Inspection on 15/12/05 for Appleton Lodge

This inspection was carried out on 15th December 2005.

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 found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Appleton Lodge 04/02/09

Appleton Lodge 08/02/07

Appleton Lodge 05/09/05

Appleton Lodge 20/12/04

Appleton Lodge 24/05/04

Appleton Lodge 23/02/04

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

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

CARE HOME ADULTS 18-65 Appleton Lodge Bath Hill Terrace Great Yarmouth Norfolk NR30 2LF Lead Inspector Hilary Shephard Unannounced Inspection 15th December 2005 10.45 Appleton Lodge DS0000027407.V269053.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 Appleton Lodge DS0000027407.V269053.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. Appleton Lodge DS0000027407.V269053.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Appleton Lodge Address Bath Hill Terrace Great Yarmouth Norfolk NR30 2LF 01493 843720 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) john.matheron@ntlworld.com Mrs Jane Allison Matheron Mr John Edward Matheron Mr Roger Laurence Beevis Care Home 15 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (15), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (5) Appleton Lodge DS0000027407.V269053.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th September 2005 Brief Description of the Service: Appleton Lodge is a detached Victorian building situated close to Great Yarmouth town centre and sea front. Accommodation and care is provided for 15 adults who have mental health problems. There are now 15 single bedrooms as the proprietors have made some internal changes to the existing accommodation. Appleton Lodge DS0000027407.V269053.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place over 4 ¼ hours during which time the inspector spoke with 3 residents and 2 staff. The views of residents and staff, where appropriate, are reflected in the findings in the report. A tour was made of the building and the inspector looked at samples of care plans and staff files. At the end of the inspection feedback was given to the 2 staff on duty. A total of 3 requirements and 1 recommendation were made as a result of this inspection. What the service does well: What has improved since the last inspection? What they could do better: Care plans for new residents need completing soon after admission to ensure the correct care is being given. Medication practices need to be better to minimise the risk of errors. Pre-employment checks on new staff need to be improved to ensure that residents are protected from harm. Appleton Lodge DS0000027407.V269053.R01.S.doc Version 5.0 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. Appleton Lodge DS0000027407.V269053.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 Appleton Lodge DS0000027407.V269053.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): Standards not assessed at this inspection. EVIDENCE: Appleton Lodge DS0000027407.V269053.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): Standards 6, 7 and 9 Care plans have been improved to include more detail about residents emotional and psychological needs, however, care plans for three new residents have yet to be drawn up creating potential for inappropriate care to be given. Risks have been assessed with strategies in place and residents are enabled to make decisions about their lifestyle. EVIDENCE: Care plans included risk assessments and guidelines in how risks are to be minimised and managed. Three recently admitted residents have not had care plans drawn up. Preadmission assessment information about one resident was also missing, although there was a lot of other information about the management of their mental health needs. A requirement has been made. Residents said they were able to make decisions about their lives and staff were there to help them as needed. Residents were seen to be managing independently and making decisions about what they wanted to do with their day. Appleton Lodge DS0000027407.V269053.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): Standards not assessed at this inspection. EVIDENCE: Appleton Lodge DS0000027407.V269053.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): Standards 19 and 20 Generally the health needs of the residents are well cared for, but by not having care plans for three residents this could affect the appropriate care given. Gaps on medication records indicates medication may not have been managed properly and unlabelled medication for one resident puts them at risk from receiving incorrect medication. EVIDENCE: Residents said they were satisfied the staff were meeting their health needs, they said staff were very good, and that they were able to see their doctor, psychiatric nurse or psychiatrist when they needed to. Medication was inspected and medication records were checked. Signature omissions were noted on one record and the medication was missing from the blister pack indicating that it had been given but staff had failed to sign to that effect. Staff advised they regularly check the records for omissions. A recommendation has been made. An unlabelled compliance aid containing tablets was found in the medication cupboard. Staff advised they were giving this medication to one of the new residents. The Commissions Pharmacist Inspector has been requested to inspect the homes medication. A requirement has been made. Appleton Lodge DS0000027407.V269053.R01.S.doc Version 5.0 Page 12 Appleton Lodge DS0000027407.V269053.R01.S.doc Version 5.0 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 the following standard(s): Standards 22 and 23 Residents feel they can raise concerns with staff, but by not completing proper recruitment checks the home is placing residents at risk from harm. EVIDENCE: Residents said they would report any concerns to staff and were confident they would be sorted out. Staff were aware of who concerns should be raised with and were satisfied they would be dealt with. Staff also had a good understanding of the correct reporting procedure for issues of abuse. Staff files indicated that new staff have been employed without a check being made on the protection of vulnerable adults (POVA) register and without proper written references. Appleton Lodge DS0000027407.V269053.R01.S.doc Version 5.0 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 the following standard(s): Standards not assessed at this inspection. EVIDENCE: Appleton Lodge DS0000027407.V269053.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): Standards 32, 34 and 35 Residents’ benefit from being cared for by competent staff, but by not completing proper recruitment checks the home is placing residents at risk from harm. EVIDENCE: Three out of eight staff have achieved NVQ level 3 and one member of staff is working towards this. Staff have also attended a number of training courses and study sessions and feel they have learned a lot from this. Staff were observed interacting well with the residents and had a good understanding of their needs. New staff have also commenced induction training. Files of two new members of staff indicated that they had been employed without a check being made on the Protection of Vulnerable Adults (POVA) register and one did not have two proper written references, only a “to whom it may concern” reference which is not acceptable. It was not clear that either staff were being supervised whilst waiting for the criminal records check to arrive. However, the home have a good style of application form which had been completed in full for both of these staff and a record had been made of their interviews. A requirement has been made regarding pre-employment checks. Appleton Lodge DS0000027407.V269053.R01.S.doc Version 5.0 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 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): Standards 37, 39 and 42 The home is well managed by an experienced manager and all residents are involved in monitoring the quality of the service. Errors with medication management have potentially put some residents at risk from harm to their health and well-being. EVIDENCE: The home uses an external person to undertake a yearly quality survey that includes all residents although the residents said some of them had chosen not to participate. A report is formulated from this survey and the manager and proprietors address areas that the residents have highlighted for improvement. Residents lead their own meetings with staff support and are also involved in reviewing and updating their care plans with their key workers. The proprietors recently opened another home next door, and the manager now shares his managerial responsibilities between the two homes. The home has appointed an assistant manager who is qualified to NVQ level 3. Residents and staff feel well supported by the manager. Appleton Lodge DS0000027407.V269053.R01.S.doc Version 5.0 Page 17 Appleton Lodge DS0000027407.V269053.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 X X X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 X X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X 1 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Appleton Lodge Score X 2 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 2 X DS0000027407.V269053.R01.S.doc Version 5.0 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 Standard YA6 Regulation 15 Requirement The Registered person must ensure that care plans are drawn up for each resident as soon as possible after admission. Timescale for action 31/01/06 2 YA20 13 The Registered person must 31/12/05 ensure that any compliance aid is properly dispensed by a suitably qualified person and that the medication administration instructions and medicine details on the compliance aids are clear. The Registered person must ensure that two written references and a POVA first check is received PRIOR to staffs commencement. Staff must also be supervised by a designated person until a satisfactory enhanced CRB is received. 31/12/05 3 YA34 19 Appleton Lodge DS0000027407.V269053.R01.S.doc Version 5.0 Page 20 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 YA20 Good Practice Recommendations The Registered person is recommended to complete regular audits of the MAR charts to reduce omissions and minimise risk of errors. Appleton Lodge DS0000027407.V269053.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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. 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