Inspection on 06/06/05 for Appleton Manor

This inspection was carried out on 6th June 2005.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Appleton Manor 18/07/07

Appleton Manor 06/09/06

Appleton Manor 07/02/06

Appleton Manor 27/01/05

Appleton Manor 17/06/04

Appleton Manor 20/01/04

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 Manor Lingard Lane Bredbury Stockport SK6 2QT Lead Inspector Sylvia Brown Announced 6 June 2005 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 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 Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Appleton Manor Address Lingard Lane, Bredbury, Stockport, SK6 2QT 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) 0161-406-7261 0161-406-8962 Southern Cross Healthcare Services Ltd Mrs P Greenfield CRH Care Home 59 Category(ies) of DE Dementia (41) registration, with number DE(E) Dementia - over 65 (33) of places OP Old age (59) PD Physical disability (41) PD(E) Physical disability - over 65 (15) Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: No more than 26 places can be used for nursing care. No service user may be received in the home who is less than 50 years old, male/female, described as Physical Disability. Date of last inspection 27 January 2005 Brief Description of the Service: Appleton Manor Nursing Home is owned by Southern Cross Health Care limited. The home shares its grounds with Appleton Lodge, which is also owned by the same company. Appleton Manor is located on the borders of Brinnington and Bredbury and is close to local amenities, with convenient access to public transport and motorway networks. The home offers nursing care for up to 26 people. In addition, the home is registered to care for up to 33 people who have a physical disability and dementia. Accommodation is spread over two floors offering single en-suite bedrooms. One double room is provided for service users wishing to share. The first floor, called the Brinnington unit, accommodates service users who have dementia. The ground floor accommodates service users who require nursing and residential care and is called the Bredbury Unit. The units will be identified by name within the inspection report. Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of Appleton Manor was announced and conducted over two days, starting at 8am on the first day and 12pm on the second. A total of 10.5 hours were spent on the premises. Two regulation inspectors and a pharmacy inspector evaluated various parts of the service. Time was spent with residents, looking at records and watching how staff conducted themselves and supported residents. Time was also spent with residents at meal times. The inspection mainly looked at the care of residents on the Brinnington unit which specialises in providing care and accommodation to people who have diagnosed dementia. Comment cards were provided to a selection of residents, relatives and medical professionals involved in the home. Eight were returned from residents, four from relatives and one from a medical practitioner. What the service does well: The health care needs of residents are met appropriately. Direct nursing tasks were completed to the appropriate standard for those residents who required nursing. Other residents received health care support from a number of health care professionals. The home offers good size accommodation and is able to meet the needs of residents. Residents are able to freely walk around the home and enjoy the many seating areas available. The independence of most residents is promoted, with some continuing to make their own decisions about where they wish to spend the day, their daily routines and what time they get up and go to bed. The registered manager ensures that where the needs of residents cannot be met by the home, support and advice are given to find an appropriate alternative placement. Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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 Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 & 5 Prospective and current residents are provided with sufficient information to enable them to make informed choices. EVIDENCE: Records showed that prospective and current residents received information about the home to enable them to make informed decisions about their stay. Comment cards indicated residents were consulted about their care needs and that they were able to make decisions for themselves. Residents’ files contained contracts and assessments of need. Newly admitted residents’ files contained information about the registered manager’s visit to them prior to being accommodated and whether they had visited the home to evaluate the services on offer before making any decisions about moving into the home. Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Residents’ care plans did not detail all their needs. Medication management systems were not adhered to. Residents were treated with dignity and respect. EVIDENCE: Care plans were in place, however one resident’s record on the Brinnington unit, who had specific behavioural difficulties, failed to record aspects of the resident’s condition and care support required. Such omission has the potential of not meeting the resident’s needs. On the Bredbury Unit the care plans did not give full details of the interventions required and although they had been regularly updated, some had not been re-written, despite significant changes in need. Risk assessments and care plans gave contradictory information in some cases. Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 10 Seven of the eight comment cards from residents stated they felt well cared for. One doctor’s comment card stated that the home communicates well with them regarding the health care needs of the residents and that it provides a high standard of care. Relatives confirmed they are able to meet the resident in private and that they felt residents were well cared for. Residents were observed to be in the main treated with dignity and respect. Records failed to accurately identify all medicines received into the home, that the homely remedies policy and procedure was adhered to and that medicines no longer required were returned to the pharmacist. Other shortfalls identified that the home was operating below the required standard for the management and administration of medicines. A separate report has been sent to the home regarding the requirements made. Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Residents on the Brinnington Unit do not have sufficient opportunity for daytime occupation and social interaction. The delivery and serving of hot breakfast items for the Brinnington Unit were not satisfactory. Some residents did not have a sufficient choice at meal times. Activity and stimulation were not provided for all residents. EVIDENCE: Whilst the home produces a variety of activities it does not ensure the residents on the Brinnington Unit have sufficient social interaction or daytime occupation. TV viewing and music was provided during the days of the inspection, however most residents were observed to be sleeping in chairs. On the day of the inspection an entertainer was on the Bredbury Unit, however only three of the 31 residents on the Brinnington unit attended the festivities. The unit manager stated she had not had sufficient notice to prepare for the entertainer nor had she sufficient numbers of staff to provide support for more than the three who attended. Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 12 When asked about the provision of daily activities and routines, care staff stated residents generally slept during the day as they were awake at night. Although it is not clear which unit one resident came from, a comment card received stated “There is not a lot to do activity wise, so I get very bored which gets me down”. Another one indicated that the home does not provide enough suitable activities. Three others commented that sometimes there were suitable activities provided. Records failed to identify that residents received enough daily occupation or social stimulation. The home’s activities co-ordinator and staff have not received any specialist training in meeting the occupational or social needs of residents who have dementia. Three mealtimes were shared with residents. The breakfast routines on the Brinnington unit were unsatisfactory. The inspector was informed that hot breakfast options were available for all residents, however it became apparent that early risers were not offered hot food. Furthermore, a fried egg was left on a plate prior to the resident being ready, porridge was delivered by kitchen staff and left on the side, to be given when required. For enjoyment and safety, food must be served at the appropriate temperature. On the second day of the inspection residents received the same meal they had had the day before. Staff stated they ordered the meal for residents who have limited capacity. Staff did not take the opportunity to look at the meals served on the previous day to ensure residents did not receive the same meal. One resident, who refused to join others at lunch-time, was not offered the opportunity of receiving her meal where she was seated. No arrangements were made to ensure she received her main meal at a later time; rather, sandwiches were provided. The serving of drinks was also insufficient. Early risers did not receive the opportunity of hot drinks until approximately 10:30am. Fluid intake charts failed to confirm that residents received sufficient fluids. Some records stated residents’ last drink was 7:30pm with the next being 10:30am the next day. The Brinnington unit is secure, preventing residents from having free access to other parts of the home or to the outside. Some residents were supported by their family to visit outside places of interest. Visiting is unrestricted and residents can receive visitors in private. All comment cards received from relatives stated they were made to feel welcome and where residents were unable to make informed choices, they were consulted about their care. Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 17 Residents were protected from abuse. Appropriate action is taken to positively resolve all complaints received. EVIDENCE: The home has written complaints and adult protection procedures in place. Records identified that where a suspicion or allegation of abuse is known, appropriate action is taken to investigate and protect the resident. The pre-inspection questionnaire stated that the home has received six complaints within the previous 12 months, four of which where substantiated. One complaint has been received by the CSCI which had been investigated previously. Inspection of records again confirmed that the home has taken appropriate action to, as far as possible, rectify issues relating into breaches of confidentiality and the use of mobile phones by staff when on duty. All residents’ comment cards stated that they felt safe and that they had a person to speak to if they were unhappy with any part of the service. Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 23, 24 & 26 The Brinnington Unit is not maintained appropriately. Other areas of the home are well maintained. EVIDENCE: During both days of the inspection, there were strong odours within the Brinnington unit. Domestic routines are in place, however they are unable to eradicate the odours within the unit. Two bedrooms had damaged plaster in the en-suites. Paintwork in the corridors is badly damaged and shows clear signs of wear and tear. Lounge seating in some areas requires replacing. The flooring in a number of en-suites, bathing and toileting areas was stained. One lounge has been upgraded and looked a relaxing and inviting place for residents to sit during the day. Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 15 One kitchen area has a refrigerator with a broken top, whilst another kitchen looked shabby, having received basic maintenance to make it usable. The Bredbury Unit which is for the care of those with nursing needs, is maintained to a higher standard which is not shared on the Brinnington unit. This matter has been brought to the attention of the company on a number of previous occasions. Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 The home has robust recruitment and selection procedures in place for the protection of residents. The home employs sufficient numbers of staff who are experienced and trained. EVIDENCE: Staff were in sufficient numbers to meet the needs of residents. The duty rota indicated that, as far as possible, staffing numbers exceed that expected by the local authority. Staff files identified that they were recruited correctly and that appropriate statutory checks were made for all levels of staff. Foreign staff have additional checks made and, where required, documents and references are translated into English. All new staff receive initial induction where they shadow experienced staff, they then complete a six week and six month induction programme. Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35 & 38 Appleton Manor is a well managed home. Residents’ health, welfare and safety is promoted and protected. EVIDENCE: The manager has been in post for a number of years and is qualified to manage a care home. Training records confirm she continues with her training and minutes of staff meetings and other records demonstrate she has a strong leadership style. The pre-inspection questionnaire stated that all equipment is serviced and maintained appropriately for the safety of residents and that residents’ finances are, in the main, managed by themselves or others. Fire safety officers inspected the premises on 7th May 2005. Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 18 The home confirmed that requirements and recommendations made have been met. All accidents are recorded and evaluated. The home keeps the CSCI informed of all accidents and incidents occurring within the home and seeks appropriate advice when required. A company representative visits each month to evaluate the day to day running of the home and, as required, a report of each visit is provided to the CSCI. Quality assurance procedures are in place. Although some residents would prefer to be in their own home, comment cards stated that they felt well cared for and safe at Appleton Manor. Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION 2 2 x x 3 3 x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x 3 x 3 x Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 25 Regulation 23(2)(p) Requirement The registered person must take appropriate action to replace and/or repair the current cooling system on the Brinnington unit and ensure that residents and staff have acceptable working conditions. (Timescale of 15/8/04 not met). The registered person must undertake full quality assurance procedures which comply with Regulations 12 and 24 and standard 33. (Timescale of 1/12/04 not met). The registered person must ensure that care plans contain all the care needs of residents and how they are to be met. Risk assessments and care plans must not contain contradictory information and required actions. The registered person must ensure that all residents with mental fraility are provided with daytime stimulation and occupation suitable to meet their specialist needs. The registered person must ensure that food is delivered to the units in an appropriate manner and at the correct Timescale for action 01/10/05 2. 33 24 01/10/05 3. 7 15 15/07/05 4. 12 16(2)(m) 01/08/05 5. 15 16 (2)(J) 15/07/05 Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 21 temperature. 6. 15 16(2)(i) The registered person must 15/07/05 ensure that residents receive variety and choice at meal times and that staff are aware of meals served previously when ordering on residents behalf. The registrered person must 31/06/05 ensure that all residents receive sufficient drinks in line with their needs and preferences. The registered person must 30/07/05 undertake a full assessment of the Brinnington unit and produce an action plan that must be supplied to the CSCI detailing all individual rooms and action to be taken to ensure that the environment is maintained to the correct standards. Timescales should be included and, where required, negotiated with the CSCI. 7. 15 16(20)(i) 8. 19 & 20 23(2)(b) (d) 9. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 12 15 Good Practice Recommendations The registered person should consult with occupational specialists who know how to meet the social and occupational needs of those with mental health frailities. The registered person should investigate how the main kitchen is managed and ensure that staff routines are based around residents choice and not their own convenience. The registered person should ensure that residents are given the opportunity to decide, as far as possible, when and where they wish to eat their meals. 3. 15 Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 2nd Floor Heritage Wharf Portland Place Ashton under Lyne, OL7 0QD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Appleton Manor F54 F04 appleton manor A s17288 v222973 060605 stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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