Inspection on 26/09/06 for Appleby House

This inspection was carried out on 26th September 2006.

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 19/10/05

Appleby House 20/05/05

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 Appleby House Longmead Road Epsom Surrey KT19 9RX Lead Inspector Mavis Clahar Key Unannounced Inspection 26th September 2006 08:40 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.V313290.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 House DS0000013891.V313290.R01.S.doc Version 5.2 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) www.careuk.com Care UK Community Partnerships Limited To be advised Care Home 75 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (75) of places Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 10 service users may be admitted from the age of 50 within the category of DE (Dementia) 19th October 2005 Date of last inspection Brief Description of the Service: Appleby House is a purpose built home providing care and accommodation for up to 75 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. Fees at this home are in the range of £650.00 to £750.00 per week. Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit, which forms part of the homes first key inspection to be undertaken by the Commission for Social Care inspection was carried out by Mrs Mavis Clahar on the 26th September 2006 and lasted for seven hours and fifty minutes; commencing at 08:40 hours and concluding at 16:30 hours. On arrival at the home the inspector was made very welcomed by the Acting deputy manager; and this was repeated by both the Manager and Deputy manager. The manager is very new in post. She commenced duties at the home three days prior to the inspector’s visit The first part of the inspection was spent explaining the changes to the inspection process as outlined by CSCI Inspecting for Better Lives. This was followed by an outline of how today’s visit would fit into the new inspection method. Time was spent with the manager discussing areas of the home she had identified as needing improvements and how she plans to get these moving. A tour of the home and gardens was conducted and the inspector was able to observe carers and service users interacting in a friendly but respectful manner. Time was also spent with service users in three dining rooms during dinnertime to observe service users and care workers interactions, delivery of meals, presentation of meals and speaking with service users about their meal. Service users commented positively on the taste, texture, and amount of food they receive. There were a variety of meals served on the day and the Chef who has had international experience appeared knowledgeable about the dietary needs of the service users. The second part of the visit was spent reviewing service users files, speaking with service users, care workers, and domestic staff; sampling policies, records and care workers’ files. The inspector did not meet with any visitors to the home even though on checking the visitors’ registration book it was evident that the home received many visitors on the day of the visit. Because of the nature of the service users medical conditions it was not always easy to obtain useful information from them. Consequently the information contained in this report is obtained from service users who were able to answer questions, from their key workers, from their records of care documented and from the deputy manager and the manager and from observations made by the inspector. Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 Page 6 Only two comment cards were received and these were complimentary about all aspects of the home. What the service does well: 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 DS0000013891.V313290.R01.S.doc Version 5.2 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.V313290.R01.S.doc Version 5.2 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): 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Good information was obtained from prospective service users prior to them being admitted to the home. This allowed for carers and service users to make informed decision regarding the planning and delivery of care. Where the assessments have been undertaken through care management arrangements the manager insists on receiving a copy of the care plans. This allowed for care workers and service users to make informed decisions regarding the planning and delivery of care. Skilled and competent staff at the home carries out all other re ad mission assessments. Standard 6 does not apply to this home. Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 Page 9 EVIDENCE: Random sample of service users files, care plans and daily work sheet, along with selected case tracking has demonstrated the homes ability to assess service users needs. This was supported by discussion with the manager, the key worker and the service users themselves. Discussions with carers have shown care workers had the knowledge suitable to meet the care needs of the service users in their care. Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 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): 7 8 9 10, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a good and clear care plan in place for service users, which also includes appropriate risks assessments. This forms the basis for care based on the agreed care needs of the service users and demonstrated that health and personal care needs were met. Care staff receives training to meet the assessed care needs of the service users ensuring that competent staff supports service users and their health and care needs are met. The home’s medication policy on receiving, storing and administering and return of medication was in place and being adhered to thereby ensuring the safety and protection of the service users. Care workers are aware of the need to treat service users with respect and to maintain their dignity and privacy when delivering personal care Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 Page 11 EVIDENCE: The randomly selected care plans were clear and easy to read, identifying potential and actual risks to service users. The daily work sheet along with discussion with service users demonstrated that service users care needs are fully met. No service user at the time of inspection was responsible for their medication, but the manager was knowledgeable about what to do should this situation arise. Good clear records are kept of medication receipts, storage, administration and returns There were no visitors to the home to speak with the inspector, but service users spoken to, rated the personal care they receive at the home as very good. Most of them said they were contented, they had enough to eat and can do as they like. They said the staff are very friendly and “this is a good place to be.” Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 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): 12 13 14 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users lifestyles matched their needs and preferences and where possible they are able to maintain contact with family, friends and the local community. Service users are able to make choices in accordance with their abilities and were provided with balanced diet in pleasant surroundings and in an unhurried way. EVIDENCE: Service users spoken to say they were able to go to bed and get up when they choose, take part in activities as they wished and consulted on how they would like to spend their time. One service user whom the inspector commenced a tracking of care on was asleep each time the inspector went to speak with her, so the inspector did not disturb her. One service user told the inspector I am able dress myself with help from my carer, after she helps me with my bathing”. “Staff are kind. I can’t knock the staff”. Another service user said, “ Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 Page 13 the food is good really good and I get enough to eat. The staff are so very good. The only thing is there is not a lot to do. I walk in the garden when the day is ok”. This service user did not know what they would really like to do In discussion with the care worker she said she was very new to the home; she has been here just four months but she loves the work. She has completed her induction and is hoping to commence the National Vocational Qualification (NVQ) Level 2 (L2) course in due time. All service users are registered with a General Practitioner (GP). Further health care provision is obtained from the District nurse, Community Psychiatric Nurse, Occupational Therapist Dentist Audiologists Physiotherapist and Chiropodist as requested by the GP. Records of visits are kept and are available for inspection. The inspector did not observe any visitors to the home, but on checking the visitors’ registration book it was seen that there were a number of visitors to the home during the time of the inspection. At the time of writing this report only two questionnaires were received at CSCI for this home and they were both complimentary on all areas. The inspector observed that service users were dressed very nicely. In discussion with the service users the inspector complemented one gentleman on how well groomed he looked. He was very proud of his Royal Air Force (RAF) tie and gave the inspector a good historical account of his days in the RAF. Catering facilities are managed and carried out by the home’s chef, who had a good knowledge of the dietary needs of the service users. On the day of the visit there were two main menus with various alternatives for service users who had made their choices. The inspector did not sample the meals, but the service users all said the food is good, the texture just right and the amount was what they ordered. The inspector observed that the food was presented in an attractive way to stimulate service users’ appetite. Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 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): 16 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a satisfactory complaints policy and procedure and training in place that evidenced that service users and relatives concerns are listened to and acted upon. Robust Safeguarding adults’ policies are in place to protect the service users from abuse. EVIDENCE: CSCI Eashing office has not received any complaints about this home since the last inspection. The one complaint received at the home since the last inspection was logged with its outcome. This demonstrated that service users and relatives complaints are taken seriously and are dealt with within the company’s time frame. Majority of the service users spoken to said they knew how to complain if there was a need to do so. However, one service user said she does not know whom to complain to if she wanted to; she hasten to say “not that I have anything to complain about”. Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 Page 15 Random sample of staff files indicated training records were not contained in their folder. In discussion with the manager it came to light that records are kept separately and she is in the process of changing this practice. The staff records were kept in the training room and it was evidenced that staff were appropriately trained to do the job they are asked to do. In discussion with care staff it was evident staff were aware of their duty to protect service users and to report any suspected or actual incidence of abuse of the service user. Since the last inspection the home has received eleven letters and cards of thanks from relatives for the care extended to service users whilst they were resident at the home. Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 Page 16 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): 19 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a well-maintained environment, which provides aids and equipment to meet the care needs of the service users. It is a very pleasant, safe place to live with rooms that meet the National Minimum Standards (NMS) or are larger and all have en-suite facilities. EVIDENCE: Since the last inspection the home has been enlarged by twenty-five beds to bring the total number of beds to seventy-five. All twenty-five bedrooms have en-suite facilities. Two lounges and dining areas have also been extended. Two conservatories are added which are used as quiet areas for service users. Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 Page 17 The manager has identified a number of areas in the home, which needs upgrading, and she has been allocated a large sum of money to commence work on these identified areas. The home presents as comfortable with attractive gardens, which are well maintained. There is good access to the gardens from various parts of the home. Some service users told the inspectors that they try to go out daily weather permitting to enjoy the gardens. The inspector noted that adverse weather would not stop service users enjoying the garden, as the windows are low enough to allow service users to view the gardens from their armchairs. It was pleasing to note that service users were able to personalise their bedrooms with small items of furniture, paintings on the wall and many family photographs. Generally, the home presents as clean, safe, pleasant, hygienic and tidy and free from offensive odours. Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 Page 18 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): 27 28 29 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Skilled competent staff met Service users needs The number of staff on duty was sufficient to meet the service users needs. The service recruitment policy is adequate and generally meets the regulations and national minimum standards. Care workers are trained and competent to do their jobs. EVIDENCE: The staff rota demonstrated the number and grade of staff on duty to provide care and attention to service users for any twenty-four period was adequate to meet the assessed care needs of the service users. The home has a programme of planned training in place and all members of staff have an individual training record. A number of care workers have attained the L2 NVQ with more staff yet to complete their course. Staff are encouraged and enabled to undertake developmental training as well as the mandatory training. . All newly appointed staff undertakes an induction Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 Page 19 programme. The home ensures that staff undertakes the mandatory training with yearly updates as necessary to maintain their competency to fulfil their duties. This was evidenced through discussion with the manager and care workers It was noted that staff turn over at the home is relatively low and that a number of care workers CRB were well out of the three years time frame. A requirement was issued on this standard. All staff are Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checked prior to commencing employment, and they are in receipt of terms and conditions of employment as evidenced in their randomly selected files. The manager informed the inspector that supervision record were not up to date and this was verified during random sampling of care workers files. The manager had shown the inspector her planned programme of improvements and supervision of staff was high on her agenda. It was evidenced from notified incidents sent to CSCI that a number of service users suffered falls, which were suitably managed. Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The manager is very new in post, but has the experience to run the home and to work continuously to improve services and provide an increased quality of life for the service users. On the day of the visit there was a strong ethos of being transparent and open in all areas of running the home. The views of service users and their relatives are actively sought in the running of the home The home does not become involved in service users finance. The service provides training on health and safety issues for all staff and service users are involved in the running of the home. Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 Page 21 EVIDENCE: The manager is very new in post. She commenced working at the home on 21st September 2006. She is a Registered General Nurse, with the Certificate of Management Studies, ENB 941 (Nursing Elderly People) ENB 998 (Teaching and Assessing in Clinical Practice) who has had over twenty years nursing and management experience. In discussion with the manager it was evident she was knowledgeable about the care needs of the service users and the training needs of the care workers to meet the identified care needs of the service users. There are clear lines of accountability within the home, each member of staff spoken to on the day of the visit was clear about their role and responsibilities. The home surveys service users, their relatives and other people involved in the running of the home bi annually to obtain feedback on the care the home provides. Service users meetings are held monthly and the minutes are available for review, although none of the service users spoken to on the day of the visit were able to discuss these meetings. The home does not become involved with service users finance except for small amount of spending money for which individual records are kept. Review of documented records demonstrated that health and safety checks are routinely carried out at the home. All equipment examined on the day was properly maintained. Records indicated that fire drills, fire alarm, water temperature fridge and freezer recordings were regularly checked. Random sample of care workers’ training files demonstrated that up to date and relevant training were carried out by care workers to protect service users’ health, welfare and safety. In discussion with care workers it was good to hear they had an understanding and implementation of appropriate procedures to safeguard service users. Further more they spoke about their understanding of promoting safe working practices based on their health and safety training. Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X x 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 Page 23 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 OP29 Regulation 17 (2) Schedule 2 (7) (b) Requirement The registered person must maintain in the care home the records of care workers CRB. All out of date Criminal Record Certificates are to be replaced by up to date copies. Timescale for action 30/12/06 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 OP9 Good Practice Recommendations The original MAR sheet must be kept in with the hand copied version at all times to reduce possible mistakes and to show the original dosage as prescribed by the GP. Appleby House DS0000013891.V313290.R01.S.doc Version 5.2 Page 24 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 © 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 House DS0000013891.V313290.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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