Their work was seen and residents said that they enjoyed it. There is an indoor activities area, which is a wooden building in the garden, which is heated. A local priest visits the home each month and provides mass for those residents who want to take part. Records show that residents enjoy this experience. Examples of residents craft and collage work are displayed on walls in the home. The home has an open visiting policy. A number of relatives were visiting during the time of the inspection and said that they could visit at any time and that staff made them feel welcome. Records showed evidence of, resident’s food likes and dislikes, clothes they preferred to wear, rising and retiring bedtimes. This information is used as part of the care plan. Menus show a fair range and choice of food. Improvements have been made and when sandwiches are offered their ingredients are now specified. Suppertime meals are now included in the menus. Records of resident’s birthdays are kept and the cook bakes a cake to celebrate these events. The dining areas are well set out to provide a relaxed atmosphere for residents. There are also social activities, which encourage the residents to enjoy food, including the “café” activity when staff set out the dining room as a café and dress as waitresses. Residents and visiting relatives enjoyed this and the staff worked hard to make sure it was a successful activity. Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good complaints procedure and they are handled well and where appropriate action is taken to make improvements when necessary. Residents are protected from abuse by policies and procedures and staff training. Improvements have been made to make sure that the staff are aware of the Safeguarding procedures and the mechanism for alerting is in place. EVIDENCE: The homes complaints policy is well written and the staff are aware of its contents and what to do if they are the person who receives a complaint. The complaints received by the home since the last inspection had been investigated appropriately and they had been concluded to the complainant’s satisfaction. The Protection of Vulnerable Adults policy is well written as is the whistle blowing policy. Staff were aware of the procedure to follow and recent improvements have been made in the understanding of the mechanism to follow when an incident occurs which might affect the welfare of he residents. Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 Page 15 There have been two safeguarding adults alerts made since the last inspection. This is where events occurred which effect the welfare of the residents, which are more appropriately looked at as part of a multi-disciplinary process. It involves appropriate professional such as Local Authority social workers (who are the lead agency for Safeguarding Adults processes), the home and others such as General Practitioners, community nurses, Commission for Social Care Inspection or the Police who meet to look at what needs to be done to protect the residents. These have been concluded and no further action has been necessary by the home to protect the residents. However, the manager did look at the issues as part of her quality assurance process to identify improvements that could be made around the issues. Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 Page 16 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 & 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally clean, pleasant and hygienic. There are generally good systems in place to ensure that the environment is safe and well maintained to protect residents. The home was generally clean and tidy. However, there were areas in the home that had an unpleasant odour, which effected the overall feeling of the home. Resident’s bedrooms are personalised. This helps them to feel at home. EVIDENCE: A tour of the home was carried out, both accompanied by the staff and alone. It was generally clean and tidy. However, there were particular areas of the home that had an unpleasant odour of urine, these areas were identified to the Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 Page 17 manager so that action could be taken to address it. The Manager will need to investigate the cause of the odour and take action to address it. Since the last inspection new downstairs corridor carpets have been fitted and decoration of these areas has been carried out to a good standard. Lounge areas are generally nicely furnished and decorated. However, more could be done to make bathrooms and toilet areas more homely and this is part of the plan of decoration. A number of resident bedrooms were seen and these were in the main nicely decorated and furnished with lots of personal effects in evidence. Resident’s bedroom doors on the ground floor have been painted in different bright individual colours, with brass nameplates to each door. Work is soon to commence to repeat this work on the upper floor for the residents. Dining areas are reasonably well decorated and furnished. The kitchen has good stocks of food. Kitchen cleaning schedules were inspected and are satisfactory. The kitchen area was clean and tidy. The laundry room was seen. COSHH information was on display. Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 Page 18 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 & 39 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are well supported by sufficient numbers of staff who have the skills to meet their needs. There are systems in place to ensure that adequate competent staff are available for the safety of residents. The recruitment policy is robust and helps to ensure the safety of residents. EVIDENCE: Duty rosters for staff were inspected and showed that the home is well staffed. The following levels of staff are employed in the home on an average day; Am, - 2 qualified and 9 care staff, Pm, - 2 qualified and 9 care staff, Nights – 2 qualified and 3 care staff. Staff rotas showed that these levels of staff are being maintained. Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 Page 19 Staff recruitment files contained all of the necessary information to make sure that the home can be confident about the identity, previous experience and skills of the staff they recruit. All of the records were completed well with all appropriate checks in place. Good records were in place for the interview process to ensure that they are considering each candidate in line with equality and diversity principles. There are more than 50 of the care staff who have already achieved level 3 in the National Vocational Qualification (NVQ). More than 86 will have achieved it by the end of 2007 as a number of staff are currently undertaking the training. This number will include seven staff who will have achieved level 3 NVQ. Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 Page 20 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is good and focuses on the needs of the residents. The systems for the management of resident’s finances are good. Supervision of staff helps to monitor the care being given and ensure that staff are competent to do their work. The health, safety and welfare of service users and staff are protected. Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home now has a new manager in post. She is currently applying to the Commission for Social Care Inspection to be the Registered Manager. A Deputy Manager who has worked in the home for some time is supporting her. The manager currently shares an office with the administrator and although this is not in conflict with any national minimum standards it makes it difficult for her to easily have private conversations either in person or on the telephone. As some of her work might be related to individual staff or residents and might be confidential she would benefit from an office or area where she can work. There are clear lines of accountability both in the home and within the company. The manager ensures safe working practices in relation to first aid, food hygiene and moving and handling and takes the necessary action to ensure the health and safety of the service users. Records support this. Formal supervision for care staff is up to date is carried out at appropriate intervals. Senior staff work with carers to carry out informal supervision when delivering care and the qualified nurses are knowledgeable about the skills of the care staff. The Manager has recently completed some internal auditing of the quality of the service provided. The company have a very detailed mechanism for central analysis of the home performance and there are a number of triggers used by the company to judge the quality of the service being provided. The Manager facilitates relative and resident meeting, which although they are not well attended, give the opportunity for the home to communicate formally with them. During the visits the relatives visiting were chatting in a very positive way with the staff and all of them were spoken to by the Manager. This gives them the opportunity to approach her informally if necessary. The personnel records kept in the home of residents who get help to manage their finances are detailed, logical and appropriate. Receipts are in place for purchases made on behalf of residents and signatures of either two staff or one and the service user were in place. The personal allowance records are audited regularly. Utility records in the home were inspected and were satisfactory. The Fire Log book and the Accident book records were also satisfactory. The aspirator kept in the treatment room is now checked on a weekly basis to ensure it is working satisfactorily. Records of these checks are kept. Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 Page 22 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 2 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 Care Home DS0000065828.V346530.R01.S.doc Version 5.2 Page 23 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. 1. Standard OP26 Regulation 16 (2) (k) Requirement The home must be kept free from offensive odours. Timescale for action 01/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that the home keep a copy of the prescriptions so that they can be checked against t he medication received. Appleby Care Home DS0000065828.V346530.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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 Care Home DS0000065828.V346530.R01.S.doc Version 5.2 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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