Inspection on 18/10/05 for Applecroft Residential Care Home

This inspection was carried out on 18th October 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Applecroft Residential Care Home 31/07/07

Applecroft Residential Care Home 05/05/06

Applecroft Residential Care Home 14/06/05

Applecroft Residential Care Home 17/02/05

Applecroft Residential Care Home 26/10/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Applecroft Residential Care Home 48/50 Brunswick Street Congleton Cheshire CW12 1QF Lead Inspector Helena Dennett Unannounced Inspection 18th October 2005 09:30 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 Applecroft Residential Care Home DS0000045159.V256564.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. Applecroft Residential Care Home DS0000045159.V256564.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Applecroft Residential Care Home Address 48/50 Brunswick Street Congleton Cheshire CW12 1QF 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) 01260 280336 01260 299862 tracy.bali3@btinternet.com B & L Property Investments Ltd Tracy Leese Care Home 25 Category(ies) of Dementia (1), Mental Disorder, excluding registration, with number learning disability or dementia - over 65 years of of places age (1), Old age, not falling within any other category (25), Physical disability (2) Applecroft Residential Care Home DS0000045159.V256564.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 25 service users to include: * Up to 25 service users in the category of OP (old age not falling within any other category) * 1 service user in the category of MD(E) (mental disorder over the age of 65) * 2 named service users in the category of PD (physical disability) over the age of 60 within the overall number of registered places 1 named service user in the category of DE (dementia) The registered provider, must at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The registered provider must provide staff to meet the dependency needs of service users at all times and shall comply with any guidelines guidelines that may be issued through the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection. 14th June 2005 2. 3. 4. Date of last inspection Brief Description of the Service: Applecroft is a privately owned care home located near to Congleton town centre and close to local shops. Applecroft was formally two private dwellings that have been converted and extended to provide a care home for older people. It is a three-storey building and residents can be accommodated on all floors. Access to all floors is via a shaft lift or stairs. Residents accommodation consists of 25 single bedrooms, some of which have en-suite facilities. The remaining bedrooms have wash hand basins. Alterations designed to upgrade and provide en-suite facilities to a number of bedrooms is in progress. Day space consists of two lounges and a dining room. There are an adequate number of toilets and bathrooms available for residents. Applecroft Residential Care Home DS0000045159.V256564.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 5 hours. The inspector toured the building; spoke with three residents, two members of staff and the owner. A number of resident comment cards with envelopes were left at the home during the inspection. Six resident and one relative comment cards have since been returned. The comments are reflected throughout the body of the report. What the service does well: What has improved since the last inspection? What they could do better: Care planning practices are in need of improvement. There were no care plans in place for three residents whose files were inspected. This is an outstanding requirement and must be addressed. The laundry must be cleaned thoroughly to ensure that residents are not placed at risk of cross infection. Applecroft Residential Care Home DS0000045159.V256564.R01.S.doc Version 5.0 Page 6 Systems in the kitchen need to be improved as there were several areas identified which could result in the risk of cross infection . Health and safety systems in the home need to be improved. Staff must make sure that products classified under Control of Substances Hazardous to Health (COSHH) are kept locked when not in use to ensure residents are not at risk. The temperature of the bath water was again found to be 50 degree Celsius which is substantially higher than the recommended temperature of around 43 degree Celsius. This is an outstanding requirement and must now be addressed. Although risk assessments were in place these must be more detailed, in particular the action staff must take to minimise risks. All staff must be made aware of the outcome of these assessments so that residents are not placed at unnecessary risk. Fire systems within the home need to be improved so that the environment is safe for residents in the event of a fire. 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. Applecroft Residential Care Home DS0000045159.V256564.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 Applecroft Residential Care Home DS0000045159.V256564.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): 3 Assessments of peoples care needs are carried out before they move into the home so there is information to show that their needs can be met at the home. EVIDENCE: There was evidence in the files that staff assess residents’ needs before they move in. The assessments record the resident’s health care needs to make sure that these needs can be met. Applecroft Residential Care Home DS0000045159.V256564.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9 &10 Although residents said they felt that staff at the home meet their needs, there were no care plans in place in three of the residents files so residents could be at risk of their needs not being met. Residents said that staff respect their privacy. The management of medicines needs to be improved so that residents are given their medicines as prescribed. EVIDENCE: Four residents care files were looked at during the inspection. For three residents there were no care plans in place. One resident had been admitted for short stay, the pre admission assessment identified several health care issues, including the resident having suffered from a stroke and at risk of falls. There was no admission assessment completed, no risk assessment and no care plans in place. Entries in the daily record indicated that staff were not aware of this residents needs and so may be at risk of needs not been met. Applecroft Residential Care Home DS0000045159.V256564.R01.S.doc Version 5.0 Page 10 In a second care file the resident suffered from Alzheimer’s disease. There were no care plans in place and no evidence that staff were monitoring the residents mental health. In a third care file it was recorded that the resident may become argumentative or challenging at times. There was no care plan in place to guide staff on the action to be taken should this situation arise. Residents spoken with were very complimentary about the care provided at the home. They were very happy with staff attitudes. One resident said that Applecroft is ‘a wonderful place’, she can suit herself, has the district nurses regularly and staff contact the GP when needed. All of the comment cards returned ticked yes by the questions ‘do you like living here, do you feel well cared for and do staff treat you well’ The relative /visitor comment card ticked yes to the question ‘are you satisfied with the overall care provided’. Staff were seen to treat residents with respect and dignity. They knocked on doors before entering and closed doors before attending to any personal care. On touring the building the inspector noted that in one residents en-suite, there was no blind/curtain to promote privacy, however the window contained frosted glass. The resident said that she felt uncomfortable using this room without a blind/curtain. The management of medicines needs to be improved. There were two instances where variable doses of medicines were not recorded on the Medicine Administration Sheet (MAR) so it was difficult to ascertain exactly the dose given to the resident. Hand written instructions on the MAR sheets were not signed or dated. It was recorded on one MAR sheet that an inhaler prescribed for one resident had been out of stock since 15th October 2005. On another MAR sheet it was recorded that the resident was asleep when the medicines were given out and therefore she did not have her daily medication. The manager said that the doctor was aware of this problem as the resident sometimes sleeps most of the day due to her condition. However this was not recorded. For another resident a Phyllocontin tablet was signed as given, however the tablet was still in the packet. See Requirement 1,2 & 3 See Recommendation 1 Applecroft Residential Care Home DS0000045159.V256564.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14 &15 Residents can choose how they spend their time in the home. There is a mobile phone available so that they can keep in contact with their friends and family. There was plenty of fresh meat and vegetables available so residents receive a wholesome appealing and balanced diet. EVIDENCE: Residents were very positive about the activities provided in the home. They said there were plenty of things for them to do. Residents said that visitors are made welcome at the home. One resident said that she could suit herself at the home. She likes to get up early in a morning and felt that staff leaves it to individual on the time they would like to get up. She went on to say that the food is ‘magnificent’ home made, with plenty of fresh meat and vegetables. The inspector looked at food stocks. The fridges were stocked with plenty of fresh meat and fresh vegetables were available. Lunch on the day of the inspection looked appetising. All of the residents appeared to enjoy it. The owner of the home has purchased a mobile telephone for residents to use so that they can keep in touch with friends and family. Arrangements can be made for residents to have their own telephone in their rooms if they wish; however this would be at additional cost to the resident. Applecroft Residential Care Home DS0000045159.V256564.R01.S.doc Version 5.0 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 the following standard(s): 16 Information about the complaints process for the home is readily available so residents and their relatives know how to make complaints and who to make them to. EVIDENCE: Information about the complaints process is available in the home. Residents spoken with said that they had no complaints and that they would feel comfortable approaching the manager if they did have a complaint. Applecroft Residential Care Home DS0000045159.V256564.R01.S.doc Version 5.0 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 the following standard(s): 19,25 &26 Systems within the kitchen need to improve so that residents are not placed at risk. The temperature of the hot water supplied to baths and sinks was 50 degrees Celsius and so residents could be placed at risk of burning. Radiators are not covered so residents could be placed at risk. Although most of the home was clean and tidy the laundry area needs to be cleaned and tidied so that residents are not placed at risk of cross infection. EVIDENCE: The owner is in the process of refurbishing the home. Work continues on the middle floor. A resident has been accommodated on this floor even though the corridor is not finished, there is no carpet on the floor and workmen are still completing some of the rooms. Although a risk assessment had been done this information was not available in the care file for staff to use. The resident said she was happy to be accommodated on the floor, however she was due to leave the day after the inspection. The manager said that CRB disclosure had been requested for all of the workmen in the home. Applecroft Residential Care Home DS0000045159.V256564.R01.S.doc Version 5.0 Page 14 Residents said that their rooms are kept clean and tidy at all times. The laundry room door has a hole and must be replaced, as this is a fire risk. The laundry was considered to be untidy and in need of cleaning. There was dust on the shelves and at the back of the machines. Several mops of different colours were stored head down in the buckets. This is not acceptable as it could lead to cross infection. The washing machine does not have a sluicing facility to deal with soiled or infected linen. The medicine storage room contained several coats belonging to staff, this is a clinical area and should not be used for the storage of staff’s belongings. Systems within the kitchen need to improve. One of the freezers required defrosting. The fridge, which stocked the fresh meat, was stained at the bottom and required cleaning. The door to the kitchen and the serving hatch were wide open during the course of the inspection. This is an infection control hazard as food was cooking and doors should be kept shut to prevent flies etc. entering the kitchen. Several staff were seen walking in and out of the kitchen with blue aprons on. This should be limited to prevent cross infection. The bin lid in the kitchen was broken which could be an infection hazard as flies etc could access it. There were several gaps in the recording of Fridge/Freezer temperatures. The temperature of the hot water of a bath in an en-suite area was tested and found to be 50 degrees Celsius, which is in excess of the recommended temperature of 43 degrees Celsius. This was found at the previous two inspections and a requirement made to ensure that residents are not placed at risk. An immediate requirement was made on this inspection. Subsequent to the inspection the CSCI has received an action plan indicating that arrangements have been made to fit valves and this work should be completed by the end of November. In the interim period the registered person must do a robust risk assessment, identifying the action to be taken to make sure that people are not placed at unnecessary risk. This information must be available for staff. Radiators are not covered so there could be a risk of burning to residents. This was identified at the last two inspections. A risk assessment has been carried out, however this needs to be reviewed and added to, to make sure that there are adequate systems in place so that residents are not placed at risk. The Applecroft Residential Care Home DS0000045159.V256564.R01.S.doc Version 5.0 Page 15 owner should consider the provision of guards as a means of making sure that residents are not placed at risk. See Requirements 4,5,6,7 8 &9. See Recommendation 2 & 3. Applecroft Residential Care Home DS0000045159.V256564.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): 27,28 &29. There was enough staff on duty so that the needs of the residents could be met. All the necessary checks are now done so residents are in safe hands and not placed at risk. EVIDENCE: Residents were very positive about staff and said they felt there was enough staff on duty to meet their needs. The comment card received from a relative ticked ‘yes’ to the question ‘In your opinion are there always sufficient numbers of staff on duty’. Residents said that staff meet their needs at all times so they feel they are in safe hands. Two staff recruitment files were seen. These contained all the required checks to make sure that they are suitable for employment in care. Applecroft Residential Care Home DS0000045159.V256564.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): 31,35 & 38 Residents were happy with the management approach of the home so they can air their views when necessary to ensure the home is run in their best interests. Although risk assessments on the environment have been done, these are not sufficiently detailed to make sure that residents would not be placed at risk. The fire authority have identified concerns regarding fire safety and a number of requirements have been made so that the environment would be safe for residents in the event of a fire. EVIDENCE: The manager who has been on extended leave has recently returned on duty. Residents were positive about the manager and the owner of the home. The six resident comment cards all said that they feel well cared for. The question ‘do you wish to be more involved in decision making within the Applecroft Residential Care Home DS0000045159.V256564.R01.S.doc Version 5.0 Page 18 home?’ Three residents ticked ‘no, one ticked ‘yes’ and two ticked ‘sometimes’. At the last inspection a requirement was made that all staff be offered training on specific mental health issues relating to residents currently living at the home. The manager said that records of staff training were kept on individual personnel files. In the two files looked at there was no record that staff have attended any training on mental health issues. This is outstanding from the last inspection. A system is in place to ensure that residents’ money is kept safe and secure. Health and safety systems must be improved. Although there are risk assessments in place these are not sufficiently detailed and should contain the action to be taken by staff to minimise risk. An officer from Cheshire Fire Service visited the home and requirements were made as a result. The date for compliance with the requirements is 25th November 2005. The manager said that all staff have had fire training so will be aware of the action to take in the event of a fire. Products stored under Control of Substances Hazardous to Health were found in the laundry room, which was unlocked. This could be a risk to residents. Portable electrical appliance testing has been carried out so that the equipment used by the home is safe. See Requirements 10, 11 12 &13. Applecroft Residential Care Home DS0000045159.V256564.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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 2 x x x x x 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 x x 1 Applecroft Residential Care Home DS0000045159.V256564.R01.S.doc Version 5.0 Page 20 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 OP7 Regulation 15 Requirement Each resident must have a written plan of care in place, identifying how their needs in respect of their health and welfare are to be met. The assessment of residents needs must be carried out on admission to the home. This must be reviewed when the residents condition changes. The registered person must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered person must not accommodate residents in the upstairs rooms along the corridor where work is ongoing, until such time as the work is completed. The laundry door must be repaired in accordance with fire regulations or replaced The temperature of the hot water supplied to baths and sinks must be maintained around 43 degrees Celsius. DS0000045159.V256564.R01.S.doc Timescale for action 30/11/05 2 OP9 14 18/11/05 3 OP9 13 18/11/05 4 OP25 12 18/11/05 5 6 OP19 OP25 23 13 25/11/05 31/10/05 Applecroft Residential Care Home Version 5.0 Page 21 7 OP25 13 8 9 10 OP38OP26 OP26 OP30 13 13 18 11 OP38 13 12 OP38 23 13 OP38 13 The registered person must ensure that persons living at the home are not at risk of burning from the pipes and radiators Systems within the kitchen must be reviewed so that there is no risk of cross infection. The bin in the kitchen must be replaced. Arrangements must be made for all staff to attend training on mental health issues specific to residents currently living in the home. (Timescale 31/8/05 not met). Risk assessments must be available for staff to read so that they know what action to be taken to minimise those risks. The registered person must take adequate precautions against the risk of fire including complying with the requirements made by Cheshire Fire Authority. Products classified under COSHH regulations must be stored in a locked cupboard. 18/11/05 18/11/05 18/11/05 30/12/05 20/10/05 25/11/05 18/11/05 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 2 3 Refer to Standard OP10 OP26 OP25 Good Practice Recommendations The registered person should provide a curtain/blind for the window in the en-suite identified to staff during the inspection. Consideration should be given to the provision of a washing machine with a sluicing facility. The registered person should consider the provision of radiator guards to ensure the safety of residents. Applecroft Residential Care Home DS0000045159.V256564.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Applecroft Residential Care Home DS0000045159.V256564.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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