Inspection on 20/05/05 for Appleby House

This inspection was carried out on 20th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Appleby House 26/09/06

Appleby House 19/10/05

Appleby House 07/10/04

Appleby House 28/04/04

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

CARE HOMES FOR OLDER PEOPLE Appleby House Longmead Road Epsom Surrey KT19 9RX Lead Inspector Miss Marianne Barham Unannounced 20 May 2005 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 House H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Appleby House Address Longmead Road, Epsom, Surrey. KT19 9RX 01372 739933 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) Care UK Community Partnerships Ltd Ms Wendy Dodimead CRH (PC) 50 Category(ies) of Dementia - over 65 years of age (DE(E)) 50. registration, with number of places Appleby House H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 7 October 2004 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 ensuite 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 H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out at 10.00am by Marianne Barham, lead inspector for the service. The inspection was carried out over a period of four and one quarter hours and was the first inspection in the Commission for Social Care year April 2005 to March 2006. The registered manager of the home, Ms Wendy Dodimead has recently been promoted within Care UK to a senior management post and though she is based at Appleby House, the day to day management of the home is being undertaken by Ms Lyn Rogers in an acting capacity. The term manager in this report will refer to Ms Rogers. Care UK is currently advertising the post of manager for Appleby House. Ms Rogers was present and a total of eleven service users, three visitors, a district nurse and six staff members were spoken to during this inspection. The home was functioning well during the inspection, with service users being engaged in meaningful activities and a calm atmosphere present throughout the home. All requirements made at the last inspection on 7th October 2004 have been met. What the service does well: The home is purpose built and the layout is such that service users are able to find their way round with ease. Communal areas of the home are comfortably furnished, clean and tidy. Service users bedrooms are personalised with their own possessions. Service users needs are well met through the homes assessment and care planning process. There is an established, suitably trained staff team who receive the necessary supervision and support to meet the needs of the service users. The home offers a wide range of activities based on the individual’s preferences and abilities. Service users were observed participating in some of the activities and were seen to engage positively with the staff members supporting them. Appleby House H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 Page 6 Service users spoken to reported that they were happy living in the home, were able to make choices such as meals and activities and that the staff team were caring and kind. Three visiting relatives spoken to were complimentary about the care their relative received and about the manager of the home. All felt that the home met the needs of their relative and all were aware of the complaints procedure and service users guide. A visiting district nurse stated that the home was well managed, communication between the home and the GP surgery was good and that service users were well cared for. The home is currently having a large extension built, however owing to effective forward planning by the manager and Care UK, there is minimal disruption to the service users and no noise or other signs of building work were detectable during this inspection. What has improved since the last 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 H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 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 House H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 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 and 5 Service users do not move into the home without a full assessment of their needs being undertaken. Service users and the families are able to visit the home prior to admission. EVIDENCE: All service users have a full needs assessment undertaken prior to admission. These were examined and found to be comprehensive and detailed. Assessments may be carried out either by the manager if the prospective service user is paying for their care, or by a care manager if they are local authority funded. Care UK has recently introduced a seventy-two hour settlement review in order to monitor new admissions to the home. The home has an admissions policy and visits by service users and their families are encouraged. The manager stated that prospective service users could visit the home as often as they needed to prior to moving in. Appleby House H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 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 and 9 All service users have a plan of care, detailing their personal, health and social needs. The homes policies and practices when dealing with medicines protect the service users. EVIDENCE: Care plans are generated from the pre-admission assessment. Those examined were found to be clearly written and to cover all aspects of the individuals care. The care plans are reviewed on a monthly basis and updated information recorded. The home has a policy and procedure in place for mediation that is in line with the Royal Pharmaceutical Guidelines. Staff receive training from Care UK in the administration of medication and are updated regularly. Medicines are supplied by Boots the Chemist, mainly in blister packs. Boots carry out advisory visits twice a year. The medication was found to be stored securely and appropriately. The controlled drugs register was accurately maintained and medicines fridge temperature was recorded daily. Medication administration record (MAR) charts were examined and found to be accurately maintained. Appleby House H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 Page 10 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 and 13 Service users lifestyle in the home reflects their cultural, social, religious and recreational interests and needs. Service users are supported to maintain links with their families and the local community. EVIDENCE: The home employs an activities coordinator and offers a wide range of activities to service users such as bowls, darts, mini golf, reminiscence sessions, quizzes, sing songs, music and movement and arts and crafts. Entertainers visit the home, such as a pianist twice a month, a violin player, a visiting pantomime and a theatre group performance. All service users have an individual timetable of activities that is organised according to their personal preferences and abilities. Records of activities undertaken are maintained along with each persons likes/dislikes, hobbies and work and family history. The home has a Church of England service every first Sunday of the month, the Catholic Priest visits and gives communion weekly. The local church choir visits regularly for choral afternoons. Service users can receive visitors at any time, either in their room or in the lounge and they may stay for lunch/dinner as long as the chef knows in advance. Staff members were observed to welcome visitors into the home in a Appleby House H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 Page 11 polite and friendly manner. Relatives and friends can use the homes activity room for service users birthday parties of other events free of charge if they wish. Appleby House H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 Page 12 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) 16 and 17 Service users and their families can be sure that their complaints will be listened to and acted upon, and that their legal rights are protected by the home. EVIDENCE: The home has a complaints procedure in place that is available in pictorial format. This was displayed around the home and service users and their families are also given a copy in their welcome pack on admission to the home. Visitors spoken with were aware of the complaints procedure and knew who to speak to should they have a complaint. There has been one complaint to the service in the last twelve months. This was recorded and dealt with to the satisfaction of the complainant. Service users are supported to take part in the civic process and all are registered to vote. Appleby House H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 Page 13 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, 21, 24 and 26 The home is generally well maintained, with sufficient toilets and bathrooms that are suitable for the service users and bedrooms that are safe and comfortable, however there are repairs outstanding as detailed below which may pose a risk to the safety of service users. EVIDENCE: The home is purpose built and this reflected in the layout of the building and the facilities provided. The home is currently being extended to provide another twenty-five beds and a day and night centre, however disruption to service users is minimal due to forward planning by the manager and Care UK and the cooperation of the building contractors. Maintenance and repair records are maintained and safety checks for the building are carried out and recorded regularly. Each unit has two assisted bathrooms and three toilets and there are also toilets in the centre of the building. It was observed that the toilet seats in toilets 1 and 3 on Russet unit need replacing. It was observed that several Appleby House H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 Page 14 floor tiles in toilet 1 on Pippin unit were missing and needed replacing and that the floor tiles by the door in toilet 3 need to be repaired or replaced. A requirement has been made to address these issues. A requirement was made at the last inspection that the lighting in communal areas of the home be replaced with more suitable lighting (lux 150). This has been met. Service users bedrooms were generally found to be clean, comfortably furnished and personalised with service users own belongings. Room 9 on Russet unit was found to have a very strong odour of urine, the manager reported that the carpet had been cleaned repeatedly but the odour remained. A requirement has been made to replace the carpet with a recommendation to replace it with washable floor covering. Room 7 on Blenheim unit also had a strong odour of urine, however the manager reported that this is not an ongoing issue and that cleaning the carpet would address the problem. A requirement has been made to clean the carpet. Room 8 on Pippin unit has a large area of missing plaster on the wall behind the bed. A requirement has been made to repair the wall. Aside from issues mentioned the home was found to be clean, tidy and free from odour. Appleby House H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 and 28 The numbers and skill mix of the staff team is sufficient to meet the needs of the service users. Service user’s safety is protected by, a suitably qualified staff team. EVIDENCE: A requirement was made at the last inspection to employ another waking night staff so that there is one staff on each unit. It was pleasing to see that this has been met. The staff rotas were examined and showed that there are sufficient numbers and skill mix of staff members to meet the needs of the service users. The home employs twenty-seven care staff, of these five hold NVQ 2 qualification and eight are currently working towards it. There are four staff currently undertaking NVQ 3, with a further two waiting to be registered on the programme. The acting manager is currently undertaking the registered managers award (NVQ 4). All domestic staff hold the NVQ 1 in housekeeping and infection control and the chef holds the advanced food hygiene certificate. Appleby House H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 34, 35 and 37 The best interests and rights of the service users are protected by the homes record keeping, accounting and financial procedures. EVIDENCE: The homes business plan is currently under review by Care UK. Details of the 2004/2005, business plan were available for examination and show the service to be financially viable. The insurance cover is adequate and in date. Service users who have no representative finances are managed centrally by, Care UK. The home employs an administrator who is responsible for the cash at the home. Personal allowance is sent to the home by cheque, which is cashed and held in the safe, robust systems for recording expenditure and receipt of cash are in place. There are currently six service users who have their finances managed by Care UK, the remainder have relatives or representatives who manage them. Appleby House H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 Page 17 Records for the protection of service users and the running of the home are maintained accurately and stored appropriately. Service users have access to their records and there is a comprehensive list of policies and procedures in place. Appleby House H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 x COMPLAINTS AND PROTECTION 2 x 3 x x 3 x 2 STAFFING Standard No Score 27 3 28 4 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x x x x 3 3 x 3 x Appleby House H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 Page 19 NO 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. 2. Standard 19 19 Regulation 23 (2) (c) (d) 23 (2) (b) Requirement The toilet seats in those areas identified in the main body of this report are replaced. The floor tiles in the toilets identified in the main body of this report must be repaired or replaced as appropriate. The plaster on the wall of bedroom 8, Pippin unit, must be repaired. 1. The carpet in room 9, Russet unit must be replaced. 2. The carpet in room 7, blenheim unit must be professionally cleaned. Timescale for action 20/06/05 20/06/05 3. 4. 19 26 23 (2) (b) 16 (2) (k) 23 (2) (d) 20/06/05 1. 20/08/05 2. 20/06/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 26 Good Practice Recommendations It is strongly recommended that the carpet to be replaced in room 9, Russet unit is replaced with washable floor covering in order to prevent the odour recurring. Appleby House H58 H09 s13891 Appleby House v218934 200505 Stage 2 unn.doc Version 1.30 Page 20 Commission for Social Care Inspection 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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