Inspection on 12/07/07 for Applegarth Nursing Home

This inspection was carried out on 12th July 2007.

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 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 Nursing Home 01/06/06

Applegarth Nursing Home 05/12/05

Applegarth Nursing Home 05/07/05

Applegarth Nursing Home 04/01/05

Applegarth Nursing Home 04/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Clover House

Langrigg House

Parkside

Dystlegh Grange

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Applegarth Nursing Home 243 Newtown Road Carlisle Cumbria CA2 7LT Lead Inspector Marian Whittam Unannounced Inspection 12th July 2007 10:30 X10029.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 Nursing Home DS0000010110.V340468.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 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.V340468.R01.S.doc Version 5.2 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 Learning disability (1), Old age, not falling registration, with number within any other category (36), Physical of places disability (36) Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 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) 1 named service user in the category of LD (Learning disabilities under 65 years of age) may be accommodated within the overall number of registered places. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 1st June 2006 2. Date of last inspection Brief Description of the Service: Applegarth care home is registered to provide nursing care for up to 36 older people and up to the same number who may have physical disabilities. Applegarth is an adapted Victorian house in a residential area of Carlisle. The home is on a main road with easy transport links to the town and local amenities and the bus route into Carlisle goes past the home. 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 is currently unavailable as a large extension is being built at the rear of the existing home. Some information is available on request from the manager in a combined statement of purpose and service user guide but this is not on display. The fees charged by the service ranges from £483.00 to £951.00 and this does not include personal toiletries, personal newspapers, and magazines, trips out and hairdressing. Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place over two days beginning on 12/07/07 at 10:30 and was completed on 16/07/07. The registered manager was present throughout the second visit to provide records and information needed. The home was inspected against the National Minimum Standards for Older Adults as the majority of people living in the home at present are over the age of 65. The two inspectors undertaking the visit looked around the home during the two visits and spoke with the manager, people living there, visiting relatives, professionals and with staff members, both nursing and care staff, including the cook and laundry staff. Staff recruitment records, complaint investigation records, training records and care plans were examined and a selection of other records required by regulation. Time was spent in communal areas observing staff and residents activities and interactions during the day. The pharmacist inspector assessed the handling of medicines during the visit on 12/07/07 through inspection of relevant documents, storage and meeting with the nursing staff and residents. The pharmacy inspection took four and a half hours. Before the visit information was also gathered on the service from records of previous visits, notifications and other regulatory activities including concerns and complaints raised with CSCI by people coming into contact with the service. Questionnaires from people and other agencies, provided by CSCI, were returned before the inspection took place. What the service does well: What has improved since the last inspection? Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 6 A large extension is being built onto the existing home and when this is completed it should offer not just improved bedroom and communal facilities for those using it but more suitable laundry and storage facilities too. Redecoration of some areas has made the home seem light and bright improving some of the more cramped areas in corridors. There has been improvement in aspects of decoration as part of the on going programme, some new carpets have been fitted and some living room and bedroom furniture and some redecoration. Damaged woodwork and doors has been improved to enhance the environment of those living there. Training provision continues to be developed and promoted and the manager and senior staff attend relevant training to enable them to give training and support to other staff. Safeguarding adults training is being provided now for all staff. The manager is presently implementing changes to the assessment and care planning as part of a structured pilot. This change can only improve records and care in the long term, when the changes are fully evaluated and developed. What they could do better: The combined statement of purpose is not on display in the home. These are under review but whilst this is going on the manager still needs to make sure that relevant information is easily available. When this review is done the manager should make sure all information required by the regulations is included and is available in formats to suit different capabilities. A copy of the last inspection report should also be included to help people make an informed choice about living there. Copies of pre admission assessments show only basic information on personal and social needs and background to form the basis of the care plan. The information taken and process does not focus on the person as an individual as they come into the home. Consideration should be given to making it clear within personal plans how people are being actively involved in creating and developing their own care plans on how they want to be helped and cared for. Activities need to be improved to cater for all the people living in the home whatever their capabilities. Clearer and more detailed information on individual’s social, cultural and recreational expectations is needed in planning them and information easily available on what is going on. Information on how to contact advocates (external agents) needs to be made accessible. Similarly the complaints procedure should be more easily available within the home and available in different formats to suit different capabilities. The manager and nursing staff must make sure that resident’s medicines are never allowed to run out so they always receive the treatment they need to keep them well. The staff must also make sure they know what medicines are for and that they give them to residents safely. Some improvement in the handling of medicines is needed to protect the people who live there and to keep them healthy. Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 7 The home is not purpose built so staff have to work around some environmental limitations on space and storage. Bedrooms are personal areas and should not be used by staff for doing ironing. Also if good hygiene is to be maintained the sluicing disinfector must be maintained in working order so it can be used to disinfect reusable items and help protect residents from the risk of cross infection. It was observed that disinfecting and cleansing substances, including bleach, were left out in bathrooms and the sluice. The lock did not work on the sluice so they could not be locked away safely. Also toiletries, sprays and nail brushes were left out in communal bathrooms. If they are people’s own property they should be returned to their rooms after use and not shared. The nurse in charge attended to this and on the second visit these substances had been put away. Staff levels drop noticeably for the afternoon period from the ratio of staff in the morning. Rotas and observation indicates that in the afternoon there are sufficient care and supervisory staff to meet only resident’s physical needs. There are systems in place to safeguard resident’s financial interests. However the recording of the monies spent, receipts obtained and signatures of those checking out the money needs to be improved to make the system more robust to protect residents and staff. There are effective monitoring systems in place and the information provided by the manager about the homes systems and evidence seen during the visit indicate that the manager has a clear focus on what needs to change and improve to take the service forward. 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. The summary of this inspection report can be made available in other formats on request. Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): NMS OP 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People coming to live at the home have information prior to admission and a basic care needs assessment to ensure their needs are known and can be met. EVIDENCE: The home has developed a statement of purpose and combined service user guide that can be provided to anyone thinking of using the service. It was not on display in the home on the day of the visit. The manager confirmed that the documents are currently being reviewed so it can be updated in readiness for the new extension to the home. However whilst this is going on the manager still needs to make sure that the current information in is easily available and Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 10 accessible within the home for anyone that wants it. When this review is done the manager should make sure all information required by the regulations is included and is available in formats to suit different capabilities. A copy of the last inspection report should also be included and easily available to help people make an informed choice about living there. Residents have welcome information leaflets provided in their rooms and these have some useful information for people including information on meal times. The manager visits residents before they are admitted to the home to assess their individual needs. Copies of care management plans developed by social services have been obtained where appropriate. Copies of pre admission assessments examined showed only basic information on personal and social needs and background to form the basis of the care plan. This information is only adequate and lacks detail. The information taken and process followed is not focused on the individual. There is no evidence of the admission process considering the individual concerns and anxieties of new residents and families as they come into the home. The manager is looking at reviewing and revising the assessment tools in use. When implemented this will promote good practice and make the admission process more person focused to reflect the complexity of different needs. Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): NMS OP 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are attended to but resident’s health and welfare are at risk when medicines kept on their behalf are not well handled. EVIDENCE: Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 12 All people living in the home have an individual plan of care stating the actions to be taken by staff in respect of people’s needs and assessments of risk. People who use the service are able to get access to health care services through their GP or by referral to specialist nursing services. The speech and language therapist was visiting the home during the visit to see some residents. Nursing problems and assessments in the care plans are being reviewed but some plans did not always reflect the information shown on the daily records. For example a wound plan for one person where details in daily records did not match the plan or have records of evaluation of the wound and progress. Some care plans do not state exactly what personal care has been given to a person each day and the monitoring of weights and psychological needs is not clear for prompt action if needed. There is no evidence in the plan of how residents or their representatives, if appropriate, are being actively involved in drawing up their plans to reflect their individual needs, preferences and goals. Consequently care plans do not have much information on social and individual preferences and life histories to illustrate the whole person and their goals. However people spoken with said they were happy with their care and spoke well of the staff. The manager is aware that care plans need to be more detailed and person centred and has plans to improve it. A pilot of a new system is to be discussed at the next staff meeting. Records for receipt, administration and disposal of medicines are mostly good. However, sometimes medicines run out so residents do not have the treatment they need and this could affect their health. The home has experienced, in at least one case, problems in relation to a prescription that may affect the supply of a medicine. The manager is aware of the issue in this case and has been working to find a solution to improve this for individuals and should continue to do so to promote their best interests. Where a resident’s medication needs to be omitted following a change in the individual their doctors must be informed in case further investigation or monitoring is needed. Instructions from doctors on administering some medication were not always being followed. Some staff were unaware what medicines were for or that they had to be given at certain times to be effective. Residents are able to look after and take their own medicines if they want and this helps them to remain independent in the task. The service involved the community pharmacist to make sure this was safe. Medication is sometimes crushed before being given through a tube into the stomach for one resident. Records did not show how this was done or if proper checks were in place to make sure this was safe. During the visit staff were observed to be polite, to knock on residents doors and approach them in an informal and friendly manner. Staff were observed Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 13 to assist and speak with people in a calm manner and for the most part engaged well with the residents as far as possible. Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS OP 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are limited organised leisure activities in the home and a lack of information on people’s social expectations and capabilities limits their opportunity for meaningful recreation. EVIDENCE: Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 15 Residents have the opportunity to follow their own interests where they are able and if they want to and can see their visitors when they want to. Visitors confirmed they were able to visit in the communal areas or in bedrooms and there are no restrictions on visiting. One resident liked to draw and do artwork and had all their materials in their room to do this. One person was playing dominoes in their room with their visitor. There are links with local churches for religious services and support and people’s own clergy visit. There is no information obviously available or on display on external advocacy and support services who can act in resident’s interests if needed. There is little information in care plans on individual recreational interests developed with individuals. Care plans should have detailed information on individuals social, cultural and recreational needs and develop staff should develop resident’s personal profiles and recreational plans with them. This would provide information that reflects individual’s own choices and feelings on what they want and can do. An activities programme is on display in the foyer but observation on the day, care plans and speaking with staff and residents indicated that this was out of date and not followed. Staff said that one of the carers takes responsibility for coordinating and developing activities both group and one to one but they were not in the home during the visit. Information on activities and advocacy should be available to people in formats that suit their capabilities. There is no provision for separate dining rooms, which means that residents eat in the lounges or their rooms. Several people require help with their meals and it was observed that the staff did assist in a calm manner and for the most part engaged with the residents as far as possible when assisting with meals. The cook described the menu in use and how people were asked what they wanted from the menu the day before so alternatives could be provided. People spoken with expressed overall satisfaction with the standard of catering and choice. Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS OP16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service has complaint and adult protection procedures in place to protect people using the service. EVIDENCE: The service has a complaints procedure but this is not on display within the home for easy reference or available in different formats to suit different capabilities. A summary of the procedure is in the service user guide but that is not on display or easily available either. The home has a system it uses for recording complaints and none have been logged for investigation since the last inspection. The home has policies and procedures on safeguarding adults in place and these are in line with current multi agency guidelines. There is also information on ‘whistle blowing’. Staff training is now given on protecting vulnerable adults on a rolling programme and care staff also cover this area of practice doing their NVQ Level 2 courses. Staff confirm that they receive Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 17 training in the procedures to follow if they are concerned about a resident’s safety or welfare. The manager and a member of the nursing staff have recently attended a training course on restraint and can pass this training onto staff in the home as well. Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS OP 19, 20, 21, 22, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean and provides a homely environment for the people who live there but disinfection equipment is not being maintained to protect the residents from possible infection. EVIDENCE: Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 19 The home is not purpose built but has been adapted for its present use, cosequently there are some environmental limitations. There are no separate dining rooms for residents to use and there are limited storage areas for equipment used in the home. The corridors on the upper floor are narrow in places so grip rails are not feasible. Equipment was being stored in bathrooms and bedrooms and staff confirm that storage is an ongoing problem. The new extension being built, will make better provision for storage. In the long term there are plans to further upgrade the existing building when the extension is complete. The home is well maintained decoratively by the maintenance staff and there are ongoing internal improvements to furnishings and bedrooms. However sluicing disinfection equipment needed to promote good infection control is not being kept in working order for use by staff. Given the nursing needs and frailty of some people living there and the use of urinals and comodes the disinfector should be in working order. This will promote good hygiene and reduce the risk of cross infection. In the absence of a working disinfector the manager must make sure a risk assessment is in place to try to minimise the risks of infection to people living in the home. The home has infection control and health and safety procedures and practices in place and staff are given training on infection control. All the bedrooms are currently single occupency and vary in size, they have all been individually decorated and are personalised and homely. They do not have en suite facilities at present, although there are adequate bathroom and toilet facilities for the people living there. The home was clean and there were no unpleasant odours noted during the visit. The long term development plan for the home is to upgrade bedrooms and include en suite facilities where possible as it is merged with the new building under construction. There are 4 lounges throughout the building, one of which is a designated as a smoking area. The manager has consulted the local authority on the new legislation on smoking. The lounges are attractively decorated and bright the residents said that they can choose which room they sit in. There were toiletries anti bacterial sprays and nail brushes left in the bathrooms. These items should not be left out when not in use. If they are people’s own toiletries they should be returned to their rooms after use and not shared as this may spread infection. The laundry facilities are small and cramped with the washing machines and drier but the new extension will have a new laundry to improve the facilities for residents. Most of the homes laundry goes out of the home for washing, except for personal and soiled items, and the manager recognised there is a problem with the present cramped laundry. The laundry assistant attends to this and ironing. There was insufficient room in the laundry for the assistant to iron items in there. The assistant said that they did the ironing in a bedroom during the day when the occupant was not in it. This is not satisfactory as resident’s room are their personal space and not for general use by staff. Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 20 Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS OP 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are safeguarded by effective recruitment procedures and consistent staff training although lowered staff numbers on some shifts may limit individual choice. EVIDENCE: Staffing levels are, overall, adequate for the lower number of residents presently in the home. The off duty records show that there are 2 registered nurses (RGN) on duty all day and 1 at night, with 6 to 7 carers on duty in the morning and 2 carers on duty in the afternoon. There are 2 carers providing individual support to 2 people who live in the home. The Primary Care Trust (PCT) finances the additional support for these individuals. The morning shift has good staff coverage and the skill mix remains satisfactory during the day but the staff numbers available for care drop noticeably for the afternoon Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 22 period from the ratio of staff enjoyed by residents in the morning. Staff rotas and direct observation indicates that in the afternoon there are sufficient care and supervisory staff to meet only resident’s physical needs. The manager and staff noted that many frail residents want to go to their rooms for a rest in the afternoon. Achieving this for people may occupy those staff for periods of time in addition there are some residents who are highly dependant. Staff may not be available for meeting other than physical needs and for supervising and interacting with other residents or supporting people in communal areas. The manager confirmed that should it be necessary the staff giving 1 to 1 support could assist and supervise the communal areas. That however may detract from their intended individual support role. On several occasions during the visits there were lounges that had no staff supervising, as the staff were busy elsewhere. Some frail and dependant residents using the lounges could not always easily access or use a call bell to get assistance. Resident’s choice in their daily lives may be affected by halving staffing in the afternoon. There may not always be staff available at all times to support individual needs, activities and improve outcomes in the quality of the daily lives of people living there in an individualised and person centred way. However those spoken to who live there and those visiting the home did not say personal needs were not being met by staff and one person commented that “staff are OK on the whole”. Training is being well supported, organised and budgeted for in the home and 90 of staff have done NVQ level 2 and some Level 3 and some staff have Learning and Disability Award Framework (LADF) accredited training. Records indicate that staff do ‘Skills for Care’ induction training and moving and handling training before they start work. Appraisals and supervision is taking place and re training and disciplinary actions are taken with staff to safeguard residents where needed. There is ongoing training and updates for mandatory and some optional topics. One member of staff doing NVQ level 3 wrote a guide to swallowing difficulties that was praised by the speech and language therapist visiting the home. Staff files were examined and confirmed the home has effective and robust recruitment procedures and follows good practice guidelines with regard to the recruitment of staff. Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks have been done for staff before starting work. Staff files were clear and up to date and had records of all necessary documentation and references taken up prior to starting work. Staff working in the home commented on the new practice, being introduced by the manager, of involving people living in the home in the recruitment and interview process. This level of resident involvement in the daily life and running of the home promotes recognition of the resident’s views and is an example of good practice. It recognises the need to try to involve people living there more in daily life. Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS OP 31, 32, 33, 35 and 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The management and administration of the home is open and there are quality monitoring systems in operation to promote and safeguard the best interests and welfare of people living there. Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager has a thorough understanding of the clinical and business aspects of running of the home. This includes a clear focus on the future development of the home and the need to make assessmnts and care planning more person centred as part of its development. The manager is well qualified and experienced in this area of care and maintains her professional development through relevant training. On the day of the first visit she was attending training on restraint to use in staff training. There are clear lines of accountability for staff within the home and staff spoken to are clear about their roles and responsibilities. Comments from staff suggest that morale is good in the team and they feel supported in their work. There are records of staff meetings and resident/ family meetings taking place in the home to allow the sharing of opinions and ideas. The minutes of resident’s meetings are provided to all residents and displayed in the foyer. The meetings are being used to keep people up to date with the progress of the new extension as well as every day items such as menus. There are procedures in place to carry out periodic audits of systems in the home and review procedures in use. This quality monitoring process is carried out by the provider to identify any areas that do not conform to their procedures so changes can be made if needed. The outcomes from last years quality audit is on display in the foyer. There are systems in place to safeguard resident’s finances and a spot check showed all balances held were correct. However the recording of the monies spent, receipts obtained for this and the details noted and signatures of those checking out the money needs to be reviewed to make the system more robust. For some small expenses such as “bets” and raffle tickets” there were no signed receipts and only one signature for the money taken. This does not offer consistent safeguards for the residents or the staff checking the money out. The other concern was the large amounts held for some residents but the manager said she was waiting for the social worker to collect the money and bank it. She said she would address this matter as quickly as possible. Records indicate that staff do receive the mandatory training required including fire training and moving and handling. There are servicing contracts in place for equipment and machinery and emergency equipment. The provider has a bacterial water analysis done annually to promote safety in this respect. During the tour of the premises it was observed that disinfecting substances including bleach were left out in bathrooms and the sluice. The nurse in charge was informed of this risk to residents and attended to it and on the second visit these had been put away. The lock did not work on the sluice so they could not be locked away safely when not in use. Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 25 Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 26 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 2 X 3 2 4 X 5 X 6 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 ENVIRONMENT Standard No Score 19 2 20 2 21 3 22 2 23 X 24 X 25 3 26 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 3 33 3 34 X 35 2 36 X 37 X 38 2 Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 27 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP9 OP9 Regulation 13 (2) 13 (2) Requirement Action must be taken to prevent medicines running out Administration of medication must be shown to be safe and in accordance with doctors instructions. Timescale for action 30/07/07 30/07/07 3. OP26 13 (3) The sluicing disinfector must be 10/09/07 in working order so good hygiene can be maintained for residents and the risk of infection in frail people is reduced. 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 OP1 OP7 Good Practice Recommendations The statement of purpose/service user guide should always be made easily available and accessible so people have information on the service if they want it. Consideration should be given to making it clear within personal plans how people living there are being actively involved in creating and developing their care plans and their personal perspectives on how they want to be helped DS0000010110.V340468.R01.S.doc Version 5.2 Page 28 Applegarth Nursing Home 3. OP8 4. OP8 5. 6. OP12 OP12 7. OP14 8. 9. 10. OP16 OP26 OP27 11. OP35 12. OP38 and cared for. The individual personal care stated in care plans should be recorded when it is carried out or the reason why it has not been done stated to make sure hygiene needs are not overlooked. Reviews of care and monitoring of weights and psychological needs should be made clear and easy to follow for prompt action if needed for resident’s health and welfare. Up to date information about activities and recreational opportunities should be made available to people using the service in formats suited to their capabilities. Care plans should have detailed information on individuals social, cultural and recreational needs, expectations and staff should develop their personal profiles and recreational plans with them. Information suited to different capabilities should be easily accessible to anyone using the service on how to contact advocates (external agents) who can act on their behalf and give support and information if needed. The complaints procedure should be easily available within the home and available in different formats to suit the capabilities of all people living in the home. Resident’s bedrooms are their personal areas and should not be used by staff for laundry tasks. The registered manager should demonstrate clearly how the ratio of staff to residents is adjusted according to need so that staff levels are always sufficient to consistently meet the varied needs of residents during different times of the day. The recording of resident’s monies when spent, the receipts obtained, the details noted and the need for 2 signatures when checking out the money needs to be followed consistently to make the system more robust. If any potentially harmful substances are to be kept in the sluice the door should be kept locked when the room is not being used. Applegarth Nursing Home DS0000010110.V340468.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V340468.R01.S.doc Version 5.2 Page 30 - 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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