Inspection on 08/08/06 for Applegarth Care Home

This inspection was carried out on 8th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Applegarth Care Home 30/07/08

Applegarth Care Home 02/11/05

Applegarth Care Home 10/06/05

Applegarth Care Home 21/06/04

Applegarth Care Home 04/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Applegarth Care Home 24 Huntercombe Lane North Maidenhead Berkshire SL6 0LG Lead Inspector Kerry Kingston Unannounced Inspection 8thAugust 2006 11.45 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 Applegarth Care Home DS0000057355.V302133.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. Applegarth Care Home DS0000057355.V302133.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Applegarth Care Home Address 24 Huntercombe Lane North Maidenhead Berkshire SL6 0LG 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) 01628 663287 01628 663987 Mr Harbhajan Surdhar Mrs Jennifer Margaret Shaw Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Applegarth Care Home DS0000057355.V302133.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd November 2005 Brief Description of the Service: Applegarth is a privately owned care home providing personal care and accommodation for up to fourteen service users over the age of sixty-five years, who have care needs associated with old age. It provides thirteen bedrooms on two floors, one of the rooms is a shared room, access to the second floor is via the stairs or a passenger lift. The home is situated in an urban location approximately five miles from Slough Town Centre and a few miles from Maidenhead. The fees are £385 - £450. Applegarth Care Home DS0000057355.V302133.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced site visit which took place between the hours of 11.45 am and 6.15 pm on the 8th August 2006, to collect additional information to inform the report for the key inspection. The Information was collected from a pre-inspection questionnaire, completed by the manager, C.S.C.I surveys sent to service users (seven of fourteen questionnaires were returned by service users, (some had been completed with the help of families), a discussion with two staff members, four service users, the manager, two family members and observations of service users and staff, A tour of the home, service user and other records were also used to collect information, on the day of the visit. What the service does well: What has improved since the last inspection? What they could do better: The proprietor could make sure that urgent repairs, replacements are done more quickly to minimise the inconvenience and distress to residents. The proprietor should formally visit the home and report on the visit, to ensure that the home is continuing to maintain the quality of care. The proprietor must supply proper records on all staff so that the manager is able to ensure that they are safe and suitable to work with the residents. Applegarth Care Home DS0000057355.V302133.R01.S.doc Version 5.2 Page 6 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. Applegarth Care Home DS0000057355.V302133.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 Applegarth Care Home DS0000057355.V302133.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): 3 The quality in this outcome area is good. The service users have their needs fully assessed and the home only offers care to those whose needs it is able to meet. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: Full assessments are completed for all service users prior to admission. A care plan is developed from the assessment which includes risk assessments and daily living plans, these are reviewed monthly and changes are made as staff get to know the service users needs, choices, likes and dislikes. The respite care service users discharge date and other specific needs were noted on his care plan. Six of the seven service user surveys returned noted that they had received enough information about the home, prior to admission. A relative advised that she was very happy with the care her relative has received and the staff can identify and meet her needs. Applegarth Care Home DS0000057355.V302133.R01.S.doc Version 5.2 Page 9 Applegarth Care Home DS0000057355.V302133.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 and 10. The quality in this outcome area is good. The home effectively, meets the health and personal care needs of service users in an open, positive and inclusive way. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: Care plans are completed to a good standard, they include daily living plans, risk assessments, likes and dislikes, decision making ability, waterlow assessments, weight charts (as necessary), health records and information to assist staff to deal with emotional and social needs of the service users. Health records clearly recorded referrals made to other health professionals, records of G.P visits, physiotherapy, C.P.Nurses visits, district nurse visits and any other visits to or by other professionals. Medication records were accurate and policies procedures adhered to. Senior staff give medication, they have been trained in this area and their Applegarth Care Home DS0000057355.V302133.R01.S.doc Version 5.2 Page 11 competence assessed by the manager. The names of those, competent to administer medication are noted on the medication file. Some service users are able to manage (with assistance) their own creams, this is encouraged and noted on the medication administration records. Three service users and two relatives spoken to said that they received good care, staff are helpful and respectful. All surveys noted that service users felt they are usually or always treated well and with respect. There was evidence that service users complain if they do not feel staff have behaved appropriately towards them. The manager deals with these concerns or complaints quickly and positively. Staff were able to describe very clearly how they upheld service users privacy and offered them respect and dignity. Applegarth Care Home DS0000057355.V302133.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 and 15 The quality in this outcome area is good. The home offers a positive and enjoyable lifestyle to the service users. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: The home holds residents meetings, service users are very participative, action plans are written and the manager takes any issues, raised in the meeting, forward, if she is able to. Care plans note service users choices for example there is a note of an individuals specific vulnerability to having her choices/decisions made for her by others and some instruction on how to make sure she is able to make as many choices as possible for herself. There are also some signed statements from individual service users, such as ‘I wish to opt out of activities.’ Activities plans are in place for the home but these change according to circumstance. Care plans include a list of activities individuals like and wish to participate in. A record is kept of all those who participate in activities and those who don’t. A family member felt that activities could be better, or possibly staff could be more skilled at motivating some service users. One staff member felt that service users would benefit from more activities in the community and/or Applegarth Care Home DS0000057355.V302133.R01.S.doc Version 5.2 Page 13 outside people coming into the home (especially those who did not go out with relatives.) Three service users spoken to felt that there were enough activities, they had plenty to do and that they weren’t bored. On the day of the visit a quiz had been organised in the morning. Lunchtime was sociable and pleasant staff observed service users, unobtrusively and offered help when needed, sensitively and respectfully. A singer was in the home in the afternoon, followed by a buffet tea, with ‘drinks’ for those who wanted it (sherry ands beer). Service users were seen to be communicative with staff, each other and visitors, stimulated and interested in what was going on in the home. The buffet tea was varied and nutritious and a relative participated in the evening meal. Service users were seen to very much enjoy this meal. Service users were seen being given choices about where to eat, what to eat, being asked what they would like to do and where they would like to be. Service users and staff were communicating and interacting very positively throughout the visit. Some staff were seen displaying great skill and sensitivity when dealing with the service users. Service users said that the food was wonderful, they could always have a choice, and that they had no complaints. A staff member felt that food budgets were small so that service users could not always be offered as good quality of food as they should be i.e. ‘value brands’ were generally used. The food budget is approx. £120 per week, the cook has great skill in creating wholesome, appetising food, and managing to offer choices on a very limited budget. Applegarth Care Home DS0000057355.V302133.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 and 18 The quality in this outcome area is excellent. The home listens to any concerns or complaints and acts properly to address them, it protects Service Users from all forms of abuse. This judgement has been made using available information, including a visit to the service. EVIDENCE: The complaints book noted complaints made by service users about issues such as daily living e.g. tea being served late, maintenance e.g. no hot water and concerns about the way staff dealt with or spoke to service users. All complaints are taken seriously, carefully recorded and appropriate action is taken. The action and timing of the response are also fully recorded, as is whether the complainant is happy with the outcome. The procedure is very open, transparent and effective. All surveys noted that service users knew how to make complaints and three service users spoken to confirmed that they knew who to talk to and were comfortable to complain about any problems they may have. A relative said that she was confident that the manager would listen and act on any of her concerns or be clear that she could not effect the change requested. All staff have received Vulnerable Adults training and are able to clearly describe how they would deal with a vulnerable adults issue. All Vulnerable Adults policies and procedures are in place. Applegarth Care Home DS0000057355.V302133.R01.S.doc Version 5.2 Page 15 The manager has been involved in dealing with a financial issue and has, appropriately, referred her concerns to the local Vulnerable Adults coordinator. Service Users said they felt safe in the home, they were observed to be comfortable and communicative with all the staff who were on duty on the day of the visit. Applegarth Care Home DS0000057355.V302133.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): 19,21,24 and 26. The quality in this outcome area is good. The home is, generally, safe and well maintained but there is currently a maintenance issue with one of the boilers, which is causing distress to some service users. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: The home is clean and well maintained, the kitchen has been fully renovated (work completed July 06) and a dishwasher has been installed. Communal areas are comfortable and the bedrooms seen (six) were personalised and well kept. The home has a budgie. The garden was neat and tidy, the manager advised that it is generally well used by service users but not in the very hot weather. One service user said the garden ‘was a disgrace’ but the inspector did not find it so on the day of the visit. Several complaints noted that some service users do not have, independent, access to hot water. The boiler was condemned after a safety Applegarth Care Home DS0000057355.V302133.R01.S.doc Version 5.2 Page 17 check on June 23 06 and no repairs have been effected, as yet. Some Service users bedroom sinks therefore, do not have a supply of hot water. Staff try to ensure that service users are able to wash, in private, by supplying buckets/bowls of hot water but the service users affected are not happy with this arrangement. Complaints have been made to proprietor via the manager, a resolution to this situation is said to be imminent by the proprietor. Applegarth Care Home DS0000057355.V302133.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 and 30 The quality in this outcome area is adequate. The service users needs are met by a competent and properly trained staff team, however the recruitment process does not always ensure that the manager can evidence the safety and competence of newly recruited staff. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: There are a minimum of two staff per waking shift but there are always three rota’ d to be on duty. The manager covers shifts in emergency, the home does not use agency staff. Rotas seen evidenced that generally there are three care staff per shift, the manager on weekdays and a cook and domestic everyday. Staff are offered professional and vocational training, this was confirmed by two staff members spoken to. Ten staff have N.V.Q. 2 or above and another three are starting on the next course in August 06 (there are fourteen care staff) A training schedule for the home and individual training plans are in place. One staff member said that a training audit had recently been completed to help the home identify what further training was needed. The two newest staff’s recruitment records showed that not all the necessary information was available in the home and the manager confirmed that she had not had sight of it. Any recruitment that the manager had been involved in had all the necessary paperwork on file, the information lacking was for those staff that the proprietor had recruited to other homes that he owns. The manager had not seen references or application forms for these staff. Applegarth Care Home DS0000057355.V302133.R01.S.doc Version 5.2 Page 19 There is only one staff on duty during the nigh time hours 9pm – 8am the inspector commented that this seemed low staffing levels. The night staff complete a night log, which appeared to show that one staff member is adequate, at this time. It would be good practice to ensure this level of staffing is reviewed with any change of service users or the changing needs of the existing ones. Staff spoken to said that they felt there are enough staff to meet the needs of the current service users, service users felt that staff were busy but were usually available when needed Applegarth Care Home DS0000057355.V302133.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): 31,33,35,36 and 38 The quality in this outcome area is good. The home is well managed, run in the best interests of the service users and the health, safety and welfare of service users and staff is protected. This judgement has been made, using available evidence, including a visit to the service. EVIDENCE: The home does not keep any service users monies. Eleven service users finances are dealt with by their families, one has her finances administered by a local authority and one service user deals with all her own money. One service user has been referred through the Local Authority’s Vulnerable Adults co-ordinator because of concerns about financial issues. All health and safety checks are up-to-date (the boiler condemned in June 06, has not yet been replaced). All staff have the mandatory Health and Safety training and up-dates as necessary. The environmental health officer visited in October 05 and made several recommendations with regard to kitchen refurbishment, the provision of a Applegarth Care Home DS0000057355.V302133.R01.S.doc Version 5.2 Page 21 dishwasher and insect screening, all recommendations have been complied with. The kitchen was seen to be extremely clean and appeared hygienic, there was efficient food storage, fridges and freezers being in good order. Accidents and incidents are monitored regularly and the manager takes any action deemed necessary immediately e.g. referral to an Occupational Therapist or G.P. as seems appropriate. Staff spoken to were very positive about the management of the home and the support they receive from the manager. All supervision is done by manager, this is currently approximately four times per year, the manager was advised that it should be done a minimum of six times per year. The manager stated she’s in the process of developing the senior team so that she is able to delegate some tasks, to ensure she has time to complete all the management tasks and duties more efficiently. Applegarth Care Home DS0000057355.V302133.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 N/A 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 4 17 X 18 3 3 X 2 X X 3 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 2 X 3 Applegarth Care Home DS0000057355.V302133.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NONE 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 OP21 OP29 Regulation 23.2 (j) 17.2 Requirement Timescale for action 19/09/06 3 OP33 26.4 To ensure that all service users are able to have a supply of hot water in their wash hand basins. To ensure that all the necessary 29/08/06 staff information is kept in the home as specified in schedule 4 (6). The provider must visit the home 01/10/06 and write a report of his findings in accordance with this regulation. 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 Refer to Standard OP33 OP36 Good Practice Recommendations To produce an annual development plan for the home. To ensure staff are supervised a minimum of six times per year. Applegarth Care Home DS0000057355.V302133.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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 Applegarth Care Home DS0000057355.V302133.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. 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