CARE HOME ADULTS 18-65
Appleton Lodge Bath Hill Terrace Great Yarmouth Norfolk NR30 2LF Lead Inspector
Hilary Shephard Unannounced 5 September 2005 09.45
th 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. Appleton Lodge I55 s27407 appletonlodge v244155 050905 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Appleton Lodge Address Bath Hill Terrace, Great Yarmouth, Norfolk, NR30 2LF 01493 843720 01493 843720 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) Mr and Mrs Matheron Mr Roger Beevis Care home 15 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (15) of places Appleton Lodge I55 s27407 appletonlodge v244155 050905 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: No more than 15 people with a mental health disorder aged between 18 and 65 may be accomodated. Date of last inspection 20th December 2004 Brief Description of the Service: Appleton Lodge is a detached Victorian building situated close to Gt 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 accomodation. Building work on the adjacent land to erect 10 flats is near to completion. Appleton Lodge I55 s27407 appletonlodge v244155 050905 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This planned unannounced inspection was carried out over 6 ¼ hours during which time the inspector spoke with three members of staff, five residents and the manager. A tour of the premises was made with the manager, and a sample of care plans was viewed. At the end of the inspection feedback was given to the manager. What the service does well: What has improved since the last inspection?
The home has introduced a comprehensive induction programme for new staff and senior staff actively support them during their induction. A new commercial style gas cooker has been installed providing residents with cooking facilities and the proprietors plan to install a domestic style electric cooker shortly. A large new fridge has also been purchased improving the homes cold storage facilities. The proprietors are also promoting good practice by changing the use of the homes double room to single occupancy. Appleton Lodge I55 s27407 appletonlodge v244155 050905 stage 4.doc Version 1.40 Page 6 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. Appleton Lodge I55 s27407 appletonlodge v244155 050905 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 Appleton Lodge I55 s27407 appletonlodge v244155 050905 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) 2 Residents are able to make a choice about where they wish to live and are confident that the home is capable of meeting their needs. EVIDENCE: Care plans were inspected and contained pre-admission assessments indicating the residents needs have been assessed prior to admission. The home is also currently offering day care services to two people, and their needs have also been assessed. These two people seemed satisfied with the care they were receiving. Appleton Lodge I55 s27407 appletonlodge v244155 050905 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 The home has developed a very good care plan structure but has omitted vital information in two of them failing to provide staff with guidelines about important care needs. EVIDENCE: Five care plans were inspected, and were generally in good order with two exceptions. One care plan was missing detail about the residents social, emotional and psychological needs and one was missing information about wound care therefore a recommendation has been made. Others had very good and clear recorded information identifying the residents health care needs and provided good clear guidelines for staff to follow. The residents and their key workers work together to complete their care plans. Staff advised these are reviewed six monthly and updated as changes occur. The home also offers day care services for two people and care plans have been compiled for them. Appleton Lodge I55 s27407 appletonlodge v244155 050905 stage 4.doc Version 1.40 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 standard(s) 12, 13, 15, 16 and 17 The home continues to provide opportunities for residents to develop new skills, residents’ abilities are encouraged and promoted and the menu remains comprehensive with healthy options. EVIDENCE: Some residents advised they have been attending college, they participate in keeping the home clean and tidy and they sometimes help in the kitchen preparing snacks and meals and join in organised activities as they wish. Residents are encouraged to obtain employment in the local community, and are supported by staff. Residents have also been going out in the local area with staff support, or unaccompanied if they are able. The home has recently installed a new commercial style gas cooker which the residents use as needed. The home has a full menu and special diets are well catered for, meals are prepared from fresh ingredients and are taken wherever and whenever the residents wish. Appleton Lodge I55 s27407 appletonlodge v244155 050905 stage 4.doc Version 1.40 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 standard(s) 18 Residents receive good support enabling them to maintain and manage their physical and mental healthcare needs. EVIDENCE: Staff advised that care is very much tailored to meet the residents’ needs and they work closely with the residents to help them overcome and manage their often complex problems and illnesses. How residents are to be supported is made clear in their care plans and evidence was also seen here of improvements being made to residents’ mental and physical health. Appleton Lodge I55 s27407 appletonlodge v244155 050905 stage 4.doc Version 1.40 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not assessed at this inspection. EVIDENCE: Appleton Lodge I55 s27407 appletonlodge v244155 050905 stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 The home is clean but the décor is now looking tired and worn. EVIDENCE: A tour of the premises was made, no improvements have been made to the décor for sometime and some areas are looking a little tatty. The proprietors advised that as work has been carried out on the home they are having built next door, some areas within Appleton Lodge have yet to be attended to. However, the proprietors advised that new carpets throughout the corridors and stairs are to be laid very soon, that plastering to cover artex on various walls will be completed shortly and a new kitchen is to be installed. In view of the proposals to make improvements to the décor, no requirements or recommendations are made at this time. The manager advised that some alterations would be made to the existing bathrooms and that at the present time one bathroom cannot be used. Bedroom accommodation has also been changed, and the double room is currently being used as a single room, and the staff sleep in accommodation has been converted to a resident’s bedroom. Appleton Lodge I55 s27407 appletonlodge v244155 050905 stage 4.doc Version 1.40 Page 14 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) 33 The home provides adequate staffing levels that are currently meeting the needs of the residents. EVIDENCE: Two care staff, the manager and a cleaner were on duty at the time of the inspection. Two further members of care staff came on duty at 1pm and this made an overlap of four staff plus the manager. Staff were spending the majority of their time with the residents and a good rapport was seen between them. Residents confirmed that they were satisfied with the numbers of staff on duty and that there was always someone around to help. Currently having two people attending the home for day care is not having a detrimental effect on the staffing levels and staff are well able to manage the needs of all residents. Appleton Lodge I55 s27407 appletonlodge v244155 050905 stage 4.doc Version 1.40 Page 15 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) Not assessed at this inspection. EVIDENCE: Appleton Lodge I55 s27407 appletonlodge v244155 050905 stage 4.doc Version 1.40 Page 16 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 3 x x x Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Appleton Lodge Score 3 x x x Standard No 37 38 39 40 41 42 43 Score x x x x x x x I55 s27407 appletonlodge v244155 050905 stage 4.doc Version 1.40 Page 17 None 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 Regulation Requirement Timescale for action 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 6 Good Practice Recommendations The Registered person is recommended to keep care plans updated with information about wound care and to record detail of residents emotional, psychological and social needs. Appleton Lodge I55 s27407 appletonlodge v244155 050905 stage 4.doc Version 1.40 Page 18 Commission for Social Care Inspection 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
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