Inspection on 23/06/05 for Appleby Court Nursing Home

This inspection was carried out on 23rd June 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

Appleby Court Nursing Home 05/03/09

Appleby Court Nursing Home 03/01/08

Appleby Court Nursing Home 23/06/06

Appleby Court Nursing Home 16/11/05

Appleby Court Nursing Home 09/12/04

Appleby Court Nursing Home 05/05/04

Appleby Court Nursing Home 04/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE APPLEBY COURT NURSING HOME 173 Roughwod Drive Kirkby Merseyside L33 8YR Lead Inspector Julie Garrity Unannounced 23 & 24th June 2005 rd 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 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 F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Appleby Court Nursing Home Address 173 Roughwood Drive Kirkby Merseyside L33 8YR 0151 548 6267 0151 548 6697 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Regal Care (Liverpool) Limited Mre Irene Ann McLaughlin Care Home 60 Category(ies) of OP - Old Age (56) registration, with number of places TI(E) Terminally Ill (4) APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Service users to include up to 56 OP and up to 4 TI. 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 manger who is registered with CSCI. Admit one male named service user under pensionable age from 07/03/05 and discharge on the 13/03/05. Date of last inspection 9/12/04 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 F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 1 day with two inspectors and was a total of 7 hours. It was a routine unannounced inspection. A tour of the premises took place, seven care staff were spoken with and care records reviewed viewed for 8 residents. Interviews were held with the deputy manager and two senior members of staff. Thirteen residents were spoken with and three family members were involved in the discussions. CSCI questionnaires were left with the deputy manager. What the service does well: What has improved since the last inspection? What they could do better: The Home has many areas of good practice it is unfortunate that this is not happening all the time and results in an inconsistent approach in many areas that include, assessments of residents prior to admission, care planning, APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 Page 6 medication, risk assessments, supervision, checks on staff prior to employment and general record keeping. Staff rely heavily on good verbal communication and this has resulted in decisions being made for the residents on the basis of staff’s knowledge that cannot be relied on and in many cases may be inaccurate, this includes the arrangements for residents taking control of their medications, meal time choices, general information regarding residents rights and choices, activities within the Home and residents access to their own money. There is a need to ensure that all training is appropriately recorded and further development for senior staff regarding medication giving, recording and receiving and an understanding of staff’s roles regarding any potential investigations of allegations of abuse. 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 F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 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 standard(s) 3 The home has a good assessment process for the majority of residents, however in some cases information that is still needed by the care staff is not available. A lack of an assessment for respite residents puts them at risk of receiving inappropriate care. EVIDENCE: The Home makes sure that all new residents are assessed before they move into the Home. Social services assessments are obtained for residents receiving transitional care (short stay from Hospital before returning Home), but no new information is sought or obtained for residents who regularly return to the Home for respite (short stay) care. Of the residents files viewed all had some assessment information, however this information was not of the same quality for all residents and in some cases had been removed from residents care plans whilst it was still needed by the staff. Staff revealed a good understanding of residents’ needs. Residents interviewed made positive comments such as “very happy here staff look after me well”, relatives spoken with supported this point of view. APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 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 standard(s) 7,8,9, Care plans have improved and a number of good quality areas were seen. However not all care plans were of good quality and do not always contain information needed for staff to meet the needs of residents. The staff rely on verbal communication rather than good accurate records. This practice will result in vital care needs being missed. The current arrangements for receiving, storing and giving medications although improved from previous inspections remains in need of further development. The current practices continue to place the residents at risk of getting the wrong medication. Staff were observed to treat the residents with dignity and respect. EVIDENCE: All but one, residents has a care plan a number of areas were 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 one newly admitted resident did not have a care plan, residents, relatives or care staff not included in writing care plans, missing care needs (3 plans viewed did not contain needs know by the staff) and inaccurate risk assessments (in 2 cases risks were APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 Page 10 identified that were not included in the care plans). 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. Residents are at risk of not having their health care needs met if these informal systems break down as in the situations detailed above. Two of the residents spoken with detailed relevant care from other professionals such as the GP, Chiropodist and opticians. One resident said, “ If I need a Doctor, the sister always gets one”. Residents are also supported to attend Hospital appointments as necessary, a relative explained “ we are asked to take mum to an appointment, however if we can’t do it the manager makes sure someone goes with mum”. On the day of inspection staff appropriately rang for an ambulance for a resident who needed additional medical attention. Records of external health care were inconsistent and were not available for all residents. This included monitoring of pressure ulcers and records to detail treatment and improvement of the wound. Medication administration has improved and continues to improve. However there remain a number of areas that would benefit from further improvement, as some of the practice remains poor. This includes the assumption that the Home undertakes the administration of medication as apposed to supporting residents to do so in an appropriate manner, not recording all medications received by the Home, staff not signing for all medications given to residents, inappropriate storage of medications and inaccurately giving medication to residents. 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. One resident said, the staff here are excellent, they are kind and caring. A relative described the manner in which staff supported her mother as lovely, I feel that mum is looked after really well. Staff observed during the inspection spoke appropriately with the residents at all times. APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 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 standard(s) 12, 14, 15 Activities and meals are available that are based on staff’s knowledge of residents. 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 will lead to inaccurate decisions being made. Staff need to take more care in attending to residents who need a special diet. 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. However discussion with residents, relatives and staff detailed that there is little information available regarding activities. Although this information is available on the notice board in the main corridor very few residents stop and read the information, several are unaware of this information existing. Presently the activities arranged are not taken from residents wishes, comments from residents included ‘ I don’t go outside of the home’ and “ I’m quite bored”. Staff try to anticipate the needs of the residents based on what they think they know about them. However this approach relies heavily on assumptions and is not based on accurate information. Relatives and staff supported the perspective that activities were in need of further development. APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 Page 12 Many of the residents said that the food was “nice” and they “enjoyed” their meals. Some residents reported that they have a choice between two main meals. If neither of these is wanted then there is no alternative. This was confirmed by members of the staff team who also felt that residents should have greater choice of food and the provision of food should be more flexible. The cook does attempt to create different meals but has no information regarding resident’s choices. A number of residents did not eat much of their meal but were not offered any alternative. One resident was given another residents dessert which had been prepared as he had diabetes and the diabetic person was given an inappropriate dessert. APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 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 standard(s) 18 The Home has formal policies and procedures in place that staff have read. However senior staff have little understanding of the means of investigating any potential abuse and this would result in staff not dealing with any allegations appropriately. EVIDENCE: Appropriate policies and procedures on protecting vulnerable adults were available. Care staff gave appropriate responses for their role within the home regarding the need to protect vulnerable adults. The senior care staff spoken with were unclear as to their role in any investigation and gave information that would have resulted in preventing a proper investigation. Only 17 of the 23 members of care staff have received training in the protection of vulnerable adults, this was a requirement on a previous report to train all staff and has not been addressed. There was, no indication of the content of the training and who has provided it and no certificates of training were available. APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 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 standard(s) 19, 26 Many areas in the Home have been redecorated. The Home is clean and well maintained. A lack of Homely touches in communal areas such as pictures, plants and ornaments makes the home appear institutional. There is a shortage of storage space and office space for staff to deal in confidence with residents, relatives and other professionals EVIDENCE: Many of the main areas in the Home have been redecorated. The décor was bright and clean. In general the main areas were institutional as there was a lack of homely touches such as pictures on the walls. New carpets and furniture have been ordered for the lounges. However residents say that the colours were not discussed with them. A resident said “ the Home looks much better” and another said “ its much brighter”, both said that it was a pity that the pictures had not been put back on the walls after redecoration. Residents bedrooms viewed were well presented and the residents had been supported to personalise their bedrooms with pictures, ornaments and furniture. Residents were appreciative of these. Most liked their bedrooms and were positive about the way that they were kept clean. Comments such as “ lovely, bright clean rooms were made”. APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 Page 15 One bathroom was being used as a storage area for wheelchairs and moving and handling equipment. This is not appropriate and reduces the number of bathing facilities available to service users. storage and office space is very limited. Care plans are locked in storage with medications on the first floor and ground floor staff must utilise a space under the stairs as an office which is inappropriate in particular whilst taking confidential telephone calls. Staff were observed to wear appropriate aprons and had ready access to gloves and aprons, which were located appropriately. Laundry and kitchen facilities were appropriate and well maintained. APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 There is a variety of training available for staff in the Home that is assists the staff in caring for the residents appropriately. Although this is not supported by appropriate certificates of training. On the day of inspection there was sufficient staff available to meet the needs of the residents. Appropriate checks are undertaken for the majority of staff, however one member of staff did not have the appropriate checks done before working in the Home and this places residents at risk. EVIDENCE: The Home has individual training records for staff. The staff have up to date basic training and a number of other courses have been arranged for staff to attend. There is some sporadic training in stoma care, care of dying, and nutritional support. Staff are supported and encouraged to attend all basic training. Relatives and residents said that the care in the Home was “good”. The staff said that there is sufficient staff and the residents who said, “there is more than enough staff available”, supported this point of view. Relatives explained that staff are “caring and kind” and are “able to meet the needs” of the residents. The Home does not monitored resident’s needs, in order to make sure that sufficient staff are available if their needs change. On the day of inspection a nurse call was unanswered for 15 minutes before staff attended the resident. Several members of staff were available at this time. This is poor practice that needs to be addressed with the staff. Staff files detailed full and proper checks before staff started working in the Home and an appropriate induction into the Home. Unfortunately a qualified APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 Page 17 member of staff did not have evidence of a Criminal Records Bureau check, up to date Nursing and Midwifery Council registration confirmed with the Nursing and Midwifery Council or a second reference. APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 36, Staff do not receive supervision on a regular basis, this means that staff will not be fully supported to correct poor practice or fully develop their good skills. Some residents’s access to their own funds is restricted and this is not appropriate. EVIDENCE: Staff meetings are called when there are significant events to relay to the staff and not as part of the course to discuss issues. Staff files and discussions with staff show that staff are not receiving regular, recorded supervision. Staff detailed that they are unsure as to the purpose of supervision and staff whose responsibility it is to supervise other staff have not received training. Residents deal with their own money whenever possible. Administrative staff hold money for those residents who are not able to manage their own. Clear accounts of money available are kept. However residents have limited access to their own funds. Staff have on occasions loaned residents money, as they were unable to access their own funds. This is restrictive of resident’s rights and compromises staff. APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 2 COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x x x 3 3 x x APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 Page 20 YES 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 OP 3 Regulation Requirement Timescale for action 24/07/05 2. OP 18 14 (1) (a) All respite residents admited to (b) (c) (d) Appleby Court must have (2) (a) (b) updated assessments that indicate their needs. Information should be obtained from all relevant parties such as the resident, Social Services, Carers, Family and district nurses. 13 (6) All staff to be trained in the prevention of service users being harmed or suffering abuse or being placed at risk of harm or abuse. 19 (1) (b) (c) 18 (2) The manager must make sure that all staff have all relevant checks in place prior to working in the Home. All staff must have appropriate supervison that is used to develop the individual members of staff at least six times a year. 3. OP 29 24/08/05 ( this is outstandin g on two previous reports) 24/07/05 4. OP 36 24/08/05 5. 6. 7. APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 Page 21 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. 6. Refer to Standard OP 7 OP 7 OP 35 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,supervison, medications and the Protection of Vulnerable Adults. A review as to how residents access their own money should be undertaken and appropriate arrangements put into place. APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 2nd Floor Burlington House Crosby Road North Waterloo 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. Extracts may not be used or reproduced without the express permission of CSCI APPLEBY COURT NURSING HOME F53 F03 S42876 Appleby Court V235503 230605 Stage 4.doc Version 1.40 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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