Inspection on 21/09/06 for Appletree Grange

This inspection was carried out on 21st September 2006.

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

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

Other inspections for this house

Appletree Grange 01/10/09

Appletree Grange 07/11/07

Appletree Grange 09/11/05

Appletree Grange 21/06/05

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 Miss Andrea Goodall Key Unannounced Inspection 21st & 27th September 9:30 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 Grange DS0000061451.V301680.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 Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Appletree Grange Address Durham Road Birtley County Durham DH3 2BH 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 4102175 0191 4102433 appletree@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Limited Mrs Margaret Anderson Care Home 32 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2), Old age, not falling within any other category (32), Physical disability over 65 years of age (8), Sensory Impairment over 65 years of age (1) Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th November 2005 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 care needs, 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 DS0000061451.V301680.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 2 days. Some time was spent with the Manager and staff reviewing the progress of the service. Health & safety records, care records, and personal finance records were examined. Much of the time was spent talking with many of the people who live here and their visitors to get their views of the service. Discussions were held with catering staff. How care staff support the residents was observed. All shared areas of the home (such as bathrooms and lounges) and a sample of bedrooms were inspected. Some information was examined before the inspection visits. This included a pre-inspection questionnaire received in April 2006 from the home; notification forms; and monthly reports from the Provider. Also residents questionnaires and relatives comment cards were received. There have been no complaints received by CSCI about the service since the last inspection. The Provider has investigated on anonymous concern, which was found to be unsubstantiated. What the service does well: The home makes sure that only people whose needs can be met move into the home. Residents and relatives said that they looked around a few homes but that this was the best for them. One resident said, I thought my previous home was good, but it was not as good as here. Another resident said, Although its not my own house it’s a very good home and we do very well. Residents said that they feel they are treated with respect and dignity within the home. Residents described staff as very helpful and friendly. One resident said, We are very well looked after. Staff are nice and helpful. It is very good practice that the home has a member of staff who is a moving & assisting trainer who ensures residents are supported by staff using the correct, safe techniques. Residents feel that the home supports them to live their own lifestyle, and provides good opportunities for their social and leisure activities. Residents have good contact with families and the home has good relations with local community services so residents can get out and about to local events. Residents, staff and visitors get on very well and there were lots of visitors to the home. Visitors described the home as very homely, family-friendly, and welcoming. One relative said, Its got a very bubbly atmosphere. Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 6 Residents said, We have fantastic cooks and all our meals are wonderful! There are always choices for each meal and residents can make their choice at the meal time. The choices are written on decorative menus at the entrance to both dining rooms, and residents are served at the well-set tables. In this way dining at this home is like being in a restaurant. Residents live in safe, comfortable home and on-going improvements to the premises means that residents have good quality accommodation. All the bedrooms are single with private en-suite toilets. The home is clean, pleasant and hygienic. The home has the right number of staff to look after the people who live here. The home carries out checks to make sure only the right sort of staff can work here. There are hardly ever any changes to the staff and many have worked here for years so they get to know the residents really well. The home provides good training for staff so that know how to care for people in the right way. The home is well run. Residents feel that that they are kept fully up to date with all information about the home, and their views are involved in plans for changes. What has improved since the last inspection? Care plans that show what support each resident needs are much clearer, and these help staff to care for residents in the right way. Residents felt that there has been improvements to the frequency of activities and most residents on the first floor commented, there is enough to keep you occupied if you want. Over the past year there have been a number of improvements to the accommodation at Appletree Grange. All bedrooms on the ground floor have been repainted, 5 bedrooms have been fitted with new carpets and new bedroom furniture is on order. On the first floor the dining room has been redecorated. There is a clear plan for more refurbishment in the future. In this way the Provider shows that it will continually improve the standard of accommodation for the people who live here. Staff have had more training including in-house fire instruction so they would know what to do if there was a fire. Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 7 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 DS0000061451.V301680.R01.S.doc Version 5.2 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 Grange DS0000061451.V301680.R01.S.doc Version 5.2 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): Quality in this area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Prospective resident have good information about the service before choosing to live here. The needs of all residents are assessed to ensure that the home can provide the right care. There are not enough staff trained in dementia care needs. EVIDENCE: Since the last inspection the home has reduced the number of places from 33 to 32. The homes Statement of Purpose has been revised to show this change. The Statement of Purpose states that the home provides care for older people with dementia care, physical disabilities, and with a sensory impairment but does not state the number of places for each care category which some prospective residents and their representatives would find useful. Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 10 During discussions residents and relatives stated that they felt they were given plenty of information about the service before making a choice. New residents are given a Welcome Pack, which includes some helpful information about the service, and a separate terms and condition statement that is also very informative. However, residents who have been here for some time do not have copies of the Welcome Pack and in this way may not have full information about the service (including how to make a complaint). Most people chose the home following a visit here. Some residents or their relatives had visited other homes, or had lived at other homes so were able to make comparisons. One resident said, I thought my previous home was good, but it was not as good as here. Another resident said, Although its not my own house it’s a very good home and we do very well. For those people whose placements are funded through Social Services Department, a Care Manager carries out an assessment of what type of care they require. Before any resident moves into this home, comprehensive pre-admission assessments of their needs are carried out by the Manager or Deputy Manager of the home. In this way, the home can make sure that Appletree Grange can provide for that persons care. The assessment records are kept in the residents care file, and are used to determine an individual plan of care for that person. The home is now registered to provide up to 10 places for older people with dementia care needs. There are currently 8 residents with dementia needs living at the home. The home has good links with a local dementia care organisation for information and advice, but at this time only a couple of care staff have had previous training in the dementia care. Whilst there was no indication during this visit that the needs of these residents are not being met, the home does not fully demonstrate its ability to provide such care. The Manager is aware of this and there are plans for all staff to have training in Positive Dementia Care. The home is pro-active in recognising when a residents needs have changed so much that the home can no longer provide the required support. It is good practice that the home requests re-assessments by Social Services Department of residents whose dependency level can only be met by other care service. Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 11 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): Quality in this area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Each residents needs are set out in a clear plan of care. Residents health care needs are met by community health care services, and their emotional wellbeing is promoted in the home. However, support with nutritional health is unclear and uncoordinated. Residents are protected by the homes medication procedures. Residents feel that they are treated with respect, but some individual staff practices did not ensure that residents dignity and privacy are upheld. Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 12 EVIDENCE: Since the last inspection a new style of care plans have been introduced and these are being completed for each residents. Of the sample examined, the new care plans are a very good improvement and are developed from comprehensive assessments of needs. The care plans identify pertinent, specific goals/needs for each resident and set out what staff support is needed to meet those needs. Goals include improved social contact; safe mobility; and reduce agitation. The monthly evaluation records show the progress of needs and include changes in need as they occur. At this time all care needs are set out on one evaluation record, which makes it harder to plot the progress of each specific area of need. Also there are no dividers in the care files, which makes it difficult to access and retrieve information. Some care plans have been signed by the residents to show that they agree with the goals and the type of support that they need, but others have not been signed. The Deputy Manager indicated that residents, or their representatives, will be invited to sign the new care plans at annual reviews. The home ensures that all residents have access to appropriate community health care services, including GP, dental, ophthalmic and chiropody services. It was clear from assessments, care plans and observations that pressure area care is well supported by the home with input from district nursing services. Pressure relieving equipment is provided to individual residents wherever this is needed. It is very good practice that the home has a member of staff who is a moving & assisting trainer who ensures that all staff are trained in this area of care. This member of staff also carries out a moving & assisting assessment of each resident. In this way resident are supported by staff using the correct, safe techniques. The home uses nutritional assessments and monthly weight records to check the nutritional needs of the people who live here. In a sample examined, a couple of residents had experienced significant weight loss over recent months. However this was not highlighted in their care plans and did not form a new care plan need. Although flood and fluid chats were put in place for these residents, the records were only sporadically completed so did not demonstrate any improvement or otherwise in their dietary intake. In discussions with catering staff there was no indication that care staff had informed them of the need for a supplemented diet. Although there were some fortifying drinks prescribed for Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 13 them, there was no evidence that a dietician had been contacted for advice. In this way, support with nutritional health needs is unclear and uncoordinated. Residents who are assessed as able to do so are encouraged to manage their own medication. The home uses a Monitored Dosage System to manage the medication on behalf of those residents who are unable to manage their own medication. Medication is securely stored within the home. Only designated senior staff, who have had suitable training, are responsible for administering medication. Records of medication were up to date. During discussions, residents indicated that they feel that they are treated with respect and dignity within the home. Residents described staff as very helpful and friendly. One resident said, We are very well looked after. Staff are nice and helpful. All bedroom and bathroom doors are lockable and those residents who can manage a key do so as they wish. It was evident during these visits that residents can spend time in the privacy of their rooms whenever they want. There were 2 matters that compromised residents dignity and privacy during these visits. One was an isolated incident when maintenance staff took remedial action to a bedroom door that was not closing properly, whilst the resident was still in bed. The second related to a care staff entering a residents en-suite and using that residents supply of continence pads for other residents use. This compromised the residents privacy, dignity and their right to the sole use of their prescribed equipment. The staff member indicated that this was the usual practice as that residents bedroom is the near the lounge. However discussions with other staff on duty indicated that this was not usual or accepted practice. Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents feel that the home supports them to live their own lifestyle, and provides good opportunities for their social and leisure needs. Residents have good contact with families and the home promotes good relations with local community services. Residents are supported and encouraged to exercise choice and control over their own lives. The excellent quality of the catering service means that residents receive an appetising, healthy diet and enjoy restaurant-style dining. EVIDENCE: All of the residents who took part in discussions were candid and confident in their comments, and said that they are still able to follow their own preferred routines within this communal setting. Some people like a lie-in, some people may choose to dine in different rooms, some people spend time in the privacy of their rooms, and some people still attend clubs outside the home. In this way the home tries to flexibly meet the individual lifestyles of the people who live here. Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 15 The home now has a part-time activities co-ordinator who arranges activities such as quizzes, crafts, coffee mornings, and spa therapy sessions. The chef also has occasional cookery and baking sessions in the dining rooms for those who wish to take part. Residents felt that there has been improvements to the frequency of activities and most residents on the first floor commented, there is enough to keep you occupied if you want. Other people described the different trips out that they had enjoyed over the summer and would like these to continue, saying we like to be out and about. Residents said the only thing that could improve the service would be a minibus to go out more often. Many of the people who live here are from the surrounding area, and the home has good links with the local community. There is a community centre across the car park from the home, and residents frequently use this facility for coffee mornings, social events, and to vote at election times. One resident commented, We go across the road to join in the dancing. Its lovely to get out and meet other people. The home also uses local shops and some residents use the local hairdressers when the visiting hairdresser is on holiday. There is a garden centre near the home and some residents enjoy trips across for a look around and a coffee. There is a steady stream of visitors to the home, and it is clear that there are good relations between relatives, staff and residents. Visitors described the home as very homely, family-friendly, and welcoming. One relative said, Its got a very bubbly atmosphere. We had seen other homes, and some seemed ok, but were very pleased with this home. The people who live here are supported to continue their own preferred lifestyle. Many of the bedrooms have been highly personalised by residents and this makes the rooms feel owned by them. People who took part in discussions said that they spend their day as they choose and use the different areas of the home when they wish. Residents are offered at least 2 main choices of menu at the actual mealtime, so that they do not have to choose the day before. Menus are well advertised so that residents can make informed choices. The decorative menus are presented on pedestals at the entrance to both dining rooms so that residents can refer to them at any time. Both dining rooms are pleasant areas where residents can enjoy restaurant-style dining. Tables are set with condiments, linen napkins and individual tea services so that residents can help themselves if they are able to do so. Residents are served at their table to their individual choices by staff. Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 16 Residents had many positive comments to make about the quality of the catering service they receive. Several residents described how the chef talks to them daily about their different likes and dislikes. Some people need softened diets and the chef has designed individual menu lists for them of different softer foods that they particularly like, which will be made for them at any time. Since the last inspection mealtimes have changed with residents involvement and suggestions. Breakfasts are now from 8am till late morning so people who like a lie in can do so without missing this meal. Tea and supper are a little later so there is not such a long gap before breakfast. Residents said that this is more flexible for them. Staff have had to change their rotas to accommodate these changes but staff said that the new mealtimes are working well for the people who live here. The only suggestion for improvement from residents was that they would like the toaster back in the first floor dining room so that they can get their toast more quickly in the morning. The catering staff at this home won an award earlier this year for the quality of the meals, and residents said that this was well deserved. One resident said, We have fantastic cooks and all our meals are wonderful! That comment was echoed by all other residents who took part in these discussions. Appletree Grange DS0000061451.V301680.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Most residents and their representatives have clear information about how to make a complaint in a suitable format, except people with a visual impairment. Staff training in adult protection ensures that residents are protected from abuse. EVIDENCE: The home has a written complaints procedure, which is included in the Welcome Pack for new residents. Some residents who have been living at the home for a while may not have this information. Also, although the home is registered to provide care for people with a significant sensory impairment, the complaints procedure is still not available in audio form (although the Service Users Guide states that it is). This lack of suitable access to information for residents with visual impairments may be seen as discriminatory. At this time the written complaints procedure directs people to discuss their concerns with the nurse in charge, however this is not applicable to Appletree Grange. Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 18 During discussions residents were clearly comfortable about making critical comments about the service as well as many positive ones. In this way it is apparent that residents feel safe and confident to raise their suggestions and concerns. Relatives also stated that they would feel comfortable about raising any issues with management staff, and stated that they were given sufficient information about how to make a complaint. All senior staff and most other staff have had training in local Adult protection procedures so are aware of how to deal with suspected abuse. Remaining staff have been nominated for forthcoming training in this area. Appletree Grange DS0000061451.V301680.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 25 and 26. Quality in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents live in safe, comfortable home. On-going improvements and refurbishment to the premises means that residents have good quality accommodation. There are enough bathrooms and toilets around the home for residents, but these would benefit from redecoration. The home is clean, pleasant and hygienic. EVIDENCE: Over the past year there have been a number of improvements to the accommodation at Appletree Grange. All bedrooms on the ground floor have been repainted, 5 bedrooms have been fitted with new carpets and new bedroom furniture is on order. On the first floor the dining room has been redecorated. Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 20 There is a clear programme of future refurbishment, including remaining bedrooms on the first floor, lounges on the ground floor, alteration and upgrade to the kitchen, ramped access from corridor fire exits, and a new fire alarm system. In this way the Provider aims to continually improve the standard of accommodation for the people who live here. At this time the homes bathrooms are functional and reasonably equipped but are now quite worn. The Manager confirmed that bathrooms are also to be upgraded and fitted with new lifting equipment as part of the future programme of refurbishment. Lighting to the first floor corridors was rather low during this visit, so may not be providing sufficient light to meet the needs of the people who live here, or to meet luminescence standards. Low lighting can contribute to a risk of falls for older people. The home is clean, hygienic and there is very good odour control throughout the building. All staff have been included in training in infection control. There are dedicated laundry staff, and a well–equipped laundry area. Residents commented positively on the improved laundry system since it was refurbished last year. Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home provides enough staff to meet the current needs of the people who live here. Residents are protected by the homes recruitment procedures. A stable staff group means that staff can provide continuity of care for residents. The home provides good training opportunities for staff so that they are competent to do their jobs. EVIDENCE: The home provides a minimum of 4 staff, including one senior staff, on duty throughout the day and evening. There are 3 staff, including one senior staff, on waking duty throughout the night. The Manager confirmed that this is sufficient to meet the needs of the residents who currently live here. From observations of the home and discussions with staff and residents there are clearly sufficient catering, domestic and laundry staff. New mealtime arrangements mean that there is an increase of catering hours which has relieved care staff from preparing the tea-time meal. The home also benefits from a maintenance staff, part-time activities co-ordinator and an administrator. Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 22 The staff team comprises a good mix of age and experience. There are 2 male care staff who mainly tend to the personal care needs of the gentlemen who live here. The home ensures gender-appropriate support is provided to the residents. Residents and relatives had many positive comments to make about staff and their helpful attitude. One relative commented that there are no senior staff on duty at week-ends. In discussions the Manager confirmed that there is always a senior member of staff on duty at all times to take responsibility for the home. However all care staff wear the same uniform, so visitors are unable to distinguish between care staff and senior staff. Of the team of 18 care staff, 11 have attained NVQ level 2 or level 3 care qualifications. Six more staff are booked onto training towards NVQ level 2. In this way nearly all the staff will be qualified in care in the near future. The home benefits from a very stable staff group, and there have been only 3 changes to the staff team over the past year. Barchester Healthcare operates rigorous recruitment procedures that include all necessary checks, to ensure that only suitable staff are appointed to care for the people who live here. A sample of staff records examined confirmed that all checks had been carried out. However, for one new staff, 2 written references from former colleagues had been accepted, rather than from their previous employer or Manager. It was clear from training records and from discussions with staff that Barchester Healthcare provides good training opportunities. The Provider employs a Regional Training Manager to ensure that all staff receive the required training. Computerised training and development records show the courses that each member of staff has completes and also monitors and highlights when training certificates will expire. All new staff receive in-depth Induction training (that complies with Skills for Care Council standards), and have support to go onto NVQ training in care. Other recent training has included protection of vulnerable adults; health & safety; infection control; and fire safety. Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 23 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): 31, 33, 35 & 38. Quality in this area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents benefit from a well managed home. Residents views are listened to and the home is run in their best interests. Residents are safeguarded by the financial procedures within the home. The health and safety of residents is promoted, although hot water temperatures meant residents were at risk until these were fixed. EVIDENCE: The Manager is suitably experienced, skilled and qualified to be responsible for the daily management of this home. She has been the Registered Manager of Appletree Grange for several years and has continued to undertake suitable training to ensure that she remained up to date with best current practice. Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 24 There are clear lines of accountability within the home and within the organisation. The Manager is supported and supervised by a Regional Manager who also carries out monthly visits and reports back to the organisation. During this inspection the Manager stated that she will be retiring in the near future. The Provider will be appointing a new Manager and an application in respect of that postholder will be submitted to CSCI in due course. Barchester Healthcare has comprehensive quality assurance system that includes a number of audits of the service, and also includes residents views. It was very evident during discussions with residents that they are kept fully up to date with all information about the home, and their views are involved in plans for changes, for example new mealtimes. There are Residents Meetings every month where residents can offer their suggestions and comments about the service. The Provider also uses an annual satisfaction questionnaire to formally collate the views of residents and their representatives. Some residents and/or their relatives continue to manage their own financial affairs and this is encouraged by the home. The homes administrator does support some residents with the safe storage and accounting of their small weekly allowances, if they wish. These are stored individually and there are clear records of any withdrawals, including receipts and 2 staff signatures for any purchases made at the request of a resident. However one entry to a residents records was not visible as it had been tippexed, rather than crossed out. Staff receive training in statutory health & safety matters so that they know how to support residents in a safe way. The maintenance staff carries out regular health & safety checks to the building and to equipment used by the people who live here. However it was noted from water temperature records (and from tests during the visit) that the hot water to washbasins in 2 communal WCs used by residents was issued at up to 59°C. This is well above the safe temperature guidelines of 43°C, and presented a risk of scalding for the people who live here. The maintenance staff stated that this had been reported to the Provider for attention. However the potential risk to residents was evident and an Immediate Requirement Notice was issued to the home for urgent action. The home was advised to ensure that all residents were safely supervised when using these rooms until action could be taken within a couple of days Written confirmation was then received from the home to confirm that thermostatic blending valves have now been fitted to the washbasins to ensure a safe water temperature for residents. Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 25 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 3 X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 X 3 X X X 2 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 x x 2 Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 26 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 OP4 Regulation 18(1)(c)i Requirement Arrangements must be made for all care staff to have training in dementia care needs, in order to equip them to provide the right support for residents with such care needs. The nutritional assessment and planning for residents must be managed by a clear, coordinated approach involving care staff and catering staff, and this must be outlined in a specific plan of care. The home must ensure that individual staff practices uphold the dignity and privacy of the people who live here. 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 previous inspections – timescale of 01/02/05 and 01/01/06 not met). The Provider must ensure that any identified risks to residents, (including unsafe hot water temperatures) must be DS0000061451.V301680.R01.S.doc Timescale for action 01/01/07 2. OP8 12(1)a 13(1)b 16(2)i 01/12/06 3. OP10 12(4)(a) 01/12/06 4. OP16 22(6) 01/01/07 5. OP38 13(4) 01/11/06 Appletree Grange Version 5.2 Page 27 addressed immediately, or made safe until such time as they can be resolved. 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 OP1 Good Practice Recommendations Consideration should be given to including within the Statement of Purpose the actual number of places in each category of care that the home provides to inform prospective residents. All residents should have a copy of the Welcome Pack so that they each have information about the service. Consideration should be given to combining each individual care plan goal with its own respective evaluation record so that the progress of each goal can be seen and retrieved easily. Weight records should include the full date. Discussions should be held with residents who use the first floor dining room about the replacement of the toaster. The home should ensure that all resident have an up-todate written copy of the complaints procedure, and that it is applicable to this home. The Provider should check that the lighting to the first floor corridor meets the luminescence standard, i.e. not less than 150 lux, so that it is sufficiently bright for the residents. Consideration should be given to how senior staff can be made distinguishable for visitors. Checks taken up for prospective new staff should include a reference from their previous employer, especially if from another care setting. Tippex should not be used to correct errors on residents personal financial records. 2. 3. OP1 OP7 4. 5. 6. 7. OP8 OP15 OP16 OP25 8. 9. 10. OP27 OP29 OP35 Appletree Grange DS0000061451.V301680.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields 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 DS0000061451.V301680.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. 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