Inspection on 27/03/06 for Applethwaite Green

This inspection was carried out on 27th March 2006.

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

Applethwaite Green 10/07/06

Applethwaite Green 21/09/05

Applethwaite Green 26/01/05

Applethwaite Green 09/06/04

Applethwaite Green 17/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Applethwaite Green Phoenix Way Windermere Cumbria LA23 1BY Lead Inspector Ray Mowat Unannounced Inspection 09:15 27 March 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Applethwaite Green Address Phoenix Way Windermere Cumbria LA23 1BY 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) 015394 62440 015394 42637 www.cumbriacare.org.uk Cumbria Care Miss Anne Hutton Care Home 28 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (28) of places Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 28 service users to include: up to 28 service users in the category OP (Old age, not falling within any other category) up to 12 service users in the category of DE(E) (Dementia over 65 years of age) When single rooms of less than 12 sqm become vacant, they must not be used to accommodate wheelchair users and where wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a larger room when one becomes available. Two service users may share a bedroom of at least 16 sqm useable floor space only if they have made a positive choice to do so, and when a shared space becomes vacant the remaining service user has the opportunity to choose to share, moving to a different room if necessary. 21st September 2005 3. 4. Date of last inspection Brief Description of the Service: Applethwaite Green is a residential care home registered with the Commission for Social Care Inspection to provide care and accommodation for up to twenty-eight residents. Accommodation is provided in three living units, one of which specialises in providing care for people with dementia. The home isowned by Cumbria County Council and operated on its behalf by Cumbria Care, a business unit of the County Council. The home is a purpose built twostorey building located on the outskirts of Windermere and is close to shops, pubs, a post office and other amenities. Accommodation for residents is provided on the ground and first floor of the home and all bedrooms are for single occupancy. Three bedrooms have ensuite toilet and bathing facilities and there are suitable toilets close to all the accommodation used by residents. The home is set in an attractive location with pleasant and safe garden areas with views towards the town and a playing field. Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 27th March 2006. I met with many of the residents during the day, also meeting some visiting relatives. I spoke to staff on the units as they went about their work, in addition to meeting with three care staff on their own. I also spoke to the supervisor on duty and the manager. I looked at records that help staff to care for residents and keep them safe. What the service does well: What has improved since the last inspection? What they could do better: The home must review how they are looking after and giving out medication to residents. The records that help staff to care for residents must be kept up to date with correct information and be agreed with residents or their representative. They should include personal information about the person and their life. Staff records must also be kept up to date at all times. Furniture and equipment must be replaced to keep it in good condition. Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3. Prospective residents are provided with appropriate information about the home to enable them to make an informed choice. The admission procedure ensures individual needs can be met within the home. EVIDENCE: The service user guide and statement of purpose are made available to people prior to and after admission to the home. This provides them with appropriate information about all aspects of the home, enabling them to make an informed choice about living there. One resident described to me how they had visited the home with a relative prior to deciding to move in and had been made “very welcome”. Another resident said they did not choose the home but the social worker had supported them through the process as they were being discharged from hospital. As part of the admission procedure the home complete their own assessment in addition to any social work or specialist assessment. Visits are encouraged, Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 9 which is good practice and enables prospective residents to gain an insight to life in the home. Private fee paying residents are issued with a contract of terms and conditions on admission to the home, which is agreed and signed by them or their representative. Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 11. The review of care plans was inconsistent with out of date and inaccurate information recorded. Medication administration procedures were poor with no effective audit being completed. EVIDENCE: Based on their own assessment or a social work assessment the home develops individual care plans. These were not being reviewed and updated and agreed with residents or their representatives as required. An example of this was a resident with dementia. I met the person and examined their care plan file. Despite the person not now having dentures, having difficulty with eating/chewing and staff saying they had lost weight the care plan did not reflect these issues. The last recorded weight was 2004 and the nutritional assessment was out of date and totally inaccurate. These are serious concerns that will have a detrimental impact on their health and quality of life. This is subject to a requirement. Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 11 The care plans were focussed on practical care and did not reflect the individual’s social history and interests. Particularly for people with dementia, ‘care mapping’ is considered to be good practice and provides staff with a valuable insight to a person’s personality and idiosyncrasies, which are so valuable when providing personal and intimate care. It is recommended the care plan record people’s social history and interests. I checked some of the medication held against the home’s records and observed medication being administered. It was evident there were gaps on the medical record sheet (MAR) where staff had not signed for medication administered. Also PRN medication was being recorded inconsistently, sometimes refusal was appropriately recorded and other days left blank this will lead to confusion and is not an accurate record. A signature or code should be used at all times. Another medication was not being administered as directed. It should have been given first thing in the morning and a half an hour before food, despite this being recorded on the dossette box in two places this was not happening as staff were following the MAR chart, which did not state this. Another MAR chart showed that a residents medication had been recorded as out of stock for two weeks but no action had been taken to rectify the situation. These are serious concerns and are subject to a requirement. Any personal preferences such as religious observance or family wishes, in relation to dealing with death and dying are recorded on care plan files. Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. On the whole residents are leading a fulfilling lifestyle of their choosing. EVIDENCE: There was evidence that residents are supported and encouraged to pursue their interests both in the home and in the community, such as attending day centres, church and church groups and visiting or keeping in touch with family and friends. An activities guide was displayed in the lounges, which included activities such as yoga, nail care, hairdressing, chair exercises and art and crafts. Part of the home is used for day care, which residents also have access to for planned activities or just to socialise. Some residents choose to spend most of the day in their own rooms, a choice that is respected by staff. I met with some residents in their own rooms and others in the communal areas of the home. They said their “choices were respected and that staff were kind and helpful”. I also met with relatives who were visiting, which is something the resident’s value. Some of them talked to me about how they had spent the previous day, Mothering Sunday, with their relatives. There were resident’s cards on display in their rooms and the lounges. Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 13 When I asked one resident about life in the home they described it as “wonderful, marvellous, moving in was the best thing I ever did”. I met with the permanent cook and examined the kitchen records, which were up to date and in order. The home operates a four-week rolling menu, which had recently been changed after consultation with residents. This reflected a balanced and nutritious variety of meals. Special diets were recorded in the kitchen and appropriate alternatives were provided. I joined a group of residents for lunch in the dementia unit. It was evident one resident was struggling to use a knife and fork was also not able to chew. I queried if food could be pureed, which it was and a member of staff then supported the resident with eating their meal. The needs of this resident were not reflected in their care plan and their nutritional assessment was out of date and inaccurate. The home must ensure nutritional assessments, including fluid intake, are kept under review and up to date to reflect changing needs. Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17, 18. Action must be taken to protect the legal right of a resident and safeguard them from abuse. EVIDENCE: There have been no recorded complaints since the last inspection when this standard was met. An issue relating to residents finances was raised with me. It was evident action must be taken by the home to ensure residents legal rights are protected and the residents are safeguarded from abuse. This is subject to a requirement. Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 25, 26. On the whole the home provides a safe and well-maintained living environment. EVIDENCE: The home was found to be safe and well maintained. Work was planned to remove moss from the paths around the home particularly at emergency exits. Requirements raised at the previous inspection relating to the environment had been attended to. All areas of the home I looked at were found to be clean and hygienic and there were no malodours in the home. Some of the easy chairs in the Bowness lounge were stained and worn and in need of replacement. Also the kitchen work unit in the same unit was worn and the sealant was loose and mouldy. These issues are subject to a requirement. It is recommended bars of soap be removed from bathrooms in line with infection control good practice. Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29. The home provides a consistent and reliable staff team, although the use of agency staff has recently increased. EVIDENCE: Due to long-term absences the home has recently had to engage agency staff. Based on discussions with regular staff and the manager it was evident they are introduced to the residents and inducted to the routines and systems of the home. The home liaise with the agency to ensure staff meet the skill specification for working in the different units. Agency staff work alongside a permanent member of staff to support and guide them. Staff were “comfortable” with this arrangement and said agency staff can “contribute to the shift as they are given relevant information and guidance”. Staff said they get “regular training” and it was relevant to their role. On the day of the inspection there were a suitable number of staff on duty including one agency staff. The organisation has suitable recruitment policies and procedures in place in line with equal opportunities and good practice guidelines, with all appropriate checks completed. Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 34, 36, 37, 38. Staff felt well supported by management. However record keeping was inconsistent resulting in some information being inaccurate and out of date. EVIDENCE: Based on discussions with staff they said they got regular supervision and support from the supervisors and manager. They also said management were “approachable and were able to discuss any concerns”. However when I examined some supervision records one did not contain any records and another the last recorded supervision was over six months ago. The home is required to maintain appropriate records of supervision in line with the National Minimum Standards. The home holds regular staff meetings, which were valued by staff, who said they were able to “raise any concerns or issues”. Residents had recently been consulted about menu changes and their preferences incorporated into the new menu plan. The home also formally Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 18 consults with residents on an annual basis regarding the quality of care in the home. The home has suitable policies in place, however as mentioned previously some records were not reviewed and kept up to date. The health and safety records examined were in order with the home providing a safe environment for residents and staff. Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 2 18 1 2 3 X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X 3 X 2 2 3 Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 20 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 Standard OP7 Regulation 15 (1, 2) Requirement The home must agree a care plan with residents and their representative and keep it under review, ensuring they contain up to date and accurate information. MAR charts must be appropriately completed in line with Royal Pharmaceutical guidelines. Medication must be administered in line with the prescribing pharmacist directions. An adequate stock of medication must be maintained at all times. The home must ensure nutritional assessments, including fluid intake, are kept under review and up to date to reflect changing needs. The home must ensure residents are not being placed at risk of harm or abuse. The furniture of the home must be kept in good condition. The kitchen worktop in the Bowness unit must be replaced. Timescale for action 01/06/06 2 OP9 13(2) 28/03/06 3 4 5 OP9 OP9 OP15 13(2) 13(2) 14(2) a, b 28/03/06 07/04/06 01/05/06 6 7 8 OP18 OP19 OP19 13(6) 16(2) c 23(2) b 07/04/06 01/07/06 01/07/06 Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 21 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 OP7 OP38 Good Practice Recommendations It is recommended the care plan record people’s social history and interests. It is recommended bars of soap be removed from bathrooms in line with infection control good practice. Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 22 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 Applethwaite Green DS0000035565.V296602.R01.S.doc Version 5.2 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!