CARE HOMES FOR OLDER PEOPLE
Appletree Court Care Home Carebase (Burnt Oak) Ltd 158 Burnt Oak Broadway Burnt Oak Middlesex HA8 0AX Lead Inspector
Tony Brennan Key Unannounced Inspection 19th April 2007 11:00 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 Court Care Home DS0000067333.V333307.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 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 Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Appletree Court Care Home Address Carebase (Burnt Oak) Ltd 158 Burnt Oak Broadway Burnt Oak Middlesex HA8 0AX 020 8381 3843 020 8952 8704 rosalind.maxwell@carebase.org.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) Carebase Ltd Ms Rosalind Frances Ben-Edigbe Care Home 77 Category(ies) of Dementia - over 65 years of age (77) registration, with number of places Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th September 2006 Brief Description of the Service: Appletree Court is owned by Carebase Ltd. Appletree Court is a purpose built care home designed to provide care for people with nursing and dementia needs. Appletree Court is located close to shops, local amenities and public transport links. There are three floors. All bedrooms are en-suite and there are sitting and dining rooms on each floor. The home has a small landscaped garden to the rear. The home aims to provide nursing and dementia care in a homely environment. The fees are between £550 and £850 a week. This report is available through the internet. Copies may also be obtained from the provider of this service. Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection was undertaken as part of the annual inspection programme. I sought to confirm that the areas for improvement identified at the last Random inspection were addressed. The inspection took place over one day. Jenny Fuller, Area Manager and Jane Sadowski, acting manager, assisted me with the inspection. I spoke with the seven people who live at Appletree Court, a friend and advocate of two people and four members of staff. I observed care practice and interaction between people living at the home and staff. I toured the building and examined a number of records relating to the care, health and safety and management of the home. I would like to thank Jenny Fuller, Jane Sadowski and all the staff who assisted me by answering questions about the running of the home. I would also like to thank the seven people who live at the home who discussed their views of the service they receive. What the service does well:
I case tracked three people who had recently come to live at the home. They were found to have detailed assessments of their needs. As part of the assessment process, information on the needs of people had been obtained from health professionals. I found that the care plans of all the people case tracked were detailed and clearly identified how the needs of people would be met. Care plans were personalised, and referred to the cultural needs of people. Care plans are in place that detailed the dementia care needs of people living at home. These were person centred, identifying both the strengths and needs of people with dementia. Diary notes showed that appropriate medical attention and advice is now being sought promptly. The records of medicines received, administered and returned to the pharmacist were all complete. I observed staff administering medication and confirm that this was done safely. Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 6 People who live at the home told me that they had a range of activities each day. One person spoken to said, “ there are activities every day, exercise and games. I enjoy this.” One person spoken to told me, “I enjoy attending the weekly church service.” The religious and cultural needs of people were recalled in their care plans. One person who is of the Hindu religion is supported to attend the temple every week. A number of staff at the home speak Hindi or Gujarati, and understand the cultural needs of this individual. The menu showed that two options are offered at each meal. I observed a number of people enjoying a choice of meals. People who live at the home were generally pleased with the quality of the food provided. I went round all three floors and found that they were appropriately decorated and furnished. There are sitting and dining facilities on each floor. All bedrooms have en suite facilities. Bedrooms were personalised with items of furniture and pictures belonging to people who live at the home. A person who lives at the home said, “ my bedroom is nice, I’ve got the things I want in it.” I examined four staff files and found that these contained all the required information relating to their recruitment. People are protected by the recruitment policies and practices of the home. The home has a system for obtaining the views of the quality of the service it provides and ensures that any areas for improvement are addressed. A survey of the views of people who live at the home, relatives and professionals was in place. All health and safety policies were available. Certificates for gas, legionella and electrical testing were in date. COSHH guidance was in place and chemicals were stored safely. I discussed health and safety issues with staff and they demonstrated their understanding. The home has an effective system for monitoring accidents to ensure the safety of people living at the home. What has improved since the last inspection?
Eleven of the twelve areas for improvement identified at the recent random inspection had been addressed. An updated initial admission assessment format had been expanded, is now in place. This was found to offer the opportunity to record more detailed information on the needs of people. It also included space to assess the specific nursing support needs of people coming to look at the home. Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 7 Detailed nutritional, tissue viability, falls and manual handling assessments have been put in place. There was more detailed information on the tissue viability needs of people living at the home. Where a high risk of development pressure sores had been identified appropriate medical advice had been sought. Since the random inspection, detailed nutritional and tissue viability assessments have been put in place. The people case tracked all had nutritional assessments. These clearly identified where they might be at risk of being malnourished due to medical or other needs. Training and planning to meet the palliative care needs of people who live at the home has been put in place. The acting manager explained that training would be provided as part of the gold standards framework to ensure that staff are able to sensitively meet the palliative care needs of people living at the home. Guidance has been put in place on the safe use of nasal gastric feeding tubes and PEG feeding. I was sent copies of this guidance prior to this key inspection. Nursing staff with whom I spoke were clear about their responsibilities in relation to this guidance to support people appropriately and safely. All carpets have been deep cleaned. This ensured the safety of people living at the home. A review of the staffing level has been carried out. This confirmed that sufficient staff are available to meet the needs of people. People living at the home told me that staff are available to meet their needs. Prior to this key inspection the Area manager had provided evidence to the Commission that all staff at the home had undergone training in all the required areas. I spoke with staff and saw records that confirmed that all areas of training had been addressed. This training has ensured that people’s needs are met by appropriately trained and competent staff. All staff have been receiving regular supervision. The Area Manager was able to produce records to confirm that staff are being supervised to ensure they can effectively and consistently met the needs of people living at the home. Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 8 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. The summary of this inspection report can be made available in other formats on request. Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 9 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 Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are assessed prior to admission to the home to ensure they receive the care and support they need. EVIDENCE: I spoke with people who live at the home who informed me that they had received information on what the home provided before deciding to come to live at the home. One person spoke to said, “ I visited with my daughter they showed me the bedroom I was going to have”. Since the last random inspection people have been moved to the floor on which their needs can be best met. There is now a separation between
Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 11 nursing, dementia with nursing, and residential care. Feedback received from relatives and discussions with people who live at the home confirm that they had been consulted regarding this change. I found that the appropriate level of staffing was available on each floor with the necessary skills to meet the needs of people who live there. I confirmed that these arrangements were in line with the statement of purpose for Appletree Court. At the recent random inspection it had been found that people had been admitted to the home without a detailed initial admission assessment of their needs. Also the initial assessment format did not provide an assessment of the specific nursing support needed by people coming to live at the home. I had received an updated initial admission assessment format that had been expanded and is now in place. This was found to offer the opportunity to record more detailed information on the needs of people. It also included space to assess the specific nursing support needs of people coming to look at the home. I case tracked three people who had recently come to live at the home. These are found to have detailed assessments of their needs. As part of the assessment process information on the needs of people had been obtained from health professionals. This had been used to form the home’s own assessment of the needs of these three people. One person recently admitted to the home comes from the Indian community and it is a practising Hindu. Information was recorded in the initial assessment of this person regarding their cultural and religious needs. There was evidence to confirm that a person and their family had been consulted about the care and support, which they needed. Needs identified in the initial assessments of the three people case tracked were highlighted in their risk assessments and care plans with guidance on how needs should be met. Nursing and care staff spoken to were able to explain the individual needs and preferences of the three people case tracked. Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s personal, social and medical care needs are fully planned for. People who use the service are fully protected by safe procedures for handling medication. People’s right to privacy is supported. EVIDENCE: Since the last key inspection there had been two adult protection investigations that highlighted concerns about whether Appletree Court could meet the personal and medical needs of people. A random inspection was carried out of the home to look into concerns about whether the home could meet the needs of three people who were in hospital. A number of areas were identified which needed to be addressed. Prior to this key inspection the homes management had provided detailed evidence to confirm that all these areas had now been addressed.
Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 13 I found that the care plans of all the people case tracked were detailed and clearly identified how the needs of people would be met. One person case tracked has been diagnosed with diabetes. There was a detailed care plan in place, which explained how this would affect the person. Records showed that the blood sugar levels had been monitored. In the care plan reference had been made to the nutritional assessment identifying areas where the person needed support to maintain their health. Care plans were personalised, and referred to the cultural needs of people. For example, a person who is of the Hindu faith had details of how their personal care needs could be met in a culturally appropriate manner. All care plans seen had been reviewed and where necessary amendments had been made so that they reflected changes in the needs of people. The acting manager explained that since the random inspection all care plans had been reviewed and updated. All care plans in the home now provide sufficient detail of the needs of people. Care plans are in place that detailed the dementia care needs of people living at home. These were person centred, identifying both the strengths and needs of people with dementia. Since the random inspection wandering assessments have been put in place when necessary. One of the people case tracked had a wandering assessment this identified when the person was likely to wander. Guidance was also provided to staff on how to respond to this behaviour in a sensitive and supportive way. I observed that staff spent time talking with people with dementia. People with dementia were found to be able to relax and no signs of ill being were observed. Since the random inspection detailed nutritional, tissue viability, falls and manual handling assessments have been put in place. The people case tracked all had nutritional assessments. These clearly identified where they might be at risk of being malnourished due to medical or other needs. Diary note showed that where necessary dieticians had been consulted. The advice of the dietician had been recorded on the care plan. People were being weighed regularly and action taken if their weight changed. I felt that since the random inspection there was more detailed information on the tissue viability needs of people living at the home. Where a high risk of developing pressure sores had been identified appropriate medical advice had been sought. Falls and manual handling assessments were found to identify risks to and needs of people living at home. Appropriate equipment had been provided to assist people to mobilise safely and independently. Diary notes showed that appropriate medical attention and advice is now being sought to promptly. Diary notes showed that the people case tracked had
Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 14 access to their GP when necessary. Diary notes also confirmed that where the GP had recommended specific medical interventions these were followed up and put in place. Guidance has been put in place on the safe use of nasal gastric feeding tubes and PEG feeding. I was sent copies of this guidance prior to this key inspection. Nursing staff with whom I spoke were clear about their responsibilities in relation to this guidance. Since the random inspection training and planning to meet the palliative care needs of people who live at the home, has been put in place. The acting manager explained that training would be provided as part of the gold standards framework to ensure that staff are able to sensitively meet the palliative care needs of people living at the home. The records of medicines received, administered and returned to the pharmacist were all complete. I found where are the GP had made changes to peoples medication this was signed by the GP to confirm the change had been made. Medicines were stored safely on all three floors. All medicines are stored at the appropriate temperature. Separate records were maintained for controlled drugs on each floor. I found these were complete and the amount of medication held, corresponded with those recorded in the controlled drugs book. I found that the medication for each of the people case tracked was accurately recorded. Training has been provided on the safe administration of medicines. I spoke with staff and found they were clear about their responsibilities and how to handle medicines safely. Training records also contained certificates confirming that this training had taken place. I was able to observe staff administering medication and confirm that this was done safely. Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are provided with varied activities to meet their needs. People living at the home are supported to maintain contact with relatives and other representatives of their choice. People living at the home are able to make choices about how they live in the home. The menu reflects the preferences of people living at the home and offers a balanced diet. EVIDENCE: I observed that activities were provided for people living at the home. On the day of the inspection a number of people went to the theatre. The activities organiser accompanied them. Staff provided activities, these included reminiscence, discussions and drawing. People who live at the home told me that they had a range of activities each day. One person spoken to said, “there are activities every day, exercise and games. I enjoy this.” I spoke with the activities organiser who explained that she provides daily activities on each
Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 16 of the three floors. She was able to show me records for each person living at the home that recorded their daily involvement in activities. The activities organiser explained that where a person lives at the home chooses not to engage in group activities she spends one-to-one time with them. I spoke with one the people lives at the home and they explained that they do not choose to take part in the group activities. However, the activities organiser does spend time with them talking about the news and daily goings-on in the home. One person spoken to told me, “I enjoy attending the weekly church service.” The religious and cultural needs of people were recorded in their care plans. One person who is of the Hindu religion is supported to attend the temple every week. A number of staff at the home speak Hindi or Gujarati, and understand the cultural needs of this individual. I spoke with people who live at the home and two visitors, they confirmed that visitors are always made welcome. One of the visitors spoken to comes to see two people live at the home who are Irish. He helps them to, with the support of the staff at the home, maintain contacts with the Irish community through the Camden an Irish Centre. He told me, “ staff here seem to be genuinely interested in people who live here”. The menu showed that two options are offered at each meal. I observed a number of people enjoying a choice of meals. People who live at the home were generally pleased with the quality of the food provided. A person who lives at the home said, “ staff aske you what you would like to eat”. Another person spoken to said, “ theres a lot of salad and fruit”. Meals are provided that reflect the cultural diversity of people living at the home. There was specific guidance on individual people’s plans where they had dietary needs. I saw that meals were well presented and they were provided in a relaxed environment on all three units. Where a person needed pureed foods this was provided. Sufficient staff was available, and when necessary, people who live at home were observed being assisted to eat. Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are confident that their complaints will be listened to, taken seriously and acted upon. The home’s procedures protect people from abuse. EVIDENCE: The complaints policy explained how to make a complaint and how it would be dealt with. People with whom I spoke confirmed that they knew how to make a complaint. The complaints record showed actions taken to resolve complaints. I found that there is a monthly analysis carried out of complaints and how they had been responded to. There had been one complaint since the last inspection and this had been responded to within the agreed time scale. There have been two adult protection investigations since the last key inspection. These raised issues relating to the consistency of care provided at the home. A number of requirements were made as a result of these investigations. These issues are referred to in the body of this report under the appropriate outcome areas. All requirements made and issues raised have now been addressed. Prior to this key inspection the home has provided evidence to show that all areas were addressed.
Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 18 The two investigations also raised issues regarding the competency of the management of the home. Carebase has addressed these issues and new management and systems have been put in place. There is an ongoing police investigation concerning the care of one person who is subject of an adult protection investigation. Another adult protection concern was raised shortly after this key inspection. There was concern that a member of staff who was in charge of the home at the time of the incident had not reported it quickly enough to ensure the safety of the person concerned. Professionals who attended the strategy meeting where this issue was discussed were concerned that Carebase had not carried out a disciplinary investigation regarding the member of staff involved. I discussed this with the area manager. She explained that she had considered the disciplinary route as a way of addressing this issue. However, she felt that the member of staff had made a genuine mistake. Given this and the recent changes at the home it would not be beneficial to either the individual member of staff or staff morale generally to use the disciplinary procedure in this case. However, this incident would be recorded on the individual staff member’s file. Jenny Fuller explained that the member of staff would undergo retraining, and regular weekly supervision to ensure that they are clear about their responsibilities. The member of staff will not be put in charge of the home until this has been completed. I discussed this with one of the managers of Barnet care services. It was felt that given the circumstances this was a reasonable response. There were comprehensive policies on handling abuse and protection. I found that staff have received training on adult protection matters. These had been reviewed as part of the Company’s response to a recent adult protection investigation. People living at the home felt confident that any concerns they raised would be handled sensitively and appropriately. Training was provided by the home on adult protection. This had been requested as part of adult protection investigation mentioned above. Staff had not been on Barnets adult protection training. The acting manager was asked to ensure that staff attend Barnet training so that they are familiar with the local procedures for handling adult protection issues. The acting manager has now provided the Commission with evidence to confirm that staff will be attending Barnets adult protection training. Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a home that provides a safe and homely environment. The home is clean and hygienic. EVIDENCE: I walked round and viewed all three floors and found that they were appropriately decorated and furnished. There are seting and dining facilities on each floor. There are two passenger lifts providing access for people who live at the home to all floors. I observed that people were able to access all areas in the home safely. This included the garden where a number of people were seen to be sitting. The home has the necessary adaptations to support people to access all areas safely. This includes the provision of handrails and assisted baths and walk-in showers. Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 20 All bedrooms have en suite facilities. Bedrooms were personalised with items of furniture and pictures belonging to people who live at the home. A person who lives at the home said, “ my bedroom is nice, I’ve got the things I want in it.” I observed that where people had nursing needs they were provided with the appropriate nursing bed. The maintenance records show that ongoing maintenance of the homes environment was dealt with. The area manager explained that a number of items including hoists and pressure relieving cushions had been purchased to reassure the comforts and safety of people living at home. Appropriate measures are in place to prevent cross infection. The home has detailed policies on the prevention of cross infection. There had been an outbreak of diarrhoea and vomiting. Appropriate measures were put in place to prevent the spread of the infection. Since the random inspection all carpets have been deep cleaned. Staff have received training on infection control measures. Staff spoken to understood how to work to minimise the possibility of cross infection. Staff confirmed that they had access to disposable gloves and aprons. Liquid soap and paper towels were available throughout the home. Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 21 Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff are available at all times to meet the needs of people who live at the home. Staff do have all the skills to meet all the assessed needs of people who live at the home. People who live at the home are protected by the home’s recruitment practices. EVIDENCE: There were forty people living at the home on the day of the inspection. The Area Manager explained that the home is currently being staffed as it would be if all beds were filled. Since the Random inspection, a review of the staffing levels has been carried out. This confirmed that sufficient staff are available to meet the needs of people. People living at the home told me that staff are available to meet their needs. The separation of people living at the home into groups that reflect their needs has made it easer for nursing staff to meet the needs of people needing nursing care. The rota showed that a consistent level of staffing is maintained on each floor. I observed that staff were available at key times a day (e.g. mealtimes) to assist people. Staff were also observed to spend time with people both individually and in small groups. This allowed more attention to the individual needs of people who live at the home.
Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 23 As part of the adult protection process issues were raised regarding the training of staff to effectively meet the needs of people who live at the home. Prior to this key inspection the Area manager had provided evidence to the Commission that all staff at the home had undergone training in all the required areas. I was able to see certificates that confirmed that training had been provided. Staff spoken to confirmed that they had received training and that this had made them confident in their ability to support the needs of people. The Area Manager was able to confirm that training has been provided on person centred dementia care and training on palliative care was being finalised. The registered manager explained that at present 36 of staff have achieved the National Vocational Qualification in care. It was a recommendation of the last key inspection report that 50 of staff achieves this qualification. The Area Manager explained that fifteen staff have been registered to complete this qualification. Once these staff have the qualification the home will exceed the 50 target. I examined four staff files and found that these contained all the required information relating to their recruitment. I found that there were no unexplained gaps in the employment history of recently recruited staff. A health check has been carried out to ensure that staff coming to work at the home could safely meet the needs of people. The file of one nurse was seen, this had evidence of their current professional registration. Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 36 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate management structures are in place to ensure that people recieve the care they need. People who live at the home are consulted about the quality of the service provided and encouraged to make suggestions for improvement. People who live at the home financial interests are protected by the home’s procedures. People who live at the home and staff are protected by the home’s health and safety procedures. EVIDENCE: Since the last key inspection the registered manager and deputy manager have been dismissed as a result of a disciplinary process. Carebase was prompt in ensuring that sufficient management support was provided for the
Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 25 home. An Area and acting managers have been involved in overseeing the day-to-day management of the home. All requirements made at the random inspection, and issues raised as part of the adult protection process have been addressed. Improvements have been made to the development and delivery of care for people living at the home. Both staff and people living at the home commented positively on the open and approachable style adopted by both the area and acting managers. The area manager explained that a new manager has been appointed and will be in post shortly. The area and acting manager will continue to provide support to the new manager. Once the new manager has completed her probation period she will apply to the Commission for registration as the manager for the home. The home has a system for obtaining the views of the quality of the service it provides and ensures that any areas for improvement are addressed. A survey of the views of people who live at the home, relatives and professionals was in place. The Company also has a system to monitor all areas of the quality of the home. People who live at the home and their relatives have meetings on a regular basis to discuss their views of how they wish the home to be run. Staff meetings are taking place to ensure staff are aware of plans to develop the service. The home does not hold money for people who live at the home. The home invoices their families or the relevant social service department for any expenditure made on their behalf. A system is in place to ensure receipts are obtained for any expenditure. Since the Random inspection all staff have been receiving regular supervision. The Area Manager was able to produce records to confirm that staff are being supervised to ensure they can effectively met the needs of people living at the home. Fire drills were taking place and the fire alarm was tested regularly. I found that the fire risk assessment had been reviewed and now included an assessment of all the potential fire risks in the home. I questioned staff on the fire safety procedures and found that they understood fire safety issues. All health and safety policies were available. Certificates for gas, legionella and electrical testing were in date. COSHH guidance was in place and chemicals were stored safely. I discussed health and safety issues with staff and they demonstrated their understanding. The home has an effective system for monitoring accidents. The temperature of food delivered to and cooked was recorded. The temperatures of the fridges and freezers were recorded and within safe limits. Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 26 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 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 X 3 3 X 3 Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 27 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. 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 OP30 Good Practice Recommendations The registered provider should ensure that 50 of staff achieve the National Vocational Qualification at level 2 in Care. Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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. Extracts may not be used or reproduced without the express permission of CSCI Appletree Court Care Home DS0000067333.V333307.R01.S.doc Version 5.2 Page 29 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
