Inspection on 05/12/05 for Applegarth Nursing Home

This inspection was carried out on 5th December 2005.

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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Applegarth Nursing Home 12/07/07

Applegarth Nursing Home 01/06/06

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 ADULTS 18-65 Applegarth Nursing Home 243 Newtown Road Carlisle Cumbria CA2 7LT Lead Inspector Colette Hibbert Unannounced Inspection 5th December 2005 09:00 Applegarth Nursing Home DS0000010110.V272476.R01.S.doc Version 5.0 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.V272476.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V272476.R01.S.doc Version 5.0 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.V272476.R01.S.doc Version 5.0 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 July 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.Applegarth is an adapted Victorian house and this has meant that some of the environmental standards are not met.Accomodation 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.V272476.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced commencing at 09:00 and finishing at 15:15. The Registered Manager and staff assisted through out the day. Time was spent touring the home, talking to residents and to staff on duty. The inspector also spoke with relatives and visitors and the hairdresser who visits weekly. There were 34 residents in the home on the day of the inspection. Residents care plans and staff files were looked at. What the service does well: What has improved since the last inspection? The home has made sure that all information relating to residents is kept secure and confidential and has improved its storage system. The residents care plans have been updated and risk assessments reflect the residents care choices and the care that is being delivered. Applegarth Nursing Home DS0000010110.V272476.R01.S.doc Version 5.0 Page 6 Meal times are very personal with residents offered choices, food is well presented and appetising and there is plenty of staff to provide assistance for those who need it. 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.V272476.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Applegarth Nursing Home DS0000010110.V272476.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 Residents were given adequate information about the home prior to admission. Residents had full assessments prior to admission to ensure their needs could be met. Written contract explained the terms and conditions to the resident within the care notes, which gave residents a clear picture of what was included in their package of care. EVIDENCE: Residents and their families confirmed that they had looked around the home prior to admission. The Manager said that families were welcome anytime to look around and that they preferred it if appointments were not made for this so that they could see the home functioning during a normal working day. Prior to admission either the Manager or the Sister from the home visit prospective residents and a full assessment is carried out. This includes health care needs and personal needs as well as any future development and aims for the resident. All information gathered is written in the care plan. Written contracts and statement of terms were developed and included in the on going care planning for each resident. Applegarth Nursing Home DS0000010110.V272476.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8, and 10 Residents’ were consulted and participated in all aspects of the home life they wished to be involved with. Residents care plans were stored securely and they felt that confidential information was private. EVIDENCE: The residents were well supported by the staff to make their own choices and to participate in the various activities in the home. Personal preferences were documented within the care plans such as if the resident wanted to get up before or after breakfast, and what activities they wish to join in with. Care plans were stored within a nurses station, which had recently had a key code lock fitted to ensure confidentiality. This was a requirement from the last inspection and has been met. A relative said that she had frequently discussed her mother with the staff and it was always in private and the staff treated any issues she talked about confidentially. A resident told me that she could talk to any of the staff in private at any time and felt that they would keep her information confidential from other residents. Applegarth Nursing Home DS0000010110.V272476.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 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 and 17. Some residents within the home are able to take up opportunities for personal development, others are restricted by there care needs. Social activities are limited, but the local community is encouraged to visit the home to provide stimulation and contacts for the residents. Meals were presented well and a choice offered enabling the residents to have a healthy well balanced diet. EVIDENCE: Many of the residents within the home had complex care needs and were unable to take a full part in social activities, but staff said that they did benefit from visitors from the local community and the in house activities such as quizzes and bingo. The homes mini bus had broken and several of the residents said that they were missing the rides out. There was an activity organiser within the home for 21 hours per week. On the morning of the inspection she had taken a resident to a hospital appointment and often did 1 to 1 outings with the more able residents. The home encouraged family involvement, which the residents liked. One visitor came in everyday to help her mother with her lunch and said she was pleased to be allowed to do this. Residents were asked the day before to choose there meals and they were well presented and appropriate to the residents’ dietary needs. Applegarth Nursing Home DS0000010110.V272476.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. 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. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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 and 21 The staff were knowledgeable about most individual residents needs and preferences, but would benefit from further training in some areas. The residents were treated with dignity and respect and their personal wishes for care during illness were written in the care plans. EVIDENCE: Residents care plans stated very clearly the resident’s individual choices regarding the care they wish to receive. The daily monitoring notes were updated with any changes. Residents said that the staff asked them if they were ready to get up and they had the opportunity to have breakfast in bed if they wished. One lady said that every day they were asked how they wanted to plan their day so if they felt unwell they could stay in bed, ‘ it was no bother to the staff ’ Staff were limited in there underlying knowledge of Huntington’s disease and training would enable the home to provide a higher level of care. Each resident had been asked about his or her individual requests in the event of illness and death. This was clearly identified within the plan and families had been included with resident’s permission. One resident had died last week and staff and residents said they were well supported by each other within the home. Applegarth Nursing Home DS0000010110.V272476.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 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 home had a good complaints system in place and appropriate policies to protect the residents. EVIDENCE: There had been a complaint made to the home since the last inspection, which was dealt with by the home in line with there own complaints procedure. Residents within the home said that if they had any problems they would talk to the Manager who was always available and would listen to them. One resident said staff were ‘easy to talk to’ and that there was always someone on duty they could confide in. The staff spoken to were aware of the homes adult protection policy and what appropriate action they would take to protect the residents within the home. Applegarth Nursing Home DS0000010110.V272476.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,and 29. The door to the laundry should be locked when not staffed for the safety of the residents. Each resident had their own room to suit their individual needs. There was adequate bathroom provision with specialist equipment to provide appropriate care. Staff required further training on infection control procedures as poor practices were observed. This will help to keep the home clean and hygienic. EVIDENCE: Each resident has his or her own room which was clean, tidy and well maintained. The residents liked their rooms and were able to personalise them. There were family pictures and photographs on display. One resident said she could ‘go to her own room at any time’ and she liked to sit with her visitors in her room, as it was more private. Several members of staff were observed putting piles of dirty linen onto the carpets within the corridor, this was apparently normal practice. Infection control procedures need to be reviewed to maintain a clean environment for the residents. The lounge areas were clean and homely; there was a separate lounge for the residents who liked to smoke away from the other residents. One lounge was for the activities and TV and there was a quiet lounge for the residents who wanted some peace and quiet. Each lounge was well decorated with Applegarth Nursing Home DS0000010110.V272476.R01.S.doc Version 5.0 Page 14 comfortable chairs and tables. There had been 2 new carpets fitted to bedrooms to improve the living accommodation for the residents. There was noticeable damage to the doorframes throughout the home many in need of repair. This was wheelchair damage and is an issue the home needs to address to retain a smart and clean looking environment for the residents. Applegarth Nursing Home DS0000010110.V272476.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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,and36. A staff group, with mixed abilities and competencies, cares for the residents. The staff were aware of their role within the team and had developed relationships with the residents. Staff support and supervision should be given regularly to enable staff to monitor the care they are giving the residents and to identify any training requirements to improve the service they provide. EVIDENCE: On the morning of the inspection there were 9 health care assistants, 2 qualified nurses, 1 cook, 1 cleaner, the activities co-ordinator for 34 residents. Staff felt that they had adequate levels of staff to provide a high level of care. One member of staff said that she had worked her way through a comprehensive induction programme and felt well supported by her colleagues. The staff had clear defined roles within the home and there was a low turn over of staff to provide continuity of care for the residents. One member of staff said they had not had formal supervision for 12 months but other staff had received some supervision. This needs to be addressed to enable the staff to raise any issues that may be affecting the quality of service they are delivering to the residents. Staff records showed that they had opportunity to attend training courses that would be of benefit to the continuing care of the residents, but the staff spoken to had not received training in Huntington Disease. This should be included within the home training programme for staff to be able to provide appropriate care for this resident. Applegarth Nursing Home DS0000010110.V272476.R01.S.doc Version 5.0 Page 16 A staff meeting had been organised by the manager but none of the staff had attended, this needs to be re organised on a formal level to enable the staff team to progress and develop. The staff should be given the opportunity to meet and discuss issues arising from there work with the management. Applegarth Nursing Home DS0000010110.V272476.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. 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 home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38,40,41,42 and43 The Manager has been in post for some time, she provides clear guidance and leadership for the home. This provides a stable environment for the residents who have confidence in the manager. Health and Safety procedures need to be addressed for the welfare of the residents. EVIDENCE: The residents speak very warmly about the manager and have confidence in her ability to run the home. They are happy with the care and service that they receive. Residents’ families said that the manager was approachable and knows all the residents needs, and if they had any problems then she ‘ would sort them out’ All policies and procedure records within the home were kept updated and stored safely to ensure residents confidentiality. During the inspection bottles of open cleaning fluid were found in the bathroom putting the residents at risk from ingesting the contents. Practices need to be reviewed for the safety of residents. Quality questionnaires had just been sent out to families and the results would be used to plan the next year’s work within the home. Applegarth Nursing Home DS0000010110.V272476.R01.S.doc Version 5.0 Page 18 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. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X 3 X 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 2 LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 2 16 X 17 Standard No 31 32 33 34 35 36 Score 3 X 3 X 2 2 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Applegarth Nursing Home Score 3 X X 3 Standard No 37 38 39 40 41 42 43 Score X 3 X 3 3 2 3 DS0000010110.V272476.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. Standard YA30.1 YA36.4 YA42.3 (i) YA42.3 (vi) Regulation 13(3) 18(2) 16(2k) 13(4a) Requirement Infection control procedures for handling laundry must be reviewed Staff must have recorded supervision at least 6 times yearly Staff must ensure safe storage of harmful substances The home must maintain a safe environment including the laundry. A lock should be fitted to the door. Timescale for action 31/01/06 31/01/06 31/01/06 31/01/06 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 YA35.7 Good Practice Recommendations Staff training and development are linked in with service users needs. Applegarth Nursing Home DS0000010110.V272476.R01.S.doc Version 5.0 Page 20 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.V272476.R01.S.doc Version 5.0 Page 21 - 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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