Inspection on 07/02/06 for Appleton Manor

This inspection was carried out on 7th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found 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 06/06/05

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 Cheshire SK6 2QT Lead Inspector Sylvia Brown Unannounced Inspection 7th February 2006 10:30 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 Manor DS0000017288.V281408.R01.S.doc Version 5.1 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 Manor DS0000017288.V281408.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Appleton Manor Address Lingard Lane Bredbury Stockport Cheshire SK6 2QT 0161 4067261 0161 4068962 appletonmanor@schealthcare.co.uk 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) Southern Cross Healthcare Services Limited Mrs Pamela Greenfield Care Home 59 Category(ies) of Dementia (41), Dementia - over 65 years of age registration, with number (33), Old age, not falling within any other of places category (59), Physical disability (41), Physical disability over 65 years of age (15) Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 6th June 2005 Date of last inspection 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 DS0000017288.V281408.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of Appleton Manor was unannounced. The inspector spent five hours on the premises and spoke with one resident, observed the care of two residents and evaluated care files and records. The inspection was primarily focused on the practices of the Bredbury unit which provides support to residents who require nursing care. To obtain a full view on how the home is operating, the reader is advised to read this report in conjunction with the report of the inspection undertaken in June 2005. What the service does well: What has improved since the last inspection? What they could do better: There were gaps in the recordings in fluid, positional change charts and personal care records, they did not sufficiently demonstrate that care support was being provided at the required frequency. Laundry facilities were inadequate and systems compromised infection control procedures. Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 Page 6 Temperature control within the building is unmonitored and, at times, the home is too hot or cold. Due to staining and/or odours, parts of the home continue to require replacement carpets. Redecoration would be of benefit in some areas. Systems are not evident for the monitoring of staff practice and assessing their competencies. Formal supervision is outstanding. 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 DS0000017288.V281408.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 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 the following standard(s): The core standards were assessed at the last inspection. EVIDENCE: Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 & 10 Residents’ care needs are known and recorded, and their health care needs are met. EVIDENCE: The home completes health care assessments on all residents. The outcomes of those assessments form the basis for the residents’ individual care plans. Care plans are in-depth and detail all the residents’ needs and how they should be met. The home maintains fluid intake charts in order to ensure residents are receiving sufficient fluids, however the charts were inconsistently maintained, as were positional changes charts. There were no management systems which ensured the monitoring of records to enable the timely identification if care support is failing or not being completed as required. Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 Page 10 Observations on the day of the inspection were that residents did receive the correct support; however, for their safety and comfort, records must demonstrate accurately health care routines and support. Professional health care visits are recorded and any changes to medication are noted. Residents receive chiropody treatments and have routine optical, dental and, where required, hearing tests. Medication administration was completed to the required standard as were medication administration records. One resident commented that they felt well cared for and looked after. The resident was able to talk about their care needs and support required and confirmed that staff were “very caring” and “thoughtful”. Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14 & 15 Residents are supported to make day-to-day choices, to receive visitors and have the opportunity to socialise. Meals and mealtimes are enjoyable with a varied and nutritious menu. EVIDENCE: Residents’ social preferences are recorded. They have daily opportunities to socialise and meet with each other. Residents are able to receive visitors when they wish and in private. Some residents continue to go into the community and spend time outside of the home. Records demonstrated that residents are consulted about their personal preferences and are able to make decisions about their rising and retiring routines and where they wish to spend the day. Some residents were observed preferring their own rooms whilst others sat in communal areas. One mealtime was observed. Residents received a variety of food options which suited their personal preferences. One resident stated that they could choose alternative options if the main meal was not desired. Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 Page 12 The inspector was able to observe staff supporting residents with one to one assistance at meal times. The soft diet served was mixed together, preventing the individual tastes of the food to be experienced. Such practice minimises the pleasure for residents and, in some instances, reduces the nutritional value of the food. Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 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 the following standard(s): 18 Residents are protected through effective adult protection procedures. EVIDENCE: Adult protection procedures are in place. The registered manager and senior team have completed Alerter training, which identifies the procedures to be followed when suspicions or allegations of abuse are made. Staff have commenced up to date adult protection training. Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 The home is clean and presentable with some upgrading required in parts. The laundry is inappropriately equipped to meet the demands of the home and systems compromise infection control procedures. EVIDENCE: Initially, the home presents itself as well maintained, however a number of carpets require replacing due to odours and staining. Furthermore, redecoration in some areas would be beneficial. A previous requirement to complete a full assessment of the home which identifies where replacement and upgrading is required has not been competed, neither has a plan of action been submitted to the CSCI. Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 Page 15 Residents’ rooms were personalised according to their individual tastes and preferences. All rooms had a selection of items brought from their own home. One resident has her own budgerigar. All rooms contained aids and adaptations to meet residents’ individual health care needs. Parts of the home felt cold, rooms failed to contain thermometers, therefore temperatures could not be identified or monitored. In summer months and warmer weather, the home becomes excessively overheated. This issue has been brought to the attention of the Company on a number of occasions and requirements have been made. The home’s infection control procedures are not followed when managing residents’ clothing and linens. Observation of the laundry identified that soiled quilts had been transported to the area uncovered and left for several days without being covered. There were no written procedures to guide staff on how to manage and launder clothing for residents with infections such as MRSA. Laundry from Appleton Manor and Appleton Lodge are brought to the laundry separately, however they become mixed when laundry procedures begin. A rack of unlabelled clothing was evident, but who they belonged to or which home could not be determined, culminating in long delays occurring before they could be returned to the correct resident. The inspection of the laundry area was undertaken after lunch time. A high number of washing baskets were waiting to be attended to, some of which had been there more than two days. One washing machine was observed to be out of order. Staff reported that it had been out of order for some considerable time, culminating in the remaining machines being unable to cope with the demand and washing not being completed in a timely manner. Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 28 The home employs sufficient numbers of care staff who are experienced and trained. There are insufficient dedicated laundry staff. EVIDENCE: The rota identified that staff are provided in sufficient numbers to meet the needs of residents. A resident stated that call bells are responded to appropriately and that staff were attentive and kind. A member of staff was able to explain the process undertaken for her recruitment and selection which included the provision of required documents and statutory checks being completed prior to her commencement. Induction procedures are in place and training is completed on a rolling programme. Staff on duty confirmed they had received up to date moving and handling training and that fire safety procedures were known. It was evident that staffing levels in the laundry were insufficient to meet the needs of the two homes which were provided with a service. At the time of the inspection 37 hours per week to man the laundry were provided. The laundry person stated that when time is available she receives support from other ancillary staff but she could not always clear the dirty laundry within her duty span. Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34 & 36 The home is well managed. Formal supervision and direct monitoring of clinical practices is not undertaken. EVIDENCE: Residents’ rights are protected by effective procedures which ensure income and expenditures are recorded. Where residents require additional support, advocacy and legal services are provided. Though the home consults with residents it does not complete quality assurance procedures, as detailed within Regulation 27 and standard 33. Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 Page 18 The nurse on duty confirmed that whilst she conducted supervision, all staff had not received it at the recommended frequency. Furthermore, she had not received supervision herself and her clinical practice had not been assessed or monitored by the home. Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 3 3 3 3 3 2 2 STAFFING Standard No Score 27 2 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 3 X 2 X X Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 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 OP19 Regulation 23(2)(b) (d) Requirement Timescale for action 01/04/06 2. OP25 23(2)(p) 3. OP25 23 The registered person must 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. (Previous timescale of 30/07/05 not met). The registered person must take 01/05/06 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. (Previous timescales of 15/8/04 and 01/10/05 not met). The registered person must 01/03/06 ensure that rooms used by residents are maintained at an appropriate temperature. Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 Page 21 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. 4 Standard OP26 Regulation 16 Requirement Timescale for action 01/04/06 5. OP27 18 6. OP33 24 7. OP36 18 The registered person must, after consultation with environmental health and PCT, ensure that infection control procedures relating to the management of MRSA are developed and know that all staff within the home follow infection control procedures. The registered person must 01/04/06 ensure that dedicated laundry staff are employed to meet the demands of the homes provided with a service from the laundry. The registered person must 01/06/06 undertake full quality assurance procedures which comply with Regulations 12 and 24 and standard 33. (Previous timescales of 1/12/04 and 01/10/05 not met). The registered person must 01/05/06 ensure that staff receive formal supervision and have their competencies assessed. Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 Page 22 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 OP7 Good Practice Recommendations The registered person should ensure that all required charts are completed appropriately and evaluated to ensure residents’ health. Appleton Manor DS0000017288.V281408.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs 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 DS0000017288.V281408.R01.S.doc Version 5.1 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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