CARE HOME ADULTS 18-65
Applegarth Nursing Home 243 Newtown Road Carlisle Cumbria CA2 7LT Lead Inspector
Lorraine Frost Unannounced 05 July 2005 09:00 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 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 Stationary 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 v232532 f58 f10 s10110 applegarth v232532 050705 ui stage 4.doc Version 1.40 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 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 Ms Caroline Whitehead Care Home 36 Category(ies) of PD - Physical Disability registration, with number OP - Old Age of places Applegarth Nursing Home v232532 f58 f10 s10110 applegarth v232532 050705 ui stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 04 January 2005 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 v232532 f58 f10 s10110 applegarth v232532 050705 ui stage 4.doc Version 1.40 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 15.20. The Registered Manager and her staff assisted throughout. Time was spent talking with the manager and staff on duty, looking at records relating to the care of residents and looking at some staff files. Time was spent with most of the residents either individually or in groups, and all parts of the home were looked at. There were 36 residents in the home on the day of the inspection and a number of visitors were seen and spoken with. What the service does well:
Staffing levels are good in the home with two Registered Nurses and ten Care assistants on duty as well as the registered manager. The home was well staffed with a cook, laundry assistant, housekeeping staff and the maintenance person. The levels take into account not only the numbers of the residents and their varying needs, but also the difficulties with the layout of the home making it a challenge to monitor all the residents in all parts of the home. The residents all said they were very happy and that the staff “pop in” to see them in their own rooms and that they never felt “forgotten.” Another resident said, “I never want for anything.” Residents enjoyed the chats that they have with the staff and they enjoy listening to their chatting. Staff work well as a team and are well organised. The activities organiser is an enthusiastic person who engages well with the residents and provides an opportunity for residents to go out of the home and encourages conversation and reminiscence. The opportunities for staff to attend training is good and they are encouraged to attend the courses and are expected to discuss their own thoughts about the training they would like to receive. There was a lot of evidence to show that the residents are treated as individuals. Staff are very aware of their specific needs and know that they have rights and choices. Previous hobbies and interests are documented and those who are able to are encouraged to follow these interests. For example one resident went to Edinburgh with a member of staff and as he likes to go the football and go out to the pub he is helped to do so. One resident said how she is taken shopping for clothes and others go out for a coffee and go to visit friends. Quality assurance audits are carried out regularly and the results are displayed in the entrance to the home. The results show the positives and the negatives and any actions to be taken. Applegarth Nursing Home v232532 f58 f10 s10110 applegarth v232532 050705 ui stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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 v232532 f58 f10 s10110 applegarth v232532 050705 ui stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Applegarth Nursing Home v232532 f58 f10 s10110 applegarth v232532 050705 ui stage 4.doc Version 1.40 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 standard(s) 3 and 4 The pre admission assessments are good and there is an opportunity for prospective residents and their families to visit the home, reassuring them that the home will meet their needs. EVIDENCE: Residents confirmed that they had been able to look around the home or that a friend or member of their family had done so on their behalf. One resident said that they had chosen Applegarth because a friend had recommended it to them. This person was very pleased with the choice. The pre admission assessment is thorough and it includes talking to other professionals. If the discharge is delayed the manager goes back to reassess that person to obtain up to date information and to ensure that any changed needs could still be met. All admissions are subject to a settling in period. A planned review meeting to discuss with the resident and other appropriate people if the home meets their needs follows this settling in period. Applegarth Nursing Home v232532 f58 f10 s10110 applegarth v232532 050705 ui stage 4.doc Version 1.40 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 standard(s) 6, 7, 9 and 10. Staff are good at supporting residents to make choices and decisions resulting in the residents having individual lifestyles. The home is good at seeking prompt specialist advice and reassessment of residents to cope with changing needs. Residents’ benefit by having detailed care plans, but they need to be improved further to ensure that they accurately reflect the information found elsewhere. Resident records were not secure therefore confidential information could be obtained without permission from the resident. EVIDENCE: Residents are consulted with and they made choices on a range of matters including, any activities they would like to take part in, where they would like to sleep, if they would like a male or female care assistant to help them and if they wished to see a visitor or not. The care plans contained good information and had been reviewed, but other documents showed that not all changes were reflected. There was easy access to confidential written information however, staff did not discuss residents openly and the handover between staff took place in the small office with the door closed. The staff are very aware of confidentiality issues and information is not given to unauthorised people.
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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 standard(s) 16 and 17 Residents are encouraged to make choices ensuring that where possible they benefit from a lifestyle that is specific to their needs, interests, and preferences. Social activities and meals were varied providing them with a range of choices and opportunities on a daily basis. The presentation of certain meals was poor and needs to be improved. EVIDENCE: Residents said that they had plenty to do and that they enjoyed the activities provided. There was a good rapport between the residents and the activities person and there was plenty of chatting between them all. One resident said that she went out with the activities person shopping or for a coffee or just for a ride in the mini bus when errands were being run. Staff were said to be “very kind, chatty and nice.” Residents said that they liked living at Applegarth and that they felt they were well cared for. The meals were complimented by most of the residents with choices offered and drinks readily available. Suggestions were made as to how to improve the appearance of some specialist diets, as they looked very unappetising.
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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 standard(s) 19, and 20 There is a skilled staff team who are sensitive and knowledgeable about the needs of each individual and they consult with other professionals when appropriate thus managing the residents’ physical and emotional health care. The medication system has improved due in part to the new system being used and also due to the strict monitoring and auditing systems that are in place. EVIDENCE: Residents’ files were detailed showing clearly how to manage the emotional, physical and health care needs of residents. The daily progress notes showed good monitoring of residents and prompt referrals to specialists and to clinics. For example one resident was exhibiting behaviour that was causing some concerns and so referrals to the GP had been made and meetings were arranged to consult with the social worker and community psychiatric nurse. The family had been consulted and had been kept well-informed seeking their views and ensuring they were aware of how the matter was being addressed. One to one care to meet the social and emotional needs of a resident was being provided. The care assistant was well aware of the changing needs of this person and the day was planned around his preferences and his abilities. A new medication and administration system was in place. Staff had received training and support on the system and commented positively about it.
Applegarth Nursing Home v232532 f58 f10 s10110 applegarth v232532 050705 ui stage 4.doc Version 1.40 Page 12 Auditing systems enabled the manager to monitor medication issues in the home and this had improved stock control and ordering systems. Applegarth Nursing Home v232532 f58 f10 s10110 applegarth v232532 050705 ui stage 4.doc Version 1.40 Page 13 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 standard(s) 22 The home has a good complaints system with residents feeling that they would be listened to and that something would be done if they did complain. EVIDENCE: Residents are given a copy of the complaints procedure and it is readily accessible to anyone should they wish to complain. Residents said they would talk to a member of staff or the manager and said they were sure “something would be done to put things right” if they had a complaint. There had been no complaints either direct to the home or to the Commission for Social Care Inspection since the last inspection. Applegarth Nursing Home v232532 f58 f10 s10110 applegarth v232532 050705 ui stage 4.doc Version 1.40 Page 14 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 standard(s) 24 and 30 Residents live in a home that is clean, tidy, and free from unpleasant smells and with little touches that make it homely. EVIDENCE: From the start of the inspection through to the end of the visit the home was free from unpleasant smells and was relatively clean and tidy, given the layout and design of the building. Residents said that they liked the home and that they had been able to personalise their rooms making them homely. One resident summed it up by saying, “this is not my bedroom this is my home.” The room of another resident was quite bare except for a few very personal items and this resident said how much she liked the furniture in her room and that the best thing about the room was the view as she could look at the flowers and trees. Another resident liked her room because she enjoyed watching the staff and hearing them laughing and chatting as they went by. A new corridor carpet had been fitted and there was ongoing redecoration of the building. Applegarth Nursing Home v232532 f58 f10 s10110 applegarth v232532 050705 ui stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, and 34. Residents are cared for by a skilled staff group, who have been appointed following a robust and thorough recruitment procedure. EVIDENCE: Staff are given the opportunity to attend training sessions throughout the year. The topics include the mandatory training as well as courses being made available on Infection Control, Dressings, Wounds and Principles, NVQ level 2 and 3. The timetable of planned courses is displayed on the notice board and staff are asked to submit their names if they are interested in attending. Registered nurses keep themselves up to date and are keen to pass on their knowledge to others. The manager ensures they are currently registered with the Nursing and Midwifery Council by checking their registration status. The staff files showed that robust recruitment and selection procedures are followed and that verbal references are confirmed in writing. The manager follows up any references that she is unsure about and discusses any issues raised with the applicant. Staff receive a good induction to the role and are supported and supervised. Applegarth Nursing Home v232532 f58 f10 s10110 applegarth v232532 050705 ui stage 4.doc Version 1.40 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 and 42 There was clear leadership, guidance and direction to staff ensuring that residents receive consistent good quality care and are treated as individuals. EVIDENCE: The manager was very motivated and spends time talking with residents and their visitors making sure they are happy with the care and service they are receiving. The manager was said to be supportive and approachable, and tried to keep staff motivated to improve their knowledge and skills. The manager is clear about the ethos of the home in that it is the residents’ home and that they have rights and choices. This is conveyed to the staff from the start of their employment through induction and on through formal and informal supervision. Quality assurance surveys are periodically sent to residents and their families and the results can be seen on the notice board in the entrance of the home. The results are set out so that they can be easily understood identifying the positives and the negatives. The manager was in the process of distributing the
Applegarth Nursing Home v232532 f58 f10 s10110 applegarth v232532 050705 ui stage 4.doc Version 1.40 Page 17 surveys for the next quality assurance check. In-house audits on a wide range of topics are also carried out and again the results are made readily available to everyone with any actions to be taken shown and where shortfalls are identified what has to be done to improve. Residents said that they felt they were listened to, as did the staff. Applegarth Nursing Home v232532 f58 f10 s10110 applegarth v232532 050705 ui stage 4.doc Version 1.40 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 x x 3 3 x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 3 2
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x x x x x 3 2 Standard No 31 32 33 34 35 36 Score x 3 x 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Applegarth Nursing Home Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 4 x x 3 x v232532 f58 f10 s10110 applegarth v232532 050705 ui stage 4.doc Version 1.40 Page 19 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. Standard OP 6 OP 10 OP 17 Regulation 15.2b 17.1b 16.2i Requirement Care plans and assessments must accuratley reflect the care being delivered. Resident information must be kept secure at all times. Meals must be presented in a way so as to make them appetising and attractive. Timescale for action 30.07.05 05.07.05 30.07.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Applegarth Nursing Home v232532 f58 f10 s10110 applegarth v232532 050705 ui stage 4.doc Version 1.40 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
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