Inspection on 18/07/07 for Appleton Lodge

This inspection was carried out on 18th July 2007.

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 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

Appleton Lodge 26/09/06

Appleton Lodge 21/10/05

Appleton Lodge 04/05/05

Appleton Lodge 22/09/04

Appleton Lodge 14/04/04

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 Appleton Lodge Lingard Lane Bredbury Stockport Cheshire SK6 2QT Lead Inspector Mrs Fiona Bryan Unannounced Inspection 18th July 2007 09:15 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 Appleton Lodge DS0000008536.V343906.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. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Appleton Lodge Address Lingard Lane Bredbury Stockport Cheshire SK6 2QT 0161-430 6479 0161 494 1158 appletonlodge@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Care Management Ltd 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) Dawn Haughton-Tarmey Care Home 30 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (10) Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Maximum number registered - 30. Services users to include up to 30 (OP), up to 3 (DE)(E) and up to 10 PD(E). 26th September 2006 Date of last inspection Brief Description of the Service: Appleton Lodge is one of the care homes owned and run by Southern Cross Healthcare. The home is located in a semi-industrial and residential area. Public transport is convenient and enables visitors and more able residents to travel to local shopping areas. Appleton Lodge is purpose built and stands in its own grounds, along with another home owned by the company. Appleton Lodge offers residents single bedroom accommodation, all with en-suite facilities. Accommodation is provided on two floors. Residents have the opportunity of sitting in various communal seating areas, one of which is designated for residents who prefer to smoke. The home has wide corridors and is able to support residents who use manual and electric wheelchairs. Fees for accommodation and care at the home vary between £417.50 and £549 per week. A service user guide is available on request. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection, which included a site visit, took place on Wednesday, 18th July and Thursday, 19th July 2007 over a total of 10.5 hours. The home was not told beforehand of the inspection visit. All key inspection standards were assessed at the site visit and information was taken from various sources, which included observing care practices and talking with people who live at the home, visitors, the manager and other members of the staff team. The manager also completed a form called an Annual Quality Assurance Assessment (AQAA) which asks the manager to tell us what they think they do well, what they have improved upon, and what they need to do better. Three people were looked at in detail, looking at their experience of the home from their admission to the present day. A partial tour of the building was conducted and a selection of staff and care records was examined, including medication records, employment and training records and staff duty rotas. Before the site visit, comments cards were sent to residents and relatives. Two residents and one relative returned the cards and some of their comments have been included in this report. What the service does well: Residents and relatives expressed satisfaction with the manager, saying she was approachable and good at her job. One person who returned a comments card said the manager encouraged communication, always listened and worked hard to solve any problems. Residents generally liked living at the home. One resident said the home was “Absolutely wonderful” and they felt their health had improved since they had been there. Another resident said, “I’m in the best place, I get waited on”. Another resident said, “Staff can’t do enough for you”. Routines seemed to be fairly flexible; residents could choose to stay in their rooms or join other residents in the lounges. Staff made efforts to ensure that residents could still maintain family contacts and visitors said they were made to feel welcome. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 6 Records showed that residents or their representatives were involved in reviewing the care they were getting at the home and were asked if the home was meeting their needs. Residents said staff arranged for their doctor to visit if they were unwell and relatives said they were kept informed of important changes to their resident’s condition. Although the home needs some refurbishment, it was clean, tidy and did not smell. Thorough recruitment checks are made, which protect the residents by making sure suitable people are employed to care for them. The manager undertakes checks each month to make sure that the home is running well and to highlight what areas need improving. It was good to see that most of the issues highlighted at this inspection as areas for improvement had already been identified by the manager, who was able to demonstrate some of the action she had already taken to address the shortfalls. The manager was very open and receptive to the feedback given about the inspection and had a positive view about the direction of the home. What has improved since the last inspection? What they could do better: Although care plans were person-centred and had been reviewed regularly, they did not always tell staff how they should monitor whether the care they were delivering was effective or not. The home employs an activities organiser who also works part of the week at the adjacent Appleton Manor. A list of activities was displayed but whether they actually took place was “hit and miss”. Staff were not sure when the activities organiser was due to work at the home and said they felt the provision of social events and stimulation was an area that needed developing. As at the last inspection, the arrangements to ensure that residents were able to order and receive a cooked breakfast if they wished were still somewhat vague and residents remain unsure of whether a cooked breakfast is available. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 7 Residents said that they had to wait at times for help and both residents and staff thought that there were not always enough staff on duty to meet the needs of the residents. Although the manager undertakes her own checks to see how the home is running, the company must send a representative each month to visit the home and assess how well it is operating. A report should be made of each visit and should be available to the CSCI on request. During the site visit some instances were noted between staff and residents where staff were not as helpful or responsive to residents as they could have been. Staff need to make sure they listen to and act on what residents are telling them and must also ensure that they act professionally at all times. Some redecoration and refurbishment has taken place but further work needs to be done as the home still appears “tired” and shabby in places. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 8 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 Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. Detailed assessments are undertaken before people come into to the home so they can feel confident that their needs can be met. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The records for three residents were looked at in detail. A detailed assessment had been undertaken for each person before they came into the home, which included risk assessments for the risk of pressure ulcers, falls, nutrition and moving and handling. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 10 Staff said that when new residents came to live at the home the senior carers discussed their care needs with the staff to ensure that staff had all the information about the care they needed to deliver. People living at the home said staff knew them well and understood what help they needed. Staff were very knowledgeable about the people they were caring for. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. The health and personal care residents receive is based on their individual needs but staff were not always responsive to information they were given by residents, which leads to a risk that their needs may not be met. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The care files for three residents were looked at in detail. Care plans generally addressed residents’ needs that had been identified during the assessment process. Care plans were person-centred and had been reviewed monthly, although staff need to make sure that risk assessments are promptly updated when there is a change to a resident’s condition to make sure that the assessment remains accurate and properly reflects the individual’s current condition. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 12 Staff also need to make sure that care plans state how a resident’s progress will be monitored. For example, one resident had been admitted to the home with a poor appetite and previous dehydration. The care plan did not say how staff would monitor if the resident was eating and drinking adequately. Records showed that residents had seen chiropodists, district nurses, GP’s and opticians. Some residents had attended hospital appointments. One resident who was new to the home said they had already improved in health since coming in, as their mobility had got better. All the care files seen contained reports of care reviews that had been attended by the resident themselves, relatives and care managers. Residents had been asked their opinion about how the home was meeting their needs. Care plans sometimes recognised people’s diverse needs quite well, for example, one resident had a detailed care plan about how staff could help her to maintain her femininity. However, some care plans addressing residents’ diverse needs were less constructive, for example, one resident was partially sighted and their care plan tended to focus on the health and safety aspects related to this without considering other issues, such as whether there were other resources that could be employed to improve the resident’s quality of life. During the site visit residents appeared clean and comfortable and were dressed appropriately. One relative said that the person they visited always looked well cared for. Residents said that staff were kind and treated them with respect. One resident said he enjoyed the banter he had with one of the carers, which was “all in fun”. The home does operate a key worker system but none of the residents or relatives spoken to were aware of whom their key worker was or what their role was. This was discussed with the manager who said she would consider how to promote better understanding of the system. During the site visit the inspector observed several incidences where the staff did not readily pick up on or respond to information that residents were telling them. These incidents were described to the manager who had already recognised that this was an area of care practice within the home that could be improved. One relative who returned a comments card said that some of the staff could be very abrupt with residents but said that they knew the manager was aware of this and was working to resolve the issue. Documentation within some staff records showed that the manager had previously discussed the importance of attention to detail and professionalism. Staff need to make sure that they are proactive in providing for residents’ needs and are thoughtful and considerate in how they respond. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 13 A selection of medicine records was looked at and was satisfactory. Robust procedures were in place to ensure that medicines were administered safely. One resident managed their own medicines. A risk assessment had been undertaken to ensure that the resident was able to manage their medicines safely. However, the risk assessment was quite vague and did not specify who would be responsible for reviewing the resident’s continuing ability to manage their medicines safely or how often this would be reviewed, or how it would be assessed or recorded. The home’s policy regarding self-medication also did not stipulate how this should be done. The manager said that she would look at this and ensure the procedure was made clearer. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. More consideration about the resources available is needed to ensure that people’s social, cultural and recreational expectations can be met. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Southern Cross Healthcare employs an activities organiser who works parttime at Appleton Lodge and part-time at the adjacent Appleton Manor. The ground floor a notice board displayed a list of various activities, such as parties and entertainers, bingo, manicure and massage, arts and crafts and a tuck shop open for residents to buy sweets and toiletries, etc. However, no specific dates were stated for when these events would take place and one relative who returned a comments card said that although activities were advertised, in practice they were few and far between. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 15 Records were kept detailing what recreational activities residents had been involved in; however many of these only recorded mundane activities, such as “lounge”, “sleeping” and “bed rest”. Where it was recorded that one to one time had been spent with a resident, no detail was provided about what had been done during that time so there was no further information about particular pastimes that the resident had enjoyed. One resident, when asked what they normally did after breakfast, replied, “that’s a good question”. Another resident said they would sit in a chair and rest. A number of residents said they spent a lot of time watching television, although one said that things were going on that they could join in with sometimes but they tended not to bother. Another resident said they enjoyed bingo, which they played about once a fortnight, and other games and quizzes that were arranged by the activities organiser. Several residents talked about a barbecue the home had arranged the previous week, which they had enjoyed. Staff spoken to were unsure exactly what hours the activities organiser worked at Appleton Lodge and felt that social events and stimulation for residents was an area that needed to be developed. The manager also agreed with this and said they were attempting to arrange some outings out of the home for residents but had to wait to borrow a minibus from one of the other homes within the Group. The role of the key workers was discussed and the possibility of extending this role to encourage carers to take more responsibility for looking at person-centred social care to meet individual interests. The majority of residents spoken to agreed that they were able to choose how to spend their day and said that their families and friends were welcomed and encouraged to visit. Some residents preferred to spend most of their time in their own rooms, whilst others spent the majority of the day in one of the communal lounges. One resident said staff were flexible, in that, she liked to watch “Deal or No Deal”, so they brought her tea for her into her room so she could watch it while she ate. Residents were generally positive about the food. One person said it could be better sometimes and that the quality of the meals depended on who was cooking, whilst another said the food was “brilliant”. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 16 All the residents agreed that there was a choice of meal at lunch and teatime. The arrangements for breakfast seemed less clear and although in theory it was said that residents could have a cooked breakfast, in practice no residents were aware of how they could request this and a complaint noted in the complaints record concerned this – one resident had complained that even when they ordered a cooked breakfast they still did not get it. The manager acknowledged that this was a problem and said she would have to involve the chef in developing a better system that all the residents were aware of so they could choose and have a cooked breakfast if they wished. On the day of the site visit lunch was either braised beef or fish cakes with mashed potatoes, carrots and swede. Both options looked and smelled appetising and all the residents asked said that their meals were tasty and hot. Several residents said the braised beef was very tender. Both dining rooms (one on the ground floor and one on the first floor) provided a pleasant setting for the residents; tables were laid with cloths, mats, cutlery and condiments. Residents were offered cold drinks with their meal and tea or coffee afterwards. Staff were observed to be helping those residents who needed help appropriately; one resident was noted to be falling asleep at the table – a carer saw this and went over to gently wake her up and encourage her to eat. Dessert was cherry pie and custard or ice cream. Menus were displayed on the tables, which listed the choices for tea as paté on toast or sandwiches followed by fruit jelly and ice cream or choc-ices. Staff said that they thought desserts for residents that were diabetic could be more imaginative, as they usually were offered either ice cream or yoghurts. The manager had recently distributed a survey to all residents, requesting their comments about the food and was going to use this information to work with the chef in devising new menus. The manager also described a new computer system that she and the chef had received training in; this would help them to create weekly menus that were nutritionally sound with the recommended ratios of protein, carbohydrate and fibre, etc., whilst also looking at sugar and salt contents. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. People feel that their views are listened to and acted upon. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home has a complaints procedure, which is displayed in the reception area of the home. Residents were able to identify someone in the home that they would approach if they had a complaint and said they felt any concerns or complaints would be dealt with properly. None of the residents said they had any complaints at the present time. A record of complaints was kept. This showed that complaints had been investigated and responded to appropriately, with the exception of the complaint about the cooked breakfasts, detailed in the last section of this report, which the manager was still attempting to address. Staff were aware of the procedure to follow if they received any complaints. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 18 Staff records showed that ongoing training was available for staff regarding the prevention of abuse and safeguarding adults. Staff spoken to were aware of the procedures to follow if they suspected abuse. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, 25 and 26 Quality in this outcome area is adequate. Improvements are needed to ensure that the environment is comfortable and well maintained for residents to live in. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: A tour of the home was conducted. The home was clean and tidy, whilst people’s individual rooms were homely and personalised with ornaments, furniture and mementos. Two residents who returned comments cards said that the home was always fresh and clean and one relative who responded said that the home was clean and did not smell. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 20 Since the last inspection the bathrooms and hallways had been redecorated. Two bedrooms had been refurbished and it was reported that soft furnishings had been ordered for another two rooms. Although these improvements had been made, many rooms were still in need of refurbishment as the home was showing signs of wear and tear. The exterior of the home needs repainting, as the paint was badly peeling, although the grounds were clean and tidy. Some double-glazing units around the home had “blown” and need to be replaced; the misty windows obstruct the residents’ view outside. A number of carpets need to be replaced and the first floor lounge requires more armchairs, as there were not enough chairs provided for all the residents accommodated on that floor to sit in the lounge if they wished. Many of the chairs in the lounge were worn and shabby. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. Staffing levels and skills may not always be sufficient to meet the needs of the residents. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Examination of staff duty rotas showed that there were five staff on duty during the day and three staff on duty at night. There were mixed views from residents about whether there were always enough staff on duty to meet their needs. One person said that there were not always enough staff and one person said they sometimes had to wait for help. A visitor said that occasionally there were too few staff but when their relative used the care call system, staff responded promptly. Staff said that, at times, they felt there were not enough staff and the importance of considering the dependency of the residents in determining appropriate staffing levels was discussed with the manager. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 22 The personnel files for three staff were looked at. All contained all the necessary documents and information to confirm that robust procedures were in place for the recruitment of staff. Files also contained evidence that staff had received supervision and that the manager knew her staff team well and was working to address some shortfalls that she had identified in staff attitude and approach. Only four of the 16 care staff working at the home have achieved an NVQ, with another six currently undertaking training. This equates to 25 of the staff currently being trained and a further 37.5 undertaking training. Once these staff have successfully completed the training, the home will have achieved the target of 50 set in the National Minimum Standards. One member of staff was undertaking the NVQ Assessor’s course so that in-house training could be provided. Records showed that new staff had undertaken induction training in line with Skills for Care specifications. All staff had received updates in health and safety training, such as moving and handling and fire safety. Some staff had undertaken training in topics such as food hygiene, infection control and customer care. The manager recognised that most of the training tended to be mandatory training in health and safety topics and said that she was trying to arrange training in dealing with challenging behaviour. One relative who returned a comments card said that they felt staff needed more training in dementia care; further consideration could be given to other training in specific topics that are relevant to the care needs of the residents living at the home. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. The manager has the skills and knowledge to properly manage the home and systems in place create an open and consultative atmosphere, promoting active involvement from people living at the home to build a positive home for people to live in. This judgement has been made using available evidence, including a visit to this service. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 24 EVIDENCE: Since the last inspection the manager has returned from maternity leave and has undertaken training in complaints management, intermediate health and safety, NUTMEG (the computer system for the development of nutritionally sound menus), payroll and income processing, and the new fire reform legislation. The manager operates an open door policy that residents and relatives were aware of. One relative who returned a comments card said they were impressed with the manager’s open door policy and all residents, visitors and staff spoken to agreed that the manager was approachable and accessible. Residents said that there had been residents’ meetings in the past but the manager acknowledged that there hadn’t been any for a while. One person said that at the last meeting residents had been able to make suggestions and give their views about how the home was running and said they would like another meeting to get an update on some of the issues that were discussed at the last one. Southern Cross Healthcare has a policy regarding quality monitoring by which the manager is required to undertake monthly internal audits looking at areas such as home presentation, medicine management, documentation, pressure ulcer monitoring, complaints management, administration and finance. Through her own audits, the manager had identified the need for a residents meeting and said she had arranged one for August 2007. Residents had recently been asked to complete a survey asking for their views about the meals and the manager was in the process of using these to devise new menus with the chef. Although the manager undertakes her own audits, there was no record of any Regulation 26 visits made to the home since 28th December 2006. These visits should be carried out on an unannounced basis, once a month. Satisfactory systems were in place for the handling of residents’ monies. Some families choose to leave a “float” at the home and will top this up as the resident spends it. Receipts are kept of all transactions and individual ledger sheets detail how much money is kept at the home on behalf of the resident. It was reported that the home had just developed a personal allowance contract for residents which stipulates what residents wish their money to be used for and gives details about how any money they keep at the home is managed. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 25 The home employs a maintenance person who undertakes regular checks of the building and equipment in respect of health and safety. Staff receive regular refresher training in health and safety topics and said there was enough equipment, such as hoists, and protective equipment, such as gloves and aprons, for them to carry out their jobs safely. It was noted that one member of staff was wheeling a resident in a wheelchair without the use of footplates. Although the staff member said this was customary for that particular resident, as they only used the wheelchair for short distances, examination of the resident’s care file showed that no risk assessment had been undertaken in relation to this and the manager confirmed that this was not encouraged practice and agreed to address it with the staff member concerned. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X X 3 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 27 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 Standard OP7 Regulation 13 Requirement The registered person must ensure that risk assessments are updated promptly to reflect any changes to a resident’s condition. Timescale for action 31/08/07 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 3 Refer to Standard OP7 OP9 OP10 Good Practice Recommendations The registered person should ensure that care plans provide staff with information about how a resident’s progress must be monitored. The registered person should review how risk assessments are undertaken for residents who mange their own medicines. The registered person should ensure that staff are responsive to what residents are telling them, act on information promptly and treat residents with respect at all times. Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 4 Refer to Standard OP12 Good Practice Recommendations The registered person should review the home’s social activities programme and ensure that service users have sufficient meaningful daytime activities and opportunities to socialise as they individually desire. Activities must be suitable to their needs and completed as detailed within the home’s activities programme. The registered person should ensure that service users are informed of the hot food choices at breakfast time and be supported to order them in the morning. The registered person should ensure that the outside of the home is repainted. The registered person should ensure that sufficient chairs are provided in the lounges to accommodate all the residents living at the home. The registered person should ensure that blown double glazing units are replaced. The registered person should ensure that visits are carried out to the home in accordance with Regulation 26 of the Care Homes Regulations 2001. The registered person should ensure that staff use safe working practices at all times when transferring residents in wheelchairs. The registered person should ensure staffing levels are sufficient to meet the needs of service users at all times, and these need to be reviewed in line with the dependency levels of service users to ensure they receive support in a timely manner. 5 6 7 8 9 10 11 OP15 OP19 OP20 OP25 OP33 OP38 OP27 Appleton Lodge DS0000008536.V343906.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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