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Inspection on 01/06/06 for Applegarth Nursing Home

Also see our care home review for Applegarth Nursing Home for more information

This inspection was carried out on 1st June 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 found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a comfortable and homely environment for the people who live here. Staff were observed to interact well with the residents and spent time talking with them. There is a pleasant friendly atmosphere and a resident said that ` they are glad that they chose to live here` The residents` were seen to be treated with dignity and respect and as individuals by the staff and the residents` benefit from a very stable staff group. Activities are worked with a weeks programme either on a group basis or an individuals needs, so that all the residents have the opportunity to benefit whatever there abilities or needs.

What has improved since the last inspection?

The dark stained wood in some of the corridors has been removed and they are much lighter and brighter and well decorated. They have purchased new furniture for the bedrooms and all the lounges this will improve the environment. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 6Health and Safety has improved with locks being put on the laundry and hazard substances stored out of the residents way. Staff professional practices have improved to prevent cross infection within the home. Staff have been given specific information to enable them to provide appropriate care for residents with special care needs. This information is kept to hand in the residents care plan for the staff to use as reference.

What the care home could do better:

The home must only admit residents within its` registration categories, or apply for variations prior to the residents` admission. Residents who are receiving nutrition via a PEG tube must have a written regime from the Dietician or Doctor, for staff to follow documented within the care plan. Residents` medication must be given as prescribed and monitored within the care plan. There should also be a documented audit of all medications on a regular basis. The home must have water from the storage tanks within the home tested for Legionella on a regular basis. Although staff supervision has been commenced the documentation of these sessions must be more in depth.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Applegarth Nursing Home 243 Newtown Road Carlisle Cumbria CA2 7LT Lead Inspector Colette Hibbert Unannounced Inspection 10:00 1st June 2006 Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 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 Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 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 and Care Homes for Adults 18 – 65*. 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 Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Applegarth Nursing Home Address 243 Newtown Road Carlisle Cumbria CA2 7LT 01228 810103 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) Mrs Julie Robb Mrs Caroline Mary Whitehead Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36), Physical disability (36) of places Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 36 service users to include: up to 36 service users in the category of OP (Old age, not falling within any other category) up to 36 service users in the category of PD (Physical disabilities under 65 years of age) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 5th December 2005 2. Date of last inspection Brief Description of the Service: Applegarth care home is registered to provide nursing care for service users who fall within the following categories: Old age, not falling within any other category (36), and Physical disability (36). The home is inspected against the National Minimum Standards for Younger Adults and the Older Adults Standards. Applegarth is an adapted Victorian house and this has meant that some of the environmental standards are not met. Accommodation is provided on two floors with access to the second floor of the home via a passenger lift or stairs. Parking is at the rear of the property and there is limited on street parking available. The bus route to and from Carlisle goes past the home. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place on 01/06/06 commencing at 10:00 and finished at 16:00. The registered manager was present throughout the day. Before the site visit information had been gathered on the service from the providers, and information on the service provided had been gathered from residents and their families using questionnaires. During the day the inspector looked around the home and spoke with residents and staff, and observed activities and looked at care plans. Policies and procedures, systems for recording complaints and personnel training records were looked at as well as other records required by regulation. What the service does well: What has improved since the last inspection? The dark stained wood in some of the corridors has been removed and they are much lighter and brighter and well decorated. They have purchased new furniture for the bedrooms and all the lounges this will improve the environment. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 6 Health and Safety has improved with locks being put on the laundry and hazard substances stored out of the residents way. Staff professional practices have improved to prevent cross infection within the home. Staff have been given specific information to enable them to provide appropriate care for residents with special care needs. This information is kept to hand in the residents care plan for the staff to use as reference. 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. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5 The quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Residents have information prior to admission and a care needs assessment to ensure their needs can be met. The manager must not admit residents out of the homes registered categories EVIDENCE: Prospective residents have information prior to admission. The home has a statement of purpose and service user guide, and residents spoken with said that they had been given a copy prior to admission. The manager visits residents before they are admitted to the home to assess their individual needs. One resident said they felt reassured by this and knew that ‘the home was keen to make sure that they could provide the right care’ Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 9 Several of the residents spoken with said that they had visited the home before moving in and had visited other home before they made their ‘choice’. The inspector noticed the home had admitted a resident outside of registered category and discussed this with the manager. It was agreed that the home would apply for a variation to registration and submit an action plan as to how the home will provide for this persons care needs. The manager said the home had an open visiting policy so that prospective residents and their families could see the home in the ‘course of a normal day’ Each resident had an individual contract and the home has a copy on file. This states the terms and conditions of the home in full. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14, and 33 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8, and 9 The quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Each resident has an individual care plan which is regularly review to ensure staff have accurate information about the residents in their care. Residents are able to make choices about their life and are encouraged to lead a full and varied lifestyle were ever possible. EVIDENCE: Residents are aware that they have an individual care plan, and they are allowed access to this if they wish. One resident said that they had asked to look at the care plan and the staff had left it with them to look through. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 11 The residents are given the opportunity to make choices in their lives, they can decide when they want to get up, when they go to bed, what they want to wear and where they would like to sit in the communal areas. They are asked each day what they want to eat, one resident said they ‘are asked each day but by the time it gets to meal time they have forgotten what they ordered but it is still nice to be asked’ Residents are consulted on the day–to-day running of the home, they had all just been involved in a meeting about a new menu. They also have a say in what activities are provided. The residents that are able are support by their families and the staff to lead a full and active life and are encouraged to get out and about within the local community. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,and 17 The quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. A programme of activities is provided that takes into account residents preferences and suggestions. Residents rights are respected and privacy and dignity is upheld. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 13 The home offered a varied menu and choice of food and catered for special dietary needs. EVIDENCE: Residents have the opportunity of personal development if they wish. One resident liked to draw and do artwork. Their room had been designed to accommodate this with an area set aside for their equipment and an accessible table area for them to work at. The home had framed some of this work and it could be seen throughout the home. One resident liked to go out for a meal and went regularly with family and staff, another said that they liked to go to town and this was programmed into the activities plan. Residents spoken with said that family and friends are always made welcome, and can visit at any time. Residents are able to access the local taxi’s as at present the home does not have its own transport. Staff were seen to treat the residents with respect and dignity and they handled difficult situations in a calm and compassionate manner. All the residents spoken with said that they enjoyed the food, the menu was varied and they had the option of a full cooked breakfast each morning. The menu had just been reviewed and more fish dishes added at the residents’ request. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 The quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Residents privacy was upheld and they were given personal support as they prefered. Some poor practices were identified in the adminstration of medication as residents did not receive medication as prescribed. EVIDENCE: Residents care needs are documented within the care plan. This was found to be accurate and up to date. One resident described their usual morning routine, which corresponded with the entries within the care plan. The care plans are reviewed monthly but the manager is looking to improve the system they are using at present. Emotional needs are supported with guidelines for staff to follow in individual care plans. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 15 At present no residents retain their own medication they are happy for the staff to deliver this service, the manager said that it would be accommodated should a resident require it. Medications were checked and signatures were observed on the MAR chart. It was noted that one resident was not receiving medication as prescribed and the manager said that she would investigate this. Another residents medication had been altered by the GP but the charts or the medication packets did not reflect the change. The manager does audit medication but at present no documentation is kept of this. A requirement has been made to improve this practice. Some residents had PEG tubes feeds and there was no documentation for the prescribed regime and dose to be given. The manager said she would contact the dietician for this and store the instructions within the care plan for staff to follow. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The home has a satisfactory complaint procedure and recording system in place and residents were confident that any concerns would be dealt with in a an appropriate manner. Adult protection procedures were in place and training provided on this to staff to promote residents safety and well being. EVIDENCE: The home has had one complaint since the last inspection and documentation was in place to cover this. This was discussed with the manager, and documentation provided indicated that appropriate action had been taken. Residents spoken with said that they would take any concerns to the manager and felt confident that she would deal with it in a confidencial way. Other residents said that the staff listened to them and any concerns would be taken seriously and discussed Staff spoken with said that they were aware of protection of vulnerable adults issues and would know what to do in such a situation. They had received training within the home. The home only keeps small amounts of residents own money and it is documented and receipts are kept. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The home is well maintained and bedrooms and social areas are decorated to provide a comfortable homely environment for the people who live there. The home is clean and hygienic and infection control procedures are in place to protect the residents from cross infection. EVIDENCE: Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 18 All the bedrooms are single and vary in size, they have all being individually decorated and are very personalised and homely. There are 4 lounges throughout the building, one of which is a designated smoking area. They are all well decorated and bright the residents said that they can choose which room they sit in. The home does not have a formal dinning area as the residents have there meals in their rooms or in one of the lounges. The home was clean, pleasant and hygienic, and infection control and health and safety practices have been improved. Two requirement were made at the last inspection and these have been met The home is at present undertaking a major refurbishment programme with new lounge and bedroom furniture on order. One residents said that they were looking forward to the ‘new look’ The corridors are in the process of being redecorated and they are being made a lot lighter and brighter and is a big improvement to the environment. Residents are protected by health and safety procedures in place whilst work is in progress. There is a garden to the rear with a shaded patio area for the residents to sit out. There is a small tidy garden area with well established plants. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34, 35,and 36 The quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The number and skill mix of care staff on the duty rota are adequate to meet the resident’s personal and nursing needs. Procedures for recruitment are satisfactory offering protection to people living in the home and staff training and supervision is being given to meet residents needs. EVIDENCE: During the morning shift there are two RGN and nine care assistants with an addition two careres for designated residents. In the afternoon there are two RGN and four care assistants and again two carers for designated residents. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 20 At night there is one RGN and two care assistants and one additional carer for a designated resident. There is additional part time activities co-ordinator, two kitchen staff per day,one laundry assistant and two domestic staff daily. Staffing levels are adequate for the number of residents in the home. Residents said that they did not have to wait long for assistance. During the inspection the staff delivered care in a calm and peaceful manner. Staff are recruited according to the policy and all relavent checks are undertaken. CRB and POVA documentation will be seen at next visit as they are not stored on site. Staff have training to improve their role, they have Link nurses for continence, tissue viability, palliative care , dementia, who liase with health authority specialist they also utilise the CHESS team. Staff training records indicate that appropriate training was being provided and induction training. Staff spoken with did not raise any concerns about their work or access to training , they said they felt supported. A requirement was made at the last inspection for staff to receive supervision. This had been commenced and is evident from discussion with staff and the staff files. The documentation needs to be improved and this was discussed with the manager , as a means of providing staff with guidence to improve their role. Care assistants are encouraged to undertake NVQ training to level II and III. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,and 42 The quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The manager has a good understanding of the day to day running of the home and the individual needs of the residents and provides a safe and consistent service. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 22 The home reviews aspects of its performance through self –review, audits and seeks the views of the residents, staff and relatives to affect the way in which the home is run EVIDENCE: The manager provides leadership and direction to the day to day running of the home. She is supernumary Monday to Friday but does cover other hours as required. There are recorded staff meetings and resident/ family meetings in the home to allow the sharing of opinions and ideas. The home carrires out a yearly audit each summer and the results and findings are collated and published The home is run to the benefit of the residents and the varied and complex needs of these residents are taken into account. A Health and Safety requirement made at the last inspection has been met, but the home must look to appropriate testing and cleaning of the water tanks for Legioella to reduce the risk to the residents. However water temperature valves are tested to prevent scalding of residents and records show that servicing and maintenance of equipment is being done. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 3 2 2 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 3 40 X 41 X 42 2 43 X 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Applegarth Nursing Home Score 3 3 2 X DS0000010110.V292609.R01.S.doc Version 5.1 Page 24 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 3 4 6 Standard YA2 YA17 YA20 YA20 YA42 Regulation 14 16 13 13 12 Requirement The manager must not admit residents outside of the homes registration categories. PEG feed regimes must be documented within the care plan Medications must be given as prescribed. A regular documented audit must be done of medications retained within the home. Water tanks must be tested on a regular basis for Legionella Timescale for action 17/06/06 17/06/06 17/06/06 17/06/06 30/11/06 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 YA36 Good Practice Recommendations Staff supervision must be fully documented and signed. Applegarth Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 Nursing Home DS0000010110.V292609.R01.S.doc Version 5.1 Page 26 - 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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