CARE HOMES FOR OLDER PEOPLE
Appletree Care Home Frederick Street Meadowfield Durham DH7 8RT Lead Inspector
Mr Peter Bentley Unannounced Inspection 1st December 2005 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 Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 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. Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Appletree Care Home Address Frederick Street Meadowfield Durham DH7 8RT 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) 0191 3783152 0191 3789080 Maria Mallaband Care Homes Limited Shannette Isobell Render Care Home 48 Category(ies) of Dementia (17), Old age, not falling within any registration, with number other category (38), Physical disability (15) of places Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Physical Disability: Up to 15 persons with a physical disability (over the age of 55 years) may be accommodated, commensurate with the home`s statement of purpose. Dementia: Up to 17 persons with demnetia (over the age of 60 years) may be accommodated, commensurate with the home`s statement of purpose. 5th November 2004 2. Date of last inspection Brief Description of the Service: Appletree Residential Care Home cares for up to 48 older people. It is one of a number of care homes owned and managed by Maria Malaband Limited. The home is situated just off the A690 Durham to Crook road in the village of Meadowfield and is about 3 miles from Durham City center. There is a drive of about 50 metres into the home from the public road. Adequate parking space is available outside the home. There is a regular bus service into Durham. The home is a modern two storey building with two passenger lifts for the use of residents. There is an enclosed garden space for the use of residents. All rooms have en suite toilet facilities. Residents are encouraged to bring with them small personal items to make their room as nice as possible. Residents can have their own external telephone line installed should they wish. Six lounges are available for the use of residents (four of which have televisions). A hairdresser visits the home weekly and a separate room is set aside for this. As part of the building there is a separate facility (the Acorn suite) specifically intended for people with dementia. Access to this area is controlled by a keypad on the doors. Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was carried out over one and a half days, in early December 2005. The last Inspection was carried out in November 2004. Evidence was gathered by watching staff with residents, discussions with members of staff, reading some documentation, and interviews with residents and relatives who happened to be visiting during the inspection. Appletree is run by a very dedicated manager. It was very clear during the Inspection that she saw her job as running the home for the benefit of the residents in a way that maintained their independence and dignity as much as possible. There was evidence that the manager was trying to make sure that all her staff shared this culture. A resident said “ they know I can be a little bit independent….I like being independent.” The home was obviously a ‘happy’ home with frequent staff smiles seen during the inspection (the ‘happiness’ of the home was checked by talking to both residents and visiting relatives). It was clear from the evidence that residents and relatives liked the home, and the attitude of the staff, particularly the way in which residents were encouraged to be independent and their dignity looked after. A relative of a resident said “…he has been incredibly happy here …this is where he lives now.” Further improvement was possible on keeping files up to date, staff training, consideration of providing two chairs in each residents room, and considering organising regular trips out for residents (particularly in the summer). What the service does well:
About nine hours was spent on the inspection over one and a half days. In addition to about two hours preparing for the inspection. A tour of the home was conducted and discussions took place with the manager and her manager (on the second day). Three residents were interviewed in some depth and briefer talks took place with a further two residents. Discussions with two relatives who happened to be visiting also took place. Some further evidence was collected from fifteen questionnaires filled in by residents and one returned by a visiting relative. How the staff related to residents was also watched. A small number of case files of residents, and some policies and procedures of the home were examined. Two recent monthly audits of care plans conducted by the manager
Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 Page 6 were looked at. The results of an internal quality assurance survey were examined. A ‘hand over’ meeting of the staff was attended as was a monthly meeting of the manager, residents and relatives. The home had systems and policies in place that met the requirements required by the government in the areas looked at. The home was a happy place for its residents. Visiting relatives commented on the happiness and feeling of home life that their relatives experienced there. Efforts were made to maintain and respect a residents independence and dignity. Standards of hygiene and cleanliness were high. The food provided was regarded by residents and relatives as good. The building was modern and its grounds were pleasant and appeared well cared for. Although the managers own recent audit had shown that some records were not fully up to date she was intending to correct this. It was impressive that the manager was aware of areas where further progress was possible and was working on ways this could be achieved. What has improved since the last inspection? What they could do better:
It is recommended that consideration be given by the home to the provision of two chairs in each residents room. If there were comfortable seating for two people in each residents room this would mean that residents can entertain a guest in their room without the necessity of one person sitting on the bed. This would give residents more choices in where to meet their visitors and other guests in comfortable and ‘home like’ surroundings. Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 Page 7 It is recommended that the monthly audit conducted by the manager includes target dates for putting right the problem, the name of the person who is to be in charge of putting it right, and the date when it was put right. It is recommended that consideration be given to organising regular trips out (particularly in the summer) to the seaside or other places of interest that the residents select. One way to help with this would be to give the activities coordinator the opportunity to talk to other activity coordinators in other homes run by the same owners in order to share knowledge of resources etc. The registered manager should take steps to ensure that she is awarded as soon as possible her qualification. Priority should be given to increasing the number of care staff who are qualified to the level specified in the relevant Standard. At present it is understood that the manager estimates the number so qualified to be about 25 compared to the 50 required by the Standard. This issue will be looked at again at the next unannounced inspection. 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. Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 The needs of a potential resident of the home are adequately assessed and recorded prior to admission, by either the registered manager or her deputy. A plan for daily living is made and set out in the residents file. EVIDENCE: The records of three residents who were recently admitted to the home were examined. All contained evidence that the needs of the potential resident had been looked at prior to admission. The manager stated that she visited potential residents prior to a decision about admission “wherever they are… at home or hospital”. There was evidence that letters are written to relatives of potential residents saying that the home can meet the assessed needs of the potential resident. One of the residents said that before admission the manager “had come out and asked me a few questions”. Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 Page 10 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): Standards 7,10 Both theses standards were complied with. The care plans of residents set out their needs and the inclusion of a brief ‘life story’ encouraged the resident to be seen by the staff as an individual, with a past life, which helped to ensure that their identity and personality were respected. It was clear that dignity and respect for residents was something that was important to the staff and equally that the staff, led by a very able and motivated manager, were working towards the goal of excellence in all their work with and on behalf of residents. EVIDENCE: Evidence was obtained by reading care plans, reading returned questionnaires and talking to residents and relatives. A relative of a resident commented: “I think it (the home) is really well run”. I feel he is safe here and the girls treat him with respect. A resident said “ you’re well respected here with the staff”.
Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 Page 11 However another resident was concerned about an incident that she said had happened to her concerning the tone of voice used by a member of staff towards her. It should be noted that this was the only negative comment about the attitude of care staff made by any of the 3 residents or 3 relatives spoken to during the inspection. The manager was clearly aware of this incident and said that she had taken appropriate action. Another resident said “(the) staff treat me very good….(they) help you any way they can…….I know they are busy but they try and help you…its not an easy job for them either” A relative said “the staff make it feel as close to a home as possible as opposed to a residential home”. Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 Page 12 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): Standards 12,13,14 Residents social, cultural and religious needs are met. Residents are supported to maintain contact with the friends and families and are able to exercise choice and control over their lives. EVIDENCE: Standard 12 A relative said that a residents religious preferences were met by a weekly service held at the home. A relative thought that further opportunities could be made available to residents to get out of the home more particularly in the summer by organising for example coach outings to the seaside or other places of interest. This matter was discussed (amongst others) at a residents and relatives meeting. The manager said at the meeting that she would explore this matter further. Standard 13 A resident commented…”its ok for relatives and welcoming”. The evidence from relatives spoken to was that the care staff were always welcoming. A relative said that “access to relatives was fantastic” and that “staff are frank, they keep us informed, my relative is safe here”
Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 Page 13 Standard 14 There was evidence from the manager, residents and relatives that residents are able to exercise choice and control over their lives. There was evidence that there is a commitment to helping residents lead fuller lives. Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 Page 14 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): Standard 18 Service users are protected from abuse. EVIDENCE: The inspector was shown and heard evidence from the manager that she rates very highly the protection of residents from abuse. There was evidence from certificates issued to staff and completed coursework that staff had attended a course in February 2005, led by the manager, on the protection of residents from abuse and enhancing staff awareness of the symptoms of abuse. Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 Page 15 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): Standards 19,26 The home provides a safe, comfortable, and well maintained environment for its residents. EVIDENCE: Standard 19 There was evidence from observation during a tour of the premises and talking to residents and relatives that the home is well maintained and is free from hazards. Standard 26 There was evidence from observation during a tour of the premises and from talking to residents and relatives that the home is clean, pleasant and hygienic. Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 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): None of the above Standards was considered at this Inspection EVIDENCE: Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 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): None of the above Standards was considered at this Inspection. EVIDENCE: Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Statutory Requirement number 1 of the Inspection dated 5th November 2004 had not, as of the 1st December 2005, been complied with. This Requirement was as follows ‘ The homes registered manager must by the year 2005 have satisfactorily completed the level four National vocational qualifications in management and care’ [Regulation 9(2)(b)(i) and Standard 31.2 apply] 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. 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 24.2 Good Practice Recommendations Consideration should be given to the provision of two comfortable chairs in each residents room in order that the Standard requirement of a minimum of ‘comfortable seating for two people’ is met. It is recommended that the monthly audit conducted by the manager includes target dates for putting right any problem identified, the name of the person who is to be responsible for putting it right, and the date when it was
DS0000061010.V260933.R01.S.doc Version 5.0 Page 20 2 33.3 Appletree Care Home 3 12.1 4 28.1 put right. Standard 33 will be considered at the next unannounced inspection. It is recommended that consideration be given to organising regular trips out (particularly in the summer) to the seaside or other places of interest that the residents select. In addition to fulfilling the outstanding statutory requirement as soon as possible it is recommended that priority should be given to increasing the number of care staff who are qualified to NVQ level 2 or equivalent to 50 as required by the Standard. Standard 28 will be considered at the next unannounced inspection. Appletree Care Home DS0000061010.V260933.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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