Inspection on 08/02/07 for Appleton Lodge

This inspection was carried out on 8th February 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 found no outstanding requirements from the previous inspection report, but made 2 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 15/12/05

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 Maggie Prettyman Unannounced Inspection 8th February 2007 09:00 Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 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.V330151.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 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.V330151.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Appleton Lodge Address Bath Hill Terrace Great Yarmouth Norfolk NR30 2LF 01493 843720 01493 334380 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) 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.V330151.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 15th December 2005 Brief Description of the Service: Appleton Lodge is a semi 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. The range of weekly fees for services is £307 - £491. Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out using information from previous inspections, information from the providers, the residents and their relatives as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the home and current judgements for each outcome group. What the service does well: What has improved since the last inspection? Individual plans of care are now written with people shortly after they move into the home. Lots of changes to the system of medication have made it safer and easier to administer. Appleton Lodge has also improved the way that it checks out staff to make sure that the right people come to work there. There has been considerable work done in the building as it has been rewired and a new fire alarm system put in. Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 Page 6 What they could do better: Two requirements and seven recommendations have been made at the end of this report. Requirements; • • All notifiable incidents must be reported to the commission without delay. Mandatory training for all staff must be kept up to date Recommendations; • • • • • • Nutritional screening may benefit some service users A staff rota should be available to residents Notes about health care needs should be kept separately Concerns, minor complaints and compliments should be recorded Supplementary adult protection training should be given to staff. Details of workers car insurance should be checked by the home 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 DS0000027407.V330151.R01.S.doc Version 5.2 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.V330151.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Prospective service users’ individual aspirations and needs are assessed Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of service users files demonstrated that detailed needs assessments are conducted for service users prior to their coming to live at Appleton Lodge. Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 8 and 9 Service users have their changing needs and personal goals reflected in an individual plan of care. 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 Page 10 EVIDENCE: Examination of service users files demonstrated that individual plans of care are put in place soon after people come to live at the home. This is an improvement since the last inspection. Discussion with service users, as well as observation of service users lifestyles and their interaction with care staff demonstrated that service users are supported and enabled to make personal and individual decisions in their daily lives. Discussion with service users and observation of records and notice boards demonstrated that service users participate in the daily running of the home. Regular residents meetings and independent quality surveys support this process. Examination of individual service user files showed that detailed and supportive risk assessments are made with the input of service users to enable them to live freely and to take supported risks in all aspects of their lives. Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 14, 15, 16 and 17 Service Service Service Service Service Service uses take part in activities that suit them. users are part of the local community. users enjoy leisure activities as they wish. users have good relationships with their family and friends. users daily lives include their rights and responsibilities. users are offered a healthy diet and enjoy their food. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 Page 12 EVIDENCE: Discussion with care workers and service users showed that service users exercise choice about work and educational opportunities. Service users are also supported to access the benefits available to them. Care staff said that people living at Appleton Lodge enjoy good relationships with their neighbours and the local community and shops. Postal votes were offered to service users at the last election. Service users were observed going out into the community confidently and happily during the course of the inspection. Records of activities undertaken demonstrated that service users enjoy a wide variety of community-based activities. A community outreach worker supports many of these activities, but all care staff are actively engaged in outside activities with service users. Care workers said that service users relationships with their family and friends are good. Service users relationships are given privacy and respect by the home and its staff. Observation of care practice demonstrated that the home offers individual routines with choice and freedom. Service users have keys to their own rooms and freedom of access to the home. Service users reported that they choose what they eat and whether they wish to be involved in its preparation. A good range of snack food is available at all times. Information about MUST Nutritional screening was left in the home by the inspector. It is recommended that the home consider looking at the benfits of implementing the MUST nutritional screening tool. Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Service users receive personal support in the way they prefer and require. Service users physical and emotional health needs are met. Service users are protected by the homes’ medication policies and procedures. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observation of interaction between care staff and service users as well as discussion with both groups demonstrated that privacy, dignity and control are maintained for service users in all aspects of personal care and support offered. A key working system further supports this process. Service users do not always have direct access to the staff rota. It is recommended that a staff rota is displayed on a notice board accessible to service users at all times. Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 Page 14 Service user files demonstrate that individual healthcare plans are in place for all service users. It is recommended that daily records kept record health care progress separately to personal and lifestyle notes for ease of access and review. Change and improvement to the system of medication at the home has been made following the requirements and recommendations of the previous report. As a result the system of medication at the home is much improved and is safe and well managed. Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Service users feel that their views are listened to. The home may benefit from further adult protection training. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Regular residents meetings and an annual quality audit mean that service users are able to express their views and concerns. No formal complaints have been made about the home since the last inspection. It is recommended that the home would benefit from recording day-to-day minor complaints and concerns, as well as compliments so that patterns and trends of satisfaction can be identified. Adult protection training is covered in-house by the providers and through NVQ training. However, one incident that may have been reportable was dealt with by the home internally. It is required that all notifiable incidents are reported to the commission without delay. It is recommended that the home provide supplementary adult protection training to all staff, particularly those who have not yet gained NVQ. Improvements in the vetting of new staff have been made following the requirements of the previous inspection report, ensuring that service users are now properly protected by these systems. Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Service users live in a homely, comfortable and safe environment. The home is clean and hygienic. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises and an invitation by service users to view their rooms demonstrated that the home is homely and comfortable, and that service users have their personal belongings around them. Following fire officer recommendations the home has been rewired and a new fire system installed. This work has left the home in urgent need of redecoration. Work toward this was seen on the day of inspection, and a full programme of refurbishment is planned once rewiring work is complete. The home was observed by the inspector to be clean, pleasant and hygienic. Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Service users are supported by competent and qualified staff. Service users are supported and protected by the homes’ recruitment policy and procedures. Some staff training needs are not being fully met by the home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 Page 18 EVIDENCE: Information provided in the pre inspection questionnaire demonstrates that a good proportion of care workers are NVQ 2 or 3 qualified or working towards their qualification. The inspector was particularly impressed by the warm, friendly and professional interaction of care workers with service users. Following requirements made during the last inspection staff files examined demonstrated that staff vetting has significantly improved. A copy of “Safe and Sound” the Commissions’ good recruitment practice guide was given to the home during the inspection. The home does not routinely ask for car insurance details from outreach workers. It is recommended that the home obtain a copy of workers car insurance details if they are involved in transporting service users in their own cars. Examination of training records kept by the home demonstrated that some shortfalls in mandatory training might occur. It is required that all mandatory training is kept up to date, in relation to workers working alone or at night. Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 Service users benefit from a well run home. An independent quality assurance procedure is in place. The home may benefit from reviewing the way in which its records are kept. The health, safety and welfare of service users and care workers are promoted and protected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 Page 20 EVIDENCE: The inspection took place on a day of particularly bad weather, which prevented the registered manager being available. However, staff present in the building demonstrated themselves to be competent and confident in presenting information required by this detailed key inspection, and are to be commended for their help and professionalism. An independent person conducts an annual quality survey. The most recent survey has been conducted, and is in the process of being compiled. Examination of records kept by care workers demonstrated that great care and attention to detail is taken in recording all aspects of service users lives. However the system has much duplication and is, consequently, time consuming. In addition the way that information is presented makes it difficult to review. Records of significant incidents are kept, but those requiring notification to the commission are not always reported. It is required that all notifiable incidents are reported to the Commission without delay. A tour of the premises demonstrated that the home is safe and that hazardous substances are correctly stored. Issues relating to shortfalls in mandatory training have been raised elsewhere in this report. Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 Page 21 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 3 2 X Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 Page 22 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 2 Standard YA23 YA35 Regulation 37 13.4 Requirement All notifiable incidents must be reported to the Commission without delay Mandatory training must be kept up to date, particularly in relation to staff working alone or at night. Timescale for action 15/03/07 30/04/07 Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 Page 23 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 4 5 6 Refer to Standard YA17 YA18 YA19 YA22 YA23 YA34 Good Practice Recommendations The home could investigate whether the use of MUST nutritional screening would be of benefit to its service users. A staff rota should be accessible to service users at all times. Separating out health care notes in service user files would make them easier to access and review. Minor concerns, complaints and compliments about the service could be recorded to enable patterns and trends to be identified. Supplementary Adult protection training would benefit the home and its service users Details of car insurance held by care workers transporting service users in their own cars should be taken by the home. Appleton Lodge DS0000027407.V330151.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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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