CARE HOMES FOR OLDER PEOPLE
Appleby House Appleby House Longmead Road Epsom Surrey KT19 9RX Lead Inspector
Marianne Barham Announced Inspection 19th October 2005 10:30 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 House DS0000013891.V252984.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 House DS0000013891.V252984.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Appleby House Address Appleby House Longmead Road Epsom Surrey KT19 9RX 01372 739933 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) Care UK Community Partnerships Limited Wendy Dodimead Care Home 50 Category(ies) of Dementia - over 65 years of age (50) registration, with number of places Appleby House DS0000013891.V252984.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th May 2005 Brief Description of the Service: Appleby House is a purpose built home providing care and accommodation for up to 50 older people who have dementia, four of which may be for respite care. The home is owned and managed by Care UK, a private healthcare organisation. The building is single storey and accommodation is arranged in five units. Each unit has its own communal facilities such as lounge, dining room, kitchen, toilets and assisted bathrooms. All bedrooms are single occupancy with en-suite facilities. There is a large activities room central to the building. The home also has a hairdressing room and a day centre that is accessed by service users in the home and from the community. The home is a short distance from Epsom town centre and has ample parking to the front of the property. Appleby House DS0000013891.V252984.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection carried out at 10.30am by Marianne Barham, lead inspector for the service. The inspection was carried out over a period of four and a half hours and was the second inspection in the Commission for Social Care year April 2005 to March 2006. The manager of the service, Wendy Dodimead was present and a total of fifteen service users, seven members of staff and a visiting relative were spoken with during this inspection. Records relating to the care of service users and management of the home were also examined. A large number of comment cards were received from service users, their families and healthcare professionals prior to this inspection, all of which were complimentary about the care and services provided by the home. What the service does well: What has improved since the last inspection?
Appleby House DS0000013891.V252984.R01.S.doc Version 5.0 Page 6 The home has replaced the toilet seats in several of the bathrooms and toilets and the floor tiles in two of the toilets have been replaced. This meets requirements made at the last inspection on 20th May 2005. The wall in one of the bedrooms has been repaired and carpets have been cleaned or replaced in some of the bedrooms. This meets requirements made at the last inspection. A recommendation was made at the last inspection to replace one of the bedroom carpets with washable flooring, however the service user’s family objected so another carpet has been laid. The home has purchased a new cleaning system for the cleaning of carpets that is more efficient in preventing odour. No unpleasant odour was noted during this inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Appleby House DS0000013891.V252984.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 House DS0000013891.V252984.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Service users are given enough information to make a choice about where they live. Each service has a written contract with the home, however service users who are funded by the local authority need to have the room they occupy and the fees charged included in the contract. EVIDENCE: The home has a comprehensive statement of purpose that gives clear information about the aims of the home and the services provided. The service users guide is in a brochure format and is given to service users and their families prior to living in the home. An information pack containing details of the various activities and services offered by the home is available on each unit of the home and also contains copies of the complaints procedure, policy on prevention of abuse and the whistle blowing policy. All service users have a written contract stating the terms and conditions of residence in the home. Service users who are privately funded have a full
Appleby House DS0000013891.V252984.R01.S.doc Version 5.0 Page 9 contract between themselves and the home that states the room to be occupied and the fees charged. Service users who are funded by the local authority have a terms and conditions of residence agreement with the home as the contract is with the funding authority. The terms and conditions agreements do not state the room to be occupied or the fees charged and a requirement has been made to address this. Appleby House DS0000013891.V252984.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8 and 10 Service users’ health care needs are met by the home, their right to privacy is upheld and they are treated with respect. EVIDENCE: All service users are registered with a local GP of their choosing. Specialist healthcare professionals are accessed through the GP practice and district nurses visit the home on a regular basis as required. An NHS funded optician visits the home every six months, as does an NHS dentist. A chiropodist visits all service users every six to eight weeks, this is paid for privately and an NHS chiropodist sees four service users twice a year. All service users have their assessed needs reviewed regularly by the home with any changes in care needs recorded in the care plan. The home seeks advice and support from the GP as required and the district nurse carries out healthcare assessment for those who need it. Risk assessments are carried out for all service users for moving and handling, pressure area care and falls. Other risk assessments are carried out required for specific activities. All risk assessments are reviewed regularly.
Appleby House DS0000013891.V252984.R01.S.doc Version 5.0 Page 11 The home has a policy on promoting and preserving service users privacy and dignity. All members of staff are made aware of this at induction. All healthcare appointments in the home are carried in the service user’s room or in the treatment room. Members of staff were observed to knock on doors prior to entry and to relate to service users in a positive and respectful way during this inspection. Service users spoken with said that the staff team are caring and that they are treated with respect. Appleby House DS0000013891.V252984.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 15 Service users are supported to exercise choice and control in their lives and they receive a balanced diet, suitable for their needs and according to their preferences. EVIDENCE: Each unit holds service users meetings every month. These meetings give service users the opportunity to discuss their ideas for activities, provide feedback on the service provided and raise any concerns they may have. The meetings are recorded along with any actions needed or taken regarding them. Service users spoken with said that they are able to get up and go to bed when they choose, take part in activities as they wish and are consulted on how they would like to spend their time. A clothing boutique visits the home and displays its’ clothes so that service users are able to choose for themselves and the home also supports those who are able to shop in the community. The home has four weekly menus that offer a good variety of balanced meals. The menus are produced in consultation with service users and are reviewed according to the season. Service users are given food questionnaires to find out their likes and dislikes prior to moving into the home and these are kept in the kitchen.
Appleby House DS0000013891.V252984.R01.S.doc Version 5.0 Page 13 Menu choice cards are given to service users each day to decide what meals they would prefer to have. Service users spoken with said that they were able to choose what they had to eat and could have a drink or snack whenever they wanted. The home employs a chef and two kitchen assistants. All have received food hygiene training and also hold NVQ level 1 in housekeeping. The kitchen is clean, well equipped and spacious and all necessary temperature and hygiene checks are carried out and recorded. The food storage areas are well stocked with a range of fresh produce and groceries. Service users spoken with said that they enjoyed the food at the home and that it is always nice. Members of staff were observed to support service users to eat their meals in a caring and dignified manner. Appleby House DS0000013891.V252984.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Service users are protected from abuse by the home. EVIDENCE: The home has a policy and procedure on the prevention of abuse and a whistle blowing policy. Staff members are made aware of these at induction and through training sessions carried out at the home by a member of the Surrey adult protection team. The home also has a copy of the Surrey Multi-Agency Procedures and all staff members have signed to show they have read and understood the procedures. Members of staff spoken with said that they had received training on adult protection and were able to demonstrate an awareness of their responsibilities in this area. Appleby House DS0000013891.V252984.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): N/A These standards were not assessed at this inspection. Please see report dated 20th May 2005 for details on these standards. Requirements made at the last inspection regarding these standards have been met. Please see the 20th May 2005 report for details of the requirements made. EVIDENCE: Appleby House DS0000013891.V252984.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 and 30 Service users are supported and protected by the home’s recruitment policies and procedures and the staff team are trained and competent to do their jobs. EVIDENCE: The home has a recruitment policy and procedure in place. Recruitment files were examined for several members of staff. These were found to be in good order with all necessary checks and documentation in place for each member of staff. The home has a programme of planned training in place and all members of staff have an individual training record maintained. Several staff members have completed or are near completion of NVQ qualifications in care, with the deputy manager currently undertaking the Registered Managers Award. Staffing training needs are identified through the supervision and appraisal process carried out in the home and all members of staff are encouraged to attend developmental training as well as the mandatory courses. All staff spoken with confirmed that they receive a high level and standard of training and receive support from the manager to attend and complete training courses. The home is to be commended for its commitment to ensuring that the staff team are sufficiently trained to meet the needs of the service users. Appleby House DS0000013891.V252984.R01.S.doc Version 5.0 Page 17 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): 33 and 38 The home is run in the best interests of the service users and their health, welfare and safety is promoted and protected. EVIDENCE: The home surveys service users, their relatives and other involved people twice a year to obtain feedback on the care and services provided. There is also a suggestion box for service users and visitors to air their views. Service users meetings are held monthly and recorded. A visiting relative spoken with expressed their satisfaction with care and services provided by the home. All feedback received is collated and an action plan put into place to address any issues or concerns raised. The home also carries out quality audits regularly and a monthly audit of the home is carried by the senior manager of Care UK to comply with regulation 26 of the Care Homes Regulations (as amended) 2001.
Appleby House DS0000013891.V252984.R01.S.doc Version 5.0 Page 18 The home has a comprehensive policy for Health and Safety and all staff are made aware of this at induction. All members of staff undergo health and safety training and are updated annually. Health and safety audits are carried out annually by, an external auditor and quarterly by the home. There is an ongoing programme of maintenance and repair in place and the home employs two maintenance workers to carry this out. All necessary checks and/or servicing of equipment is carried out and recorded and workplace risk assessments are in place for all work activities. The home is currently undergoing extensive building works on a large extension to the property. This is being handled very well by the home with a minimum of disruption to the service users. Appleby House DS0000013891.V252984.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 3 Appleby House DS0000013891.V252984.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? NO 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 2 Regulation 5 (b) (c) Requirement The registered person must ensure that all service users contracts state the room to be occupied and the fees charged. Timescale for action 19/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Appleby House DS0000013891.V252984.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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