Inspection on 09/11/05 for Appletree Grange

This inspection was carried out on 9th November 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 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 Unannounced Inspection 9th November 2005 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.V253403.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 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 Barchester Healthcare Homes Limited Mrs Margaret Anderson Care Home 33 Category(ies) of Dementia - over 65 years of age (3), 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 (33), Physical disability over 65 years of age (8), Sensory Impairment over 65 years of age (1) Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st June 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.V253403.R01.S.doc Version 5.0 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 November 2005. 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. The lunchtime meal was sampled, and how staff support the residents was observed. All shared areas of the home (such as bathrooms and lounges) and a sample of bedrooms were inspected. Discussions were held with the Deputy Manager and some staff about the progress of the service. Care records, personal finance records and health & safety records were examined. There have been no complaints about the home since the last inspection. What the service does well: What has improved since the last inspection? Since the last inspection staff have tried hard to get care records up to date and these have improved. The temperature of baths has now been fixed so that it is warm enough for the people who live here. Some small defects in the home have also been fixed, such as signs and lock fitted to the laundry room. Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 6 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.V253403.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 4. (Standard 6 is not applicable to this home) The needs of all residents are assessed to ensure that the home can provide the right care. Increased needs are being met but this needs to be formally recognised in the homes registration. EVIDENCE: 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, a pre-admission assessment is carried out by senior staff 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, but some are not dated. This home is registered to provide up 33 places, however for much of the year one bedroom has been converted for use as a staff office. This has been a beneficial use of a small, unused room, but it means that the registered number of places is not correct. Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 9 The home is registered to provide up to 3 places for older people with dementia care needs. At this time there are 6 people with dementia care needs living at the home. It is acknowledged that some peoples needs have changed over time, which has led to this increase in dementia care needs. The home is registered to provide 2 places for older people with significant sensory impairments, but there are now 4 residents with such needs. The home is registered to provide 2 places for older people with mental health needs, but there are now 4 people with such needs living here. There was no indication during this visit that the increased dependencies of these residents were not being met. However, the current numbers and needs of residents are not reflected in the homes registration nor in its Statement of Purpose. Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9. Residents needs are set out in a plan of care, and some people have been included in their own care planning. Care plans are not sufficiently reviewed, and are not supported by the other care recording systems. Residents are protected by the homes medication procedures, but the system takes more staff time than necessary. EVIDENCE: There have been some improvements to care plans since the last inspection. There are new care plans in place for each of the residents that identify any areas that they need extra support with from staff. 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. However there is no record of how residents with a sensory impairment have been included in drawing up their care plan. There are monthly evaluation records for staff to record the progress of each residents goals. However some evaluations have not been completed. Others state no change for several entries, which does not reflect any support given Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 11 over each month. In this way care plans do not demonstrate the good support that is actually provided in the home, which was evident through observations. Also, daily reports are not completed on a daily basis. In some cases there were gaps of 2 weeks, so it was not possible to follow-up the daily well-being of the people who live here. The Deputy Manager stated that there is also a seniors report that is used at staff handovers. It is not necessary for 2 reporting systems. There were also bath records that are rarely completed and are unnecessary. Conversely the monthly weight records, that may indicate a significant change in need of some residents, have not been completed for several months. The home uses a Monitored Dosage System to manage the medication on behalf of those residents who are unable to manage their own medication. Individual residents medication is supplied by a pharmacist in blister-packs, and these are securely and suitably 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. However, staff are recording incoming medication is 2 different ways and this is unnecessary, repetitive and taking time from their support of the people who live here. Staff correctly record incoming medication onto the designated record produced by the pharmacist. However they are also transcribing all incoming medication by hand into a hardback ledger. This is time consuming, could lead to errors in transcribing or recording, and is unnecessary for the audit of medication. Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 & 15. Residents are supported and encouraged to exercise choice and control over their own lives. The quality of the catering service means that residents receive an appetising, healthy diet and enjoy restaurant-style dining. EVIDENCE: 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. Several residents said that they like to spend some time in lounges socialising, then spend some time in their own bedrooms for privacy and quiet. All of the residents are supported with their appearance and all were well dressed. Several ladies enjoy having their nails painted by staff and this helps them to continue to choose their appearance and presentation. During discussions with residents it was clear that they are kept very well informed about forthcoming events, including changes to the building or to staff. 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 Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 13 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. Staff were sensitive in their support of a small number of people who need extra assistance at meal times. The mealtimes are unhurried and residents spend time chatting at tables after the meal. Residents had many positive comments about the quality of the meals and were very pleased that the chef often chats to them about menu suggestions. Residents comments included, weve got 2 of the best cooks and we can ask for whatever we want and they will make it for us. Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. Most residents and their representatives have information about how to make a complaint in a suitable format, except people with a visual impairment. EVIDENCE: The home provides clear written information 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. 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. At the last inspection the Manager stated that was to be addressed by the organisation, but this remains outstanding. Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 & 25. Residents accommodation is warm and comfortable. A programme of redecoration is planned to refresh the décor. Residents own rooms meet their needs. EVIDENCE: Overall the accommodation for residents is warm, comfortable and homely. There are some areas of minor wear and tear throughout the building, particularly in bedrooms and bathrooms. However a programme of redecoration is to start in the new year to address this. Residents said that they are generally satisfied with the accommodation. They are fully aware of the redecoration programme ahead, which they believe will make the home even better. Residents said that the home is kept spotlessly clean. Residents described their en-suite facilities as very important as this supports their privacy and dignity. One newer resident has not yet been given a key to their own bedroom, which is also important in terms of privacy and independence. Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 16 Minor premises issues noted at the last inspection have been addressed, but there is no sign on the staff office door to help residents orientation. The home is sufficiently light and ventilated. The temperature of hot water to baths is now checked and recorded by maintenance staff to make sure that it is at a safe temperature for use by the people who live here. Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 17 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): 28. Residents needs are supported by homes staffing complement. 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. At the time of this inspection the Deputy Manager was responsible for the day to day management of the home while the Manager was on holiday. There were 4 care staff, 3 housekeeping staff, and 2 catering staff on duty. This was sufficient to meet the needs of the residents who currently live here. The home also benefits from a maintenance staff and an administrator. 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. There are currently 2 new staff from Europe working at Appletree Grange. Staff stated that it is the policy of Barchester Healthcare that each home has a proportion of foreign care staff in post. Residents described both staff as kind, gentle and helpful, and there was clearly a good level of day-to-day Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 18 communication between residents and those staff. In discussions other staff on duty were also very supportive of the 2 new staff. At this time it was unclear how long the 2 staff will be at the home. In discussions, it was apparent that the home had been directed to make a number of arrangements for the staff before they arrived, including finding local accommodation and arranging transport. These matters had taken some time to arrange, and could not be repeatedly frequently, as it is additional work for the Manager and staff that may remove them from the running of the home. Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 19 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, 35 & 38. Residents benefit from a well managed home. Residents are safeguarded by the financial procedures within the home. The health and safety of residents is promoted, although fire safety may be compromised by insufficient training for night staff. 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 remains up to date with best current practice. 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. Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 20 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. 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. He keeps a record of the checks and of any remedial action taken, however the record does not always include the full date. The staff team has had certificated training in fire safety. However there were no records of the required in-house fire instructions for new staff, nor of the required 3 monthly in-house instruction for night staff. The sluice rooms contains equipment and a hot water supply. The door to the sluice room was unlocked, which a resident could have entered by mistake. Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 21 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 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 x 2 x x x 3 x 3 x STAFFING Standard No Score 27 x 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x x x 3 x x 2 Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4 Regulation 4(b) & 12(4)b Requirement The Provider must apply for a variation for registration to take account of the reduced number of places and the increase in numbers of residents with dementia care, mental health and sensory impairment needs. The monthly evaluation records of care plans must be completed on a monthly basis and must reflect a meaningful review of the support given and any progress for each goal. 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 2 previous inspections – timescale of 1.2.05 not met). All residents must have a key to their own bedroom unless a risk assessment determines otherwise. A record must be kept of inhouse fire instruction that must include 2 instuctions in the first month for new staff, and not less DS0000061451.V253403.R01.S.doc Timescale for action 01/01/06 2 OP7 15(2)b 01/01/06 3 OP16 22(6) 01/01/06 4 OP24 12(2)a 01/01/06 5 OP38 23(4) 01/01/06 Appletree Grange Version 5.0 Page 23 6 OP38 13(4) than 3 monthly instruction for night staff.(Previous timescale of 1/8/05 not met) The door to the sluice room must 01/01/06 be kept locked to prevent potential tripping or scalding hazards to residents. 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 2 Refer to Standard OP3 OP7 Good Practice Recommendations Assessment records should be dated for future reference and review. Daily records should be recorded on a daily basis to show the progress of each residents well-being. The home may wish to consider using only one daily record rather than the additional seniors report. Consideration should be given to the value of the bath record which should be either completed or discarded. The monthly weight records should be completed on a monthly basis, particularly where this relates to an identified need in the care plan. Consideration should be given to the value and necessity of the second, transcribed incoming medication record system. There should be a sign on the staff office door to help residents get around the home. The support arrangements for foreign staff should be arranged by the organisation, and should not impact on the management or running of the home. Records of maintenance checks should include the full date and year. 3 4 5 6 7 8 OP7 OP7 OP9 OP19 OP29 OP38 Appletree Grange DS0000061451.V253403.R01.S.doc Version 5.0 Page 24 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.V253403.R01.S.doc Version 5.0 Page 25 - 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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