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Inspection on 16/11/05 for Appleby Court Nursing Home

Also see our care home review for Appleby Court Nursing Home for more information

This inspection was carried out on 16th November 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff in Appleby Court demonstrate a genuinely caring attitude towards the residents and each other. Many staff spoke of the good team that the care staff have and the support that they give each other. The staff within the Home are capable of areas of good practice, which can be found in their caring attitude, enthusiasm to care for the residents and a wish to provide the best levels of care that they can. Residents and their relatives spoke highly of the care they received from a stable staff team, who work well together, and communicate well with both residents and each other

What has improved since the last inspection?

There has been further development on the documentation in the Home. All residents receive an assessment before they are admitted and care plans are written within 24 hours of admission. Care staff on the second floor which is allocated to residents who require personal care only, have improved their management of medications. All staff are appropriately checked prior to working in the Home.

What the care home could do better:

The home has provided a variety of training both formal and informal. However the contents of informal training by staff in the Home can not be determined The competency of staff to undertake a variety of tasks such as usage of "thick and Easy"(a food supplement), PEG feeding and medications is not demonstrated and some practices place residents at risk. An opportunity to determine staff competency, such as formal training records, supervision and assessment of competency must be undertaken. Care plans remain in need of further development, with care needs not detailed, risk assessments not up dated and no monitoring of pressure ulcers.

CARE HOMES FOR OLDER PEOPLE Appleby Court Nursing Home 173 Roughwood Drive Kirkby Merseyside L33 8YR Lead Inspector Mrs Julie Garrity Unannounced Inspection 16th November 2005 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 Court Nursing Home DS0000042876.V267654.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. Appleby Court Nursing Home DS0000042876.V267654.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Appleby Court Nursing Home Address 173 Roughwood Drive Kirkby Merseyside L33 8YR 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) 0151 548 6267 0151 548 6697 Regal Care (Liverpool) Ltd Mrs Irene Ann McLaughlin Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (56), Terminally ill over 65 years of age (4) of places Appleby Court Nursing Home DS0000042876.V267654.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service Users to include up to 56 Old Persons and up to 4 Terminally Ill. 5 registered places can be utilised for service users in the age range 55 years and over. The service should, at all times, employ a suitably qualified and experienced Manager who is registered with the CSCI. 23rd and 24th June 2005 Date of last inspection Brief Description of the Service: Appleby Court is a Care Home that provides personal care and nursing care. The Home is registered for 60 residents over retirement age. The main centre of Kirkby is approximately 10 minutes away from the Home by foot. The Home is purpose built on 2 storeys and provides a passenger lift to the second floor. There are 56 single rooms, 2 double rooms and 21 rooms providing en-suite facilities. There are 2 lounges and 1 dining room on each floor. There are well kept gardens to the side of the Home, which are accessed by service users from the ground floor dining room. Parking is available to the front and rear of the Home, and there are main travel routes via bus that provide easy access to the area in which the Home is located. Appleby Court Nursing Home DS0000042876.V267654.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 1 day and was a total of 7 hours. It was a routine unannounced inspection. A tour of the premises took place, five care staff were spoken with and care records reviewed viewed for six residents. Interviews were held with the manager and two senior members of staff. Fourteen residents were spoken with and two family members were involved in the discussions. What the service does well: What has improved since the last inspection? What they could do better: The home has provided a variety of training both formal and informal. However the contents of informal training by staff in the Home can not be determined The competency of staff to undertake a variety of tasks such as usage of “thick and Easy”(a food supplement), PEG feeding and medications is not demonstrated and some practices place residents at risk. An opportunity to determine staff competency, such as formal training records, supervision and assessment of competency must be undertaken. Care plans remain in need of further development, with care needs not detailed, risk assessments not up dated and no monitoring of pressure ulcers. Appleby Court Nursing Home DS0000042876.V267654.R01.S.doc Version 5.0 Page 6 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. Appleby Court Nursing Home DS0000042876.V267654.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 Appleby Court Nursing Home DS0000042876.V267654.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): None of the standards in this area were reviewed at this inspection. Core standard 3 was reviewed at the last inspection of 23rd and 24th of June 2005. EVIDENCE: Appleby Court Nursing Home DS0000042876.V267654.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 are cared for in a respectful manner. There has been little development in care plans, which do not fully reflect the needs of residents. Not all the healthcare needs of residents are available in sufficient detail in order to make sure that staff attend appropriately to the residents needs. A separate pharmacy inspection highlighted a number of areas of unsafe practice that needs to be addressed. EVIDENCE: Many of the care plans viewed had a number of areas of good quality such as social history, updated information and the resident or their representative included in writing the plan. However this good standard was not available in all care plans examples included missing care needs and out of date risk assessments. Staff explained that they do not read the plans and any information they receive is given to them verbally from senior staff. Residents and relatives had spoke with were unaware that care plans were available. This approach is dependent on staff memory and good verbal communication systems. A review of healthcare detailed that the Home accesses external support such as District nurses, GP’s and hospital appointments as needed. However details Appleby Court Nursing Home DS0000042876.V267654.R01.S.doc Version 5.0 Page 10 regarding pressure ulcers and wounds were inadequate, staff had not monitored the size, shape, or grade of the wound. In some instances dressings not prescribed by a GP were in usage, there was no evidence that staff had consulted with external experts such for advice and guidance. Residents are at risk of not having their health care needs met if the informal systems break down as in the situations detailed above. A pharmacy inspector reviewed medication administration. Although staff have received a variety of training in medications it was clear that this had, had little impact on the practice of the nursing staff. Care staff who deal with medications had improved their practice and the medications on the second floor were managed in a more appropriate manner. Residents and relatives were clear that they are treated with dignity and respect at all times. Residents spoken with were very complimentary about the way staff act. A resident said, the staff here are lovely” another detailed that staff are “kind, nothing is too much trouble”. A relative said staff were “supportive” of themselves and the resident and “approachable”. She explained that she was “confident that the staff will always do their best”. Staff observed during the inspection spoke appropriately with the residents at all times. Appleby Court Nursing Home DS0000042876.V267654.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 Relatives are supported to maintain contact and welcomed to visit the Home. Activities are available for residents. Staff try to do activities that they think the residents want to do. The majority of this knowledge is verbal and open to interpretation. The practice of basing resident’s choices on what staff think resident want is inappropriate and may lead to inaccurate decisions being made. EVIDENCE: There are activities available within the Home that include, music, occasional trip out, hairdresser visit, bingo, dominoes, cards, dancing, the occasional drink and visits by local organisations. Better information regarding activities is now available and posters are available on the main corridors advertising up and coming events. Presently the activities arranged are not taken from residents wishes, comments from residents included ‘ I don’t go outside of the home and would love at least to go to the local shops’ and “ there’s chatting to each other and the telly”. Staff do try to keep the residents happy and entertained, but there has been no exploration of residents personal preferences, written details of residents preferences are not available to guide staff in the daily routine and activities of residents. Appleby Court Nursing Home DS0000042876.V267654.R01.S.doc Version 5.0 Page 12 Relatives spoken with detailed that they “feel welcomed to visit” and are “kept up to date with what’s going on”. Interactions between staff and relatives were friendly and relaxed. Relatives detailed, “staff are kind and always happy to help”. Appleby Court Nursing Home DS0000042876.V267654.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All complaints are dealt with in an appropriate manner, they are taken seriously with and acted on promptly. The Home has a procedure in place to ensure a proper response to any suspicion of allegation of abuse. EVIDENCE: Three residents spoken with said “if I have a problem its dealt with”, “I have no need to complain, but if I did I’m sure that Matron would make sure it was fixed” and “any problems I’ve ever had, I’ve told the staff about and they’ve made sure it was all okay”. The manager keeps clear records of any complaints and how they have been dealt with. Staff spoken with were aware of how to deal with any complaints including allegations of abuse and how they would be dealt with. Senior staff were unclear as to how Protection of Vulnerable Adults would be dealt with but were aware that a full policy and procedure was available to refer to. Staff receive a copy of the policy and procedure and training from nursing staff. However details as to the contents of the training is not available. Appleby Court Nursing Home DS0000042876.V267654.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 Appleby Court is well presented, clean and hygienic. EVIDENCE: Many of the main areas in the Home have been redecorated. The décor was bright and clean. Laundry and Kitchen facilities are thoroughly cleaned on a regular basis. Staff spoken with were aware of the ways to maintain appropriate hygiene levels and prevent cross-infection. All rooms viewed had soap and towels readily available in order to make sure that staff can clean their hands after caring for the residents. One residents said 2the Home is always lovely and clean”. A relative detailed “the cleaning staff work very hard to keep the Home clean”. Appleby Court Nursing Home DS0000042876.V267654.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29, 30 All staff are appropriately checked before they start work. Staff competency needs to be developed to make sure they make the best of the training provided by the Home. The lack of competency in medications as an example places residents at risk. EVIDENCE: Residents and relatives spoken with were positive about the staff and their ability too care for them. One resident said 2satff are really kind, caring and look after us very well”. A variety of training has been made available to staff, however the details of this training is not always available or records that staff have been reviewed as competent from the training. Subsequently staff are undertaking tasks for which they cannot demonstrate that they are competent to do. An example of this includes the medications, which not dealt with competently or in a safe manner. There is no regular staff supervision in place that can assist in determining staff’s competency A thorough recruitment process is in place, which includes appropriate checks on staff such as references and Criminal Records Bureau. There is little evidence of a check on individual identity in order to determine that they are who they say they are. Appleby Court Nursing Home DS0000042876.V267654.R01.S.doc Version 5.0 Page 16 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, 38 The manager has suitable skills and experience to undertake her job role. Suitable training for health and safety is in place in the Home and staff have a good understanding of maintaining health and safety. Some practices within the Home do not promote and safeguard the health, safety and welfare of the residents. EVIDENCE: The manager has been in post for several years and is registered with CSCI. She holds regular meetings with the residents and the staff in order to communicate changes or to make sure that residents are able to influence the care in the Home. Residents and relatives were complimentary and comments included “the matron is very helpful, she makes sure that I’m well looked after” and “the matron is good at her job, residents get good care in this home”. Appleby Court Nursing Home DS0000042876.V267654.R01.S.doc Version 5.0 Page 17 Staffing records detailed up to date and relevant for moving and handling and fire training for staff. Staff confirmed this and detailed that health and safety policies were readily available in the main office. The establishment has invested resources in purchasing fireguard systems that allow doors to remain open unless a fire occurs in which case the doors will automatically close. However the inspector identified 2 rooms that although this equipment was in place it was not functioning and they were inappropriately wedged open. Regular checks on the equipment have not been undertaken. Appleby Court Nursing Home DS0000042876.V267654.R01.S.doc Version 5.0 Page 18 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 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 x X X X X X X 3 STAFFING Standard No Score 27 X 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 2 Appleby Court Nursing Home DS0000042876.V267654.R01.S.doc Version 5.0 Page 19 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 OP7 Regulation 15(1) (2) (a – d) Requirement The manager must review all care plans and make sure that each plan covers the identified needs of the residents, is written in sufficient detail to accurately instruct staff in caring for residents needs. Plans must include accurate monitoring of pressure ulcers and is regularly reviewed and update. (Outstanding from previous report) The report from the pharmacist must be action within the timescales detailed in that report when received by the Home. (Pharmacy requirements have been outstanding from 3 previous reports.) All staff must have appropriate supervision that is used to assist in the development of the individual members of staff at least six times a year. (Outstanding from the previous report) The manager must ensure that residents choices are sought documented and used to DS0000042876.V267654.R01.S.doc Timescale for action 16/01/06 2. OP9 13 (2) 16/11/05 3. OP36 18(2) 16/01/06 4. OP12 12 (2) (3) 16/01/06 Appleby Court Nursing Home Version 5.0 Page 20 5. OP38 23 (4) (c) (iv) determine menus, activities and access to funds. (Outstanding from previous report) All fire equipment must be regularly checked. 16/12/05 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. Refer to Standard OP7 OP7 No specific standard. OP35 Good Practice Recommendations A model care plan, which would guide staff when compiling files and plans should be developed. Senior staff should undertake further training in care planning, supervision, medications and the Protection of Vulnerable Adults. The manager should review the audits available in the Home for medications, care planning, competency, training and staffing levels and make sure that they identify any areas of development needed A review as to how residents access their own money should be undertaken and appropriate arrangements put into place. 4. Appleby Court Nursing Home DS0000042876.V267654.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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. 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