Inspection on 21/06/05 for Appletree Grange

This inspection was carried out on 21st June 2005.

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

Appletree Grange 01/10/09

Appletree Grange 07/11/07

Appletree Grange 21/09/06

Appletree Grange 09/11/05

Appletree Grange 17/12/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Appletree Grange Durham Road Birtley County Durham DH3 2BH Lead Inspector Andrea Goodall Unannounced 21 June 2005 at 10.00 am 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. Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Appletree Grange Address Durham Road Birtley County Durham DH3 2BH, 0191 4102175 0191 4102433 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) Barchester Healthcare Homes Limited Mrs Margaret Anderson Care Home 33 Category(ies) of OP Old Age (33) registration, with number PD(E) Physical Disability over 65 (8) of places DE(E) Dementia over 65 (3) MD(E)Mental Disorder over 65 (2) SI(E) Sensory Impairment over 65 (1) Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17 December 2004 Brief Description of the Service: Appletree Grange is registered to provide personal care for 33 older people, a small number of whom may have dementia, physical disability or a sensory impairment. It is not registered to provide nursing care. All bedrooms are single and have en-suite facilities. The home provides some aids and adaptations to support the needs of people with a physical disabilities. The layout and the design of the building ensure easy access to WC’s and a choice of lounge areas for the people who live here. There is a lift to take people to and from the first floor. To the front of the building is a grassed area, with garden seating for use by residents and their relatives. A large car park is sited to the rear of the home and provides ample parking for visitors. The main access into the building is via a short ramp at the rear entrance. Two additional fire exits are located at each side of the building, however these are stepped and so could not be used by people who use a wheelchair to exit the building in the event of a fire. The home is situated in Birtley on the main Durham Road. It is on a bus route and is close to local shops and other local amenities. Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day and evening in June. Over half of the time was spent talking with many of the people who live here and 5 visitors to get their views of the service. The Inspector also joined residents for a teatime meal to sample the catering service and to observe staff interaction and their support of the people who live here. All communal areas of the home and a sample of bedrooms were inspected. Discussions were held with the Manager and some staff about the progress of the service, and care records were examined. The people who live here said they prefer to be referred to as residents rather than service users, and this is reflected within the body of this report. What the service does well: What has improved since the last inspection? There has been an improvement to the staffing levels since the last inspection, and residents said the service they get is much better because of this. Staff Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 Page 6 said that there is more time to support people and spend a bit of time with them. Visitors said they had noticed a positive change in the number of staff on duty to help residents. There is now a laundry staff, and residents and visitors said that the laundry service has significantly improved. Residents now get the correct clothes back from the laundry and this is very important to them in terms of dignity. There have been some good changes to the building. There is a new laundry area with upgraded washing machines. There is a new office for the Manager, and there is now a small, unused bedroom providing space for staff to complete and store care records. The garden areas are also receiving attention and residents said that they enjoy sitting out at the front where new fencing has been provided. 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. Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 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 Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 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. The home provides clear information for prospective residents and their representatives to make an informed choice about the service. EVIDENCE: Appletree Grange provides clear, factual information for prospective residents and their representatives when considering whether the home is suitable for them. There is a brochure and a Statement of Purpose that contain information about the organisation, management of the service, staff and facilities provided. There is also a Service Users Guide and an Information pack that set out information about the accommodation, mealtimes, activities, residents rights, complaints procedure, and a summary of the previous inspection report. This is written in plain English and provides much of the information that people may wish to take away and consider know when choosing a care home. The Information Pack remains available to residents and their visitors in the entrance hallway for them to refer to at any time. Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 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 & 10. Individual care plans set out peoples needs and involve the resident, but are not sufficiently detailed or reviewed. Residents are treated with respect and their privacy and dignity is maintained. EVIDENCE: There are care plans in place for each of the residents that identify any specific areas (goals) that they need extra support with from staff. The care plans are signed by the residents to show that they agree with the goals and the type of support that they need. Since the last inspection new care plans have been designed and these are being introduced as new residents move into the home. A sample of the new care plans showed that some need much more detailed guidance so that all staff know how to support people with each goal. The Deputy Manager agreed with this and is to support staff to complete the care plans in this way. In the meantime the old care plans are still in place for residents who have been living here for a while. These should have been evaluated on monthly basis, but had not been updated for some considerable months and in some cases were up to a year out of date. In this way it was not clear if the goals or Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 Page 10 needs of those residents had changed, and staff would be using out of date information to support people. At the last inspection many residents and their visitors described their concerns about the laundry service in the home, often receiving the wrong clothes and their own clothes being mislaid. Following that inspection the laundry system has changed, staffing has increased and there is a dedicated laundry staff now. During this visit residents and their visitors had many positive comments to make about the improvements to the laundry system. They stated they are now very satisfied that the laundry service ensures their dignity by returning the correct clothes to each resident. The home also now ensures residents privacy when using the telephone. There are now portable telephones on each floor so that residents can make and receive calls in private. Residents have a key to their bedroom door (unless a risk assessment determines otherwise) and some people make use of the keys to keep their rooms locked when they wish. Residents and their visitors were also very positive about staff attitude, describing them as welcoming, helpful and courteous. Staff were seen to be sensitive and respectful when supporting and talking with the people who live here, and this helps to maintain peoples dignity. Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 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. Residents can follow their own preferred lifestyles and have good opportunities for social and leisure activities. Residents can maintain contact with family and friends and can access the local community if they wish. EVIDENCE: Discussions with over half the residents living here confirmed that they can continue to follow their own daily lifestyles within the home. Residents said that they get up and go to bed when they wish, they spend their day as they want, use their own bedrooms for privacy whenever they want, and join in activities and social events when they want. Residents confirmed that there are no set routines in the home other than main mealtimes. Residents spoke positively about the social activities and trips out that they have recently enjoyed and had particularly enjoyed sitting out in the patio area at the front of the home with drinks and ice creams. Residents demonstrated that they are kept very well informed about future events and said that they were excited about the appointment of an Activities Co-ordinator who is to commence in the near future. Several people spoke about visits to the local garden centre for coffee and to look at plants, and spoke about the shops and facilities that they can use nearby with support from staff or relatives. Residents who took part in these Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 Page 12 discussions said that they have good contact with relatives and friends either by telephone or by visits. Throughout this inspection there was a steady stream of visitors to the home. Visitors said that they were very pleased with the standard of the service and they too demonstrated that they are kept very well informed of any changes or plans for improvement. Visitors said that they can drop in at anytime (although they try to avoid mealtimes) and that they were made to feel very welcome by staff and residents. Visitors spent time in the lounges talking with residents and also spent time in the privacy of residents bedrooms if the resident chose. Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 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. Residents and their representatives have information about how to make a complaint, and are confident that any complaints will be taken seriously and acted upon. EVIDENCE: The home provides clear information to service users on the method of making a complaint. Residents and their visitors confirmed this during discussions. The complaint procedure is included in the Service Users Guide, which is available in large print. Residents and visitors said that they would feel comfortable about raising any concerns with the Manager and would be confident that she would look into any complaints and take appropriate action. There are a small number of people with severe visual impairments living at the home, but at this time they still do not have information in a suitable format, for example on cassette tape. The Manager stated that this is being addressed by the organisation. The Manager demonstrated that records would be kept of any complaint, action taken and outcome. There have been no formal complaints about the home since the last inspection. Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 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, 25 and 26. Residents live in comfortable surroundings and have access to outdoor areas. Water temperatures are not sufficient for residents to bathe comfortably. The home is clean and hygienic. EVIDENCE: Overall the accommodation for residents is warm, comfortable and homely. There are small areas of wear and tear throughout the building, particularly in bedrooms, such as chipped paintwork. Resident said that these do not detract too much from the cosy, comfortable feeling that the home has, but indicated that some areas would benefit from redecoration. The Manager confirmed that there are plans to address this within the next few weeks through a programme of refurbishment to 14 bedrooms and new carpets within the home. There have been several long-awaited improvements to the premises since the last inspection. The laundry area has been upgraded and fitted with new Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 Page 15 laundry equipment. A new office has been built in the entrance hallway for the Manager, and the former office has created space for a hairdressing room. At this time one small bedroom is now being used as staff office and this has been very helpful in providing a place for staff to write and store care records. This has reduced the number of bedrooms to 32, so the Owner will have to consider whether to apply to formally reduce the number of registered places at the home. Fencing has been put up around the front patio area of the home and this provides shelter and privacy for residents when they sit out in better weather. The Manager also indicated that the rear garden areas are to receive attention and fencing. The temperature of hot water to baths is not warm enough. This is a matter that was raised at the last inspection and since then the boiler has been fixed. However the temperature of both baths was still too low at 35-36 degrees Centigrade. All areas of the home that were inspected were clean and hygienic. There were some minor premises issues that do not support the dignity of the residents. For example, unsightly laundry trolleys are stored in view in corridors; staff instruction notices are pinned up in residents bathrooms; one communal toilet had an unpleasant odour; and there is no sign on a bathroom door for residents information. This detracts from the otherwise homely environment and promotes a more institutionalised feel. Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 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. Residents needs are supported by the number of staff on duty. The people who live here are protected by the homes thorough recruitment procedures. EVIDENCE: At the last inspection there were not sufficient staff on duty to support the needs of the people who live here. Following that inspection, staffing levels in the evening and night time were increased by the owner. There are now 4 care staff on duty through the day, 4 care staff in the evenings and 3 care staff on night time duty. Also there is now a dedicated laundry staff which has relieved care staff of this task. Residents commented positively on the increased support that they get now that staffing levels have improved. Some residents and visitors stated that the staff now have a bit more time to spend with them. The staffing rota ensures that there are 2 staff to each floor. There is always at least one senior member of staff on duty to take responsibility for directing the staff team. There have been 4 changes to the staff group since the last inspection, which is not a high turnover for the staff group here and residents indicated that this has not effected the continuity of their care. There have been some new posts created, including laundry staff, maintenance/driver and Activities Coordinator. These posts will benefit the residents and the home in providing dedicated staff to those service areas. Barchester Care Ltd has very thorough Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 Page 17 recruitment & selection procedures. These include all necessary checks and clearances before new staff start work, in order that the people who live here are protected. Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 Page 18 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) 36 & 38. Staff are appropriately supervised. A small number of premises issues do not promote the health & safety of residents. EVIDENCE: There is a system of staff supervision in place, and a recording format, so that each member of staff has the chance to discuss their work with a supervisor. The Manager carries out supervision with senior staff, who in turn carry out supervision sessions with the remaining staff. The senior staff are receiving training in supervisory management so that they can be equipped to carry out this role. All staff have training in health & safety matters so that they carry out safe working practices when supporting the people who live here. Health & safety audits are carried out in the home and maintenance staff carry out necessary routine checks. All records and certificates of maintenance and equipment checks are held at the home. Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 Page 19 At the time of this visit there was a small number of health & safety issues in the home. The restrictor to one bedroom window on the first floor was missing (so the window opened out fully); the laundry door was not locked and has no signage (so residents could have walked in amongst the laundry machines by mistake); and the fire door between the 2 rooms in the laundry was propped open with a fire extinguisher (so a potential fire could have spread and the laundry staff could have tripped over the fire extinguisher). At this time there is still no smoke detection equipment in the new laundry room or the new office. The staff receive in-house fire instruction to make sure that they know what to do in the event of a fire. However new staff have not received two instruction sessions within the first month; there is no indication of what the instruction consists of; or who the instructor is; or what the actual date was (rather than just the month). There were no records of the required fire drills. Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 Page 20 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 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 x COMPLAINTS AND PROTECTION 2 3 x x x x 2 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x x x x 3 x 2 Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 Page 21 Yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 15(1)b Requirement Care plans must set out clearly how the residents needs are to be met. Care plans must be reviewed at least once per month. The Complaints Procedure must be available in a suitable format for people with a visual impairment, e.g. on cassette tape. This is outstanding from the last inspection timescale of 1.2.05. Signage must be put on bathroom and laundry doors; greater odour control in one WC is needed; staff notices must be removed from residents bathrooms. The temperature of hot water to baths must be adjusted to around 43 degrees Centigrade. A door lock of keypad lock must be fitted to the laundry door and this door kept locked to prevent residents from mistakenly entering this room. A window restrictor must be refitted to a bedroom window on the first floor. The internal fire door within the laundry must be kept closed and Timescale for action 1.8.05 2. 16 22(6) 1.9.05 3. 19 12(4)a & 23 1.8.05 4. 5. 25 38 23(2)j 13(4) 1.8.05 1.8.05 6. 7. 38 38 13(4) 13(4) 1.8.05 1.8.05 Page 22 Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 8. 38 23(4)d & e 9. 38 23(4)c the fire extinguisher placed in its desgnated location. Advice could be sought from the Fire Authority about the status of the internal door. In-house fire instruction records must include the date; the contents of the instruction; and the name of the instructor. New staff must receive two instuctions within the first month of their employment. Fire log records must also include of the drills, which must be carried out not less than 6 monthly. Smoke detectors must be fitted to the laundry room and to the Managers office. 1.8.05 1.8.05 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 19 Good Practice Recommendations The Owner should consider the long term use of the small bedroom currently being used as a staff office. If the bedroom is to be taken out of commission, the Owner should apply for a Variation to Registration to reduce the number of places to 32. An alternative storage area for laundry trolleys should be sought away from public view and from residents accommodation. 2. 26 Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Baltic House Port of Tyne South Shields Tyne and Wear NE34 9PT 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 Appletree Grange B52-B02 S61451 Appletree Grange V217615 210605 Stage 4.doc Version 1.40 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. 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