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Inspection on 03/01/08 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 3rd January 2008.

CSCI found this care home to be providing an Adequate service.

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 company continues to employ long-standing members of staff who offer great stability to the home. Staff stated they had worked at the home for many years, and discussed how they felt about it. They were very happy and settled. They were happy with their training and felt they had benefited from all their courses. Some positive interactions were observed between residents and staff especially in the dining area and one of the lounges were residents were supported in being comfortable and choosing what they wanted to do. There have been various initiatives including, audits and training to improve on the administration and storage of medications.

What has improved since the last inspection?

Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 65 staff surveys received prior to our visit were all positive in their responses. Some comments and suggestions made by staff included, "Continue to improve standards and continue our training programme." "Continue to improve our activity programme." "Create a good living environment and give clients what they require, make it homely as possible." "To make it from home to home offering their family a cup of tea and sandwich when they visit at any time day or night." "Our aim is to do our best always." "offer a home as near to a persons quality of home, life, including ensuring family and friends who visit the service user feels welcome and comfortable. We are always available to answer all their questions to the best of our ability." The training plans for the home showed that training had taken place and included a wide range of courses to help staff support residents diverse needs. The staff had been developed and had updated staff files. They have produced evidence of all necessary checks being in place prior to staff commencing employment at the home including CRB (police) checks. These files showed good recruitment procedures, which helps to safeguard residents at the home and shows good practice in supporting and training staff. Various other audits were also seen. Some covered health and safety, management of medications, review of accidents, weekly audits of funds and regular audits of care plans. These tools helped to show how well managed the home was by the manager and what checks were in place to maintain the standards achieved. The registered manager has been in post for many years and continues to provide an effective leadership role. Feedback from all parties stated how they were happy at the home. We spoke to various residents and some were aware of the complaints procedure and felt that if they had any concerns that they had would be listened to and taken seriously. One said `I can speak to the staff or matron and they can help me if I have any worries.` Some said that staff were helpful and that they had no problems. Some of the comments made in resident comment cards included, "yes I am very pleased with Appleby Court, the staff and matron is always on hand if I would like to talk to them...." "The housekeeper is the best." The cook currently caters for different dietary needs e.g. diabetic diets and liquidised meals and has worked at the home for many years.Currently the staff display an activities planner on each floor inviting people from each unit to join in. The staff also organise a regular newsletter that is displayed on the notice boards and gives them general information. Developments have been made in organising activities now the home has their own activities organiser and they continue in developing initiatives to help support and develop activities appropriate to each residents needs.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Appleby Court Nursing Home 173 Roughwood Drive Kirkby Merseyside L33 8YR Lead Inspector Miss Diane Sharrock Unannounced Inspection 3rd January 2008 11:00 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.V347688.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 Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 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 applebycourt@btconnect.com 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 (60), Terminally ill over 65 years of age (4) of places Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users to include up to 60 Old Persons Eight registered places to be utilised for service users aged 50 years and above in the category PD Date of last inspection 8th January 2007 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 gardens to the side of the Home, which are accessed by residents 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. The registered Manager is Mrs Irene McLaughlin and the Responsible person is Mr Mike Donegan. The fees charged, range from £266 to £457.17 per week. Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This visit took place over one day and was the homes key unannounced inspection. A selection of comment cards were sent to a sample of residents and staff. We also had discussions with both staff and residents during this visit. In total 7 resident and 5 staff comment cards have been submitted to the Commission. The service was inspected against key standards for older people to see how well it was meeting a range of needs. These standards cover moving in, the care and support provided, lifestyles, complaints, safety, comfort and cleanliness, how staff are employed and trained, and how the service is managed and developed. We looked around the home and looked at resident care plans and various other records. “Case tracking’ was used as part of the visit to the home. This involves looking at the support and care a person gets when they live at the home and the quality of the staff that provide this. We discussed all areas of the inspection and findings with the manager at the end of this visit. What the service does well: What has improved since the last inspection? Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 6 5 staff surveys received prior to our visit were all positive in their responses. Some comments and suggestions made by staff included, “Continue to improve standards and continue our training programme.” “Continue to improve our activity programme.” “Create a good living environment and give clients what they require, make it homely as possible.” “To make it from home to home offering their family a cup of tea and sandwich when they visit at any time day or night.” “Our aim is to do our best always.” “offer a home as near to a persons quality of home, life, including ensuring family and friends who visit the service user feels welcome and comfortable. We are always available to answer all their questions to the best of our ability.” The training plans for the home showed that training had taken place and included a wide range of courses to help staff support residents diverse needs. The staff had been developed and had updated staff files. They have produced evidence of all necessary checks being in place prior to staff commencing employment at the home including CRB (police) checks. These files showed good recruitment procedures, which helps to safeguard residents at the home and shows good practice in supporting and training staff. Various other audits were also seen. Some covered health and safety, management of medications, review of accidents, weekly audits of funds and regular audits of care plans. These tools helped to show how well managed the home was by the manager and what checks were in place to maintain the standards achieved. The registered manager has been in post for many years and continues to provide an effective leadership role. Feedback from all parties stated how they were happy at the home. We spoke to various residents and some were aware of the complaints procedure and felt that if they had any concerns that they had would be listened to and taken seriously. One said ‘I can speak to the staff or matron and they can help me if I have any worries.’ Some said that staff were helpful and that they had no problems. Some of the comments made in resident comment cards included, “yes I am very pleased with Appleby Court, the staff and matron is always on hand if I would like to talk to them….” “The housekeeper is the best.” The cook currently caters for different dietary needs e.g. diabetic diets and liquidised meals and has worked at the home for many years. Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 7 Currently the staff display an activities planner on each floor inviting people from each unit to join in. The staff also organise a regular newsletter that is displayed on the notice boards and gives them general information. Developments have been made in organising activities now the home has their own activities organiser and they continue in developing initiatives to help support and develop activities appropriate to each residents needs. What they could do better: Full feedback was given to the manager during and on conclusion of this inspection. There were various improvements noted especially in evidencing that some of the outstanding regulations were now being met. However other areas were noted to need action taken and further evidence to be in place to meet other standards and regulations. Care plans must include all necessary care and support needed for all residents in meeting all of their social needs and requests. Finances should continue to be developed and actions taken to provide clear and easy to read and accurate information for all residents regarding the management of their monies. This will give residents added safety in showing how their funds are managed and in their best interest. Records should be clear in identifying who acts as appointee for each resident and they should be up to date and reflect the resident’s choice. One issue around the management of one residents funds needed a referral and check to the local authority to arrange an updated care management review. The manager agreed to keep the commission updated on the outcome of the review. The commission should be updated regarding a residents concern regarding an alleged loss of monies brought to our attention during the time of our visit. The manager is to review and make sure all procedures are in place to satisfy the commission and residents that the procedures are followed in the safeguarding of residents finances. Outside agencies such as the local crime prevention officer have been invited to assist the home in maintaining a secure environment for its residents. Staffing levels should be kept under review in order to make sure that staffing levels are appropriate to the needs of the residents. These reviews should be included with staff and residents and their opinions should be included in the reviews. The Statement of Purpose should be developed further so that the company’s commitment to the basic number of staff provided to the home each day is openly available. Once updated, steps should be taken to ensure that staff, residents and visitors are aware of the documents and their updates. A maintenance, refurbishment and decorating plan must be developed to show a planned approach in refurbishing and decorating the home. Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 8 Bathrooms and toilet areas still need work and repair to the broken baths. The static baths with no adaptations need to be accessible to residents. Development and investment to these areas should aim to eventually achieve a more homely environment, as currently they are “sparse” and basic in appearance. A complete review of the environment must take place to identify when carpets will be replaced including the lounges, corridors and bedrooms, which currently have worn and stained carpets. There replacement will help develop the environment of the home so it can always provide an adequate standard of décor to the residents living facilities. Risk assessments must be in place for frayed worn and ruffled carpets stating what actions will be taken by the company to prevent any risks to people at the home. To continue developing the environment including dining areas and include residents/relatives and staff in the development of their home and look at introducing strategies as to how they can be more involved. To review the current use of day space in the lounge areas so that all residents are comfortable when sitting in these communal areas. A review of the maintenance and contractor checks at the home including those for the gas services was noted to be in need of urgent attention and the manager agreed to take appropriate action. Activities should continue to be developed so they can meet all of the resident’s social needs and steps should be taken in developing care plans to show what care and support will be given to help residents with their social needs and requests. 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 Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 9 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.V347688.R01.S.doc Version 5.2 Page 10 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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are assessed before coming to stay at the home in order to ensure their needs can be met prior to their moving in to Appleby Court. EVIDENCE: The company have assessment procedures and these show that an assessment of the persons needs are carried out with the person and care manager prior to coming to stay at the home. This makes sure the staff can meet the person’s needs. We looked at four care plans during our visit and one included a recently admitted resident to the home. Care plans had pre-assessments in their file, which showed their needs had been assessed prior to moving in which helps the staff and resident in deciding if Appleby court is right for them. Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 11 The homes Statement of Purpose gives people various information about the home including the fees charged. This helps people make a decision as to what type of home they would like to choose. The homes manager has made sure these documents accesible to everyone and are located on each floor. Discussion took place with the manager, as this document had no information on the staffing levels. No body was kept informed as to what staffing levels the company will commit to, to provide basic care. Residents who chatted to us said they were happy at the home. Comments cards sent to the commission before this visit included comments from residents such as, “before I moved into the home I went into Appleby Court for respite….” “I have had a short stay before.” “yes my family visited others then decided Appleby Court was the best for me, I agree.” Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 12 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. The staff did show they were adequately managing residents health and personal care needs. EVIDENCE: We looked at four care plans during our visit. Following the previous site visit, the management have developed all care records and have taken time to share and discuss these records with the residents. Individual plans of care are available and identify relevant aspects of health and personal care. Most of the care plans seen were detailed and gave a good account of the residents needs and were able to demonstrate they can meet the diverse needs of residents at the home. Some care plans gave good details how the residents nursing needs could be met but some plans had no details around social support and no detail in how the residents would be supported with their social needs. Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 13 Recent audits of care plans showed that they are regularly reviewed to ensure they maintain all the necessary information and standards needed to meet the residents care and support. We received 7 comment cards from residents prior to our visit. Most of the comment cards offered positive comments such as, “Yes I am very pleased with Appleby Court, the staff and matron is always on hand if I would like to talk to them….” Various positive interactions were observed with staff supporting residents throughout the day. Staff appeared to have a good rapport with residents. Two staff were observed to be patiently helping one person into a hoist and helping them be transferred into their wheelchair although the lounge was a little cramped in manoeuvring the hoist in and out of this area. Medications are stored within a separate locked room and minimal stock was kept. A sample of medications, records and storage were viewed. The management of medications appeared tidy and organised showing a well-managed area. Internal auditing of medications had been developed and showed various audits and actions taken to maintain good practices in the management of medications. Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 14 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 adequate. This judgement has been made using available evidence including a visit to this service. The staff provide adequate support to residents to meet their social needs. EVIDENCE: The activities organiser described a variety of activities that she had started and described her plans in developing events and she hoped to look into other organisations and training regarding how she could start up various activities. Currently the staff display an activities planner on each floor inviting people from each unit to join in. We looked at care plans there were no care plans for social care or any explanation as to how staff were to meet the resident’s social needs and requests. Some of the residents said they like to get involved in the activities and others felt there wasn’t much to do. During our visit the staff brought out the mobile shop offering various items for anyone to buy. The planner in reception told everyone the hairdresser was calling but staff later explained that this had been cancelled. Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 15 Staff acknowledged they would like to organise more trips out similar to the Christmas party at a local hotel were they hired a local coach. They felt they could organise more trips out if they had their own minibus. Staff felt travel arrangements were an issue especially the cost of using coaches and they felt this effected them going out more as residents did not always have the funds to pay for this type of transport. Staff and residents have regular ‘resident meetings’ to discuss some aspects of the home. We saw some of these minutes which showed good discussions on meals and activities and the recent events over Christmas. Everyone said they really enjoyed the Christmas party. In reviewing the funding of this event the manager acknowledged that residents had been inadvertently charged for staff costs and arranged to have this cost taken from the company budget and the residents reimbursed. Some staff comments from comment cards felt that they wanted to, “Continue to improve our activity programme.” “Create a good living environment and give clients what they require, make it homely as possible.” “To make it from home to home offering their family a cup of tea and sandwich when they visit at any time day or night.” Two comment cards from residents said that usually and sometimes there were enough activities on offer. Two comment cards said they were mostly happy with meals. Collectively residents said they were fine, those that were able to chat said they enjoyed their lunch and said it was good, they said it was nice here and they were well looked after. The Cook currently caters for different dietary needs e.g. diabetic diets and liquidised meals and has worked at the home for many years. The The The and kitchen area was clean and tidy, well organised and well stocked with food. cook was knowledgeable about the residents’ likes and dislikes. staff were able to show a well-organised kitchen with plenty of supplies ingredients for lots of home made foods. The dining areas were not welcoming, there were worn, stained, carpets and old and scraped dining furniture. Staff explained the furniture had been at the home for many years and only basic upright chairs were provided Staff tried to make this area more homely by dressing each table with tablecloths and condiments. Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 16 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. Policies, procedures and practices are in place for dealing with complaints and aim to protect residents against abuse. EVIDENCE: Residents who chatted to us were generally happy and they said they would always discuss their concerns or queries with staff at the home. We asked some of the residents do they know how to make a complaint, one person stated, “…I go straight to nurse in charge or the matron.” The home has a complaints procedure, which is time scaled appropriately. A copy of the complaints procedure is available to residents in the statement of purpose and there was a small poster on the first floor giving people details about how to contact the Commission. The pre inspection questionnaire gave details of 8 complaints over the past 12 months and the homes complaints records were seen during this inspection. Four had been upheld and the manager gave details of 4 referrals made to the local authority in following the local safeguarding adults policy. These records showed that any complaint that was made, that staff had followed the company policy and dealt with it appropriately. Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 17 While speaking to staff they explained they had attended mandatory training and were happy with the training on offer. Staff had received abuse awareness training and had access to the homes policies. Staff are trained and experienced to support and protect residents. We spoke to staff who explained they were aware of how to deal with any complaints including allegations of abuse and how they would be dealt with. This was evidenced during this inspection as the manager made a referral to the local authority following the local procedures for protecting vulnerable adults. The manager has since submitted a report to the Commission explaining what actions she had taken following our visit. There have been various allegations of theft over the last 2 years and the manager has shown she has followed the local policies and procedures for reporting such allegations. Outside agencies such as the local crime prevention officer have been invited to assist the home in maintaining a secure environment for its residents. Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 18 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): 19/26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The environment is adequately managed but in need of much improvement and investment to the décor and standards of redecoration to help improve the residents living areas and facilities. EVIDENCE: We saw a sample of areas throughout the home during our visit. Some of the bedrooms seen showed personalised rooms with various personal belongings. However some had worn stained carpets and stained walls which gave a shabby and unsatisfactory standard of decoration to residents personal living areas. Some areas have still not yet redecorated including bathrooms and toilets. They remained basic and sparse and highlighted the need to be made more comfortable and homely as standards achieved in some other areas in the home. Some of the baths still had static baths with no adaptations and some Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 19 were broken and out of use. Staff explained that they could use them for the residents so this gave less choice and facilities for bathing. The main areas that had been developed from the previous visit was the new shower/ “wet room.” This had been funded by the local Primary Care Trust and helped provide one bathroom facility in the home offering a modern and highly maintained bathing facility accessible to everyone. The environment generally looked worn with bits on the carpet making some areas look shabby in parts even in the afternoon when domestic staff had carried out their cleaning duties. Staff felt the shabbiness of the carpets was due to them being old and worn and some being in the home from when it was first opened. Currently domestic staff have low level hoovers and agreed they would benefit from upright equipment to improve on the current facilities and health and safety. Some of the carpets in the lounges were worn and stained with frayed edges starting at the joins in the middle of the room. One corridor carpet was ruffled in various areas and presented as a potential trip hazard. The ground floor lounge was noticeably crowded with at least 13 residents sat around the room with some sat directly next to the television unable to see the screen and one person was struggling to hear a conversation with the person next to them. The manager explained they were receiving another grant to develop the external gardens so they were more accessible to the residents with plans to provide raised garden beds. At the last key visit the manager hoped they would be developing the reception and nurse station area and the large window area in the main ground floor lounge however the company had not funded this development. The only evidence of a planned maintenance programme was a yearly planner where the maintenance person tries to paint approximately 2/3 areas every 2/3 months. There was no evidence of any plans to replace any of the worn carpets in the lounges and corridors or bedrooms/ or replace any of the old, worn dining furniture or refurbish the bathrooms and toilets to the standards already achieved in one bathroom funded by external grants. The manager felt that they tried to replace some bedroom carpets as the rooms became empty. There was no evidence of any investment or organised plan to replace the current unsatisfactory worn and stained carpets. Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 20 There was no evidence of any plans by the company to refurbish the above areas in the home and there was no evidence of any planned financial investment for refurbishment. Various staff comments from cards sent to the commission included suggestions to improve the home such as, “Give more ensuite facilities.” “Create a good living environment and give clients what they require, make it homely as possible.” Staff felt more could be done to make the home more comfortable and homely and felt that some areas were worn and old including the dining room furniture which they felt had been in place for many years and provided very basic seating. Some resident’s comments included, “Sometimes need to ask for change of towels and face cloths.” “The housekeeper is the best.” There was no evidence that staff and resident’s comments had been involved in any planned investment and development of the home. The managers plans from the previous visit had not been implemented by the company regardless of the staff being able to show it would be beneficial to the home in providing better privacy in the main lounge. The manager had updated all environmental risk assessments and had various audits and documents to show they were regularly checked to help keep the home safe including radiator guards and window restrictors and in-house fire equipment checks. A sample of maintenance certificates were seen and most reflected accurate and up to date checks as listed in the homes pre inspection questionnaire which helped show what actions were taken to keep the home safe to live in. Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 21 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): 27/28/29/30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are supported by a well-established staff team who have been provided with training to support resident’s diverse needs. EVIDENCE: We looked at 4 staff personnel files which were noted to be organised and were found to contain all relevant information and safety checks including police checks, induction and references. It was obvious that the home have good recruitment and selection procedures that help to safeguard residents. The manager and her deputy have continued to develop a large visual training matrix located in her office, which enables them to organise all necessary training including mandatory training especially when updates are due. Staff confirmed that they receive a variety of training and the pre inspection questionnaire gave details of all training that had taken place in the home since the last inspection. The investment and management of training for staff has continued to help provide a mainly well-trained and competent team able to achieve appropriate standards of care and support and meet the diverse needs of residents. Most of the resident comment cards offered positive comments however 5 cards indicated, staff were only “usually” available when needed. One person stated, Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 22 “at times when staff are busy then I understand I may have to wait.” The other 2-comment cards felt that staff where “always available. Staff comments included, “Staffing can be affected due to sickness or holiday-cover is provided by overtime or agency.” Some of the staff we met were ok with current staffing levels however most felt it wasn’t enough especially on the top floor at certain times in the day and on the ground floor due to the level of needs of the residents. Staff asked us what the staffing levels should be. There was no published staffing notice by the company or evidence to show what level they commit to, to provide basic nursing care. There was no evidence to show that residents, staff and relatives are involved in respecting their opinions in the current staffing levels. Staff felt that if they had an extra carer on each shift it would help in their opinion in providing a lot more choice for residents. They explained it was difficult at times when they have sudden staff absences due to illness and when staff have to escort residents to appointments and to the hospital as no extra staff are brought in to cover for this. Staff came across as very enthusiastic and motivated and 2 staff said they felt the home was really good and everyone was responding in how to develop the home further especially with activities. The home employs a large number of duel qualified nurses and support staff. There is always qualified nurse’s on duty 24 hours a day. The manager said she would be introducing a staffing calculation, which will help to show everyone at the home how staffing levels are determined based on the residents dependency levels. The manager agrees to review the cover of staffing levels especially for appointments and sudden staff sickness. Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a well run home especially regarding the leadership and management of the home. Management of heath and safety issues that need investment put people at risk if not attended to. EVIDENCE: The homes registered manager is a qualified nurse and has many years experience in caring for older people. The Manager has been at the home for many years and offers a great stability and rapport to all the residents and staff. The home is visited on a regular basis by a representative of the organisation. In line with quality assurance processes the home is visited at least once per month and a report is produced with the findings of the visit. These visits form Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 24 part of the quality assurance process and form an opinion on the standard of care provided. We looked at four residents finances. Finances are well managed and organised, however one persons records were not easy to understand as a lot of verbal information was in place but no written evidence of why their monies were managed by the local authority and the home. The manager agreed that this person needed an updated care management review to make sure the management of their funds was managed, appropriate and in their best interest. The manager agreed to inform the commission of the outcome of this review following our visit to the home. Regular audits now take place by the manager to make sure the storage and record keeping are up to date and accurate regarding management of resident’s finances. The manager continues to organise regular staff and resident meetings. This ensures that staff members have a regular forum to discuss issues that may affect the service provided to residents and the implementation of polices, procedures and practices within the home. Staff minutes were seen of recent staff meetings. Some showed details of various topics about the home, including training and policies and procedures. The pre inspection questionnaire gave some details regarding what policies are in place to staff and residents at the home however this document acknowledged that some policies were not yet in place including, individual planning, racial harassment, record keeping, smoking and use of alcohol etc These documents are necessary in keeping staff updated in all necessary guidance when working in a care home. Health and safety arrangements are mainly well managed by the manager however those areas needing major and continual investment were noted to need attention to the environment such as potential trip hazards of old worn frayed and ruffled carpets. Various maintenance certificates were produced showing some evidence of appropriate checks to facilities at the home. One certificate for gas was dated 11/6/07 and had a number of actions needed to be taken to improve the current facilities. The manager explained that most of the actions had been done and she felt one large job would be complete by the following week. Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 25 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 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 26 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 OP27 Regulation 18 1 a Requirement Staffing levels must be kept under review in order to make sure that staffing levels are appropriate to the needs of the residents. These reviews should include staff and residents opinions. Staff must act in accordance with company policy and show evidence of how they have covered any staff absence including any external clinic appointments were staff escort and support residents. The management of finances must be clear and show that they are managed in the best interest of residents with clear details of who is acting as appointee on behalf of residents. The financial records and assessments must be easy to read so that residents are supported in making decisions in their best interests. All bathrooms currently out of order and bathrooms without the appropriate adaptations must be DS0000042876.V347688.R01.S.doc Timescale for action 05/03/08 2 OP35 20 a b 05/03/08 3 OP19 23 1 2 05/03/08 Appleby Court Nursing Home Version 5.2 Page 27 4 OP38 13 4)a b c repaired and developed to make sure they meet the residents needs. All hazards and risks must have updated risks assessments in place to say what actions will be taken to eliminate risks at the home. Assessments must be in place for all risks seen during this visit, eg. Corridor carpets that are ruffled and any carpet that is frayed and coming away from the joins. Updated actions and maintenance work must take place as a matter of priority to show that the gas certificate dated 11/6/07 has been acted upon and all actions carried out to improve the safety of the service. 05/03/08 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 OP1 Good Practice Recommendations The Statement of Purpose should be developed further to include details of the companies commitment to a basic staffing notice to help provide basic nursing care which helps to keep everyone informed of what staffing levels to expect. Activities should be further planned and developed to meet residents social needs and should be clear in including residents opinions in the development of an activities programme accessible to all residents and displayed on each floor. Appropriate funds should be provided so staff DS0000042876.V347688.R01.S.doc Version 5.2 Page 28 2. OP12 Appleby Court Nursing Home 3. OP19 can arrange suitable transport so residents can go out on more trips. Financial policies and procedures must be clear and accurate and explain any financial outgoings Eg, payments charged for any activity including transport, meals and all costs incurred for appointments. All care plans must include details around each person’s social needs and requests stating what actions will be taken to meet their needs. To include residents in the development of their home and include plans in developing the current bathroom, toilet areas, lounge and corridor carpets to help provide a more homely and attractive environment that promotes dignity and choice over residents living areas. To review the current use of day space especially in the ground floor lounge so that resident have enough space to be comfortable and be able to see the television or be able to chat if they choose. To carry out a complete review of the homes environment so that an appropriate action plan can show what developments and investment will take place to provide a satisfactory standard in the home. To review and update all actions taken to date regarding any allegations of theft within the home. Further advice could be sought from the relevant authorities including the crime prevention officer. To update residents and reiterate safety arrangements in the home regarding the facilities for storage and safe keeping of personal items. To provide all necessary policies and procedures especially those not yet in place as explained in the pre inspection questionnaire. Eg individual planning, racial harassment, record keeping, smoking and use of alcohol etc. This will help in keeping staff updated in all necessary guidance when working in a care home. 4. OP18 5 OP33 Appleby Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Northwest Regional Contact Team Unit 1, 3RD Floor Tustin Court Port Way Preston PR2 2YQ 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 Court Nursing Home DS0000042876.V347688.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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