Inspection on 27/02/06 for Applewood Care Home

This inspection was carried out on 27th February 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

Applewood Care Home 24/10/08

Applewood Care Home 07/07/06

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Applewood Care Home Coopers Lane Bramley Basingstoke Hampshire RG26 5BZ Lead Inspector Marilyn Lewis Unannounced Inspection 27th February 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 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. Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Applewood Care Home Address Coopers Lane Bramley Basingstoke Hampshire RG26 5BZ 01730 895485 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) Milkwood Residential Care Ltd Natalie Betsworth Care Home 19 Category(ies) of Dementia - over 65 years of age (9), Old age, registration, with number not falling within any other category (19) of places Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th May 2005 Brief Description of the Service: Applewood is a large detached property situated in a quiet residential area in the village of Bramley, Hampshire. The home provides care and accommodation for nineteen older persons, nine of whom may have dementia. Accommodation is provided over two floors with a passenger lift and stair chair lift allowing residents access to each floor. There are two communal lounges, a conservatory where a dining area is situated and there is also a small sitting room that can be used as a quiet room or for residents to entertain their visitors. The home has pleasant gardens where seating is provided for residents and their visitors. The home’s ownership changed in December 2005 and it is now registered with Milkwood Care Ltd, an organisation that owns a number of care homes in the South of England and in Wales. Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 27th February 2006. The inspector toured the home and met with six of the sixteen residents, two visitors, two care staff members, the registered manager and one of the organisation’s directors. Care plans were sampled for five residents and records were seen for staff recruitment and training, fire safety, complaints and medication. The home changed ownership during December 2005 and although this was the second inspection for the year 2005/2006, this was the first inspection for the home under its new organisation, Milkwood Residential Care Ltd and the registered manager Natalie Betsworth. Information on the standards assessed at the first inspection can be found in the inspection report dated the 16th May 2005. An additional visit was also undertaken on the 4th July 2005 to review the requirements issued during the first inspection. What the service does well: The home looked clean and homely. Residents and visitors spoken with during the visit said that the staff were caring and friendly and they were satisfied with the care provided. The meals served at lunch looked appetising and well presented and residents said that they enjoyed the food provided at the home. The records of complaints seen indicated that all complaints were taken seriously and acted upon. Residents’ safety was protected by staff awareness of abuse issues. The registered manager has experience in providing care in a residential setting and is currently studying for the Registered Managers Award. Residents spoken with said that they felt the registered manager was a good listener and a caring friendly person. Residents and their relatives and staff have opportunities to give their opinions on the quality of care provided at the home and they benefit from the open approach to management practiced there. Residents’ financial interests are protected by the home’s clear procedures for handling residents’ money. Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Recruitment records seen for staff members indicated that the home had not obtained a full employment history for two staff members and one person had commenced work at the home without the completion of a Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) check. The home is to notify the commission as soon as it has obtained the required POVA First check. The lack of robust recruitment procedures has the potential to put the residents’ safety at risk. Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 Page 7 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. Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 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 Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 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): 3 and 6 No one is admitted to the home without a full care needs assessment to ensure the home can meet their needs. EVIDENCE: A full care needs assessment is undertaken by the registered manager for each prospective resident prior to a place being offered at the home. Two assessments seen covered all aspects of care needs including mobility, nutrition, personal and emotional needs. Information from care managers was included in the care assessment and the registered manager said that relatives were encouraged to participate in the assessment process. An assessment seen that had been undertaken for a person currently in hospital indicated that the registered manager would not admit anyone if it was felt the home could not meet their assessed needs. The home does not provide intermediate care and therefore standard 6 is not applicable. Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 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, 8, 9 and 10 There has been an improvement in the care planning process and residents are treated with respect, their health care needs are met and they are protected by the home’s clear procedures for dealing with medicines. EVIDENCE: The full assessment forms the basis for the individual care plans. Care plans seen for five residents provided information required by staff to support the residents including personal, emotional and social care needs. Risk assessments were included in the plans and those seen had risk assessments for mobility, risk of falls and bathing. Care plans seen indicated that residents received advice and support from their GP and other health professionals such as district nurses and community psychiatric nurses as required. One care plan recorded that they had received visits from their optician. Medication records seen had been completed appropriately and medicines were stored safely. At the time of the inspection there were no residents receiving controlled medicines but Temazepam tablets were stored in the controlled Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 Page 11 medicines cupboard. At present only one staff member signs the records when Temazepam is administered but the registered manager is arranging for the system to change so that two staff members sign when administering the tablets. Only a very limited stock of medicines was kept at the home ensuring that medication was not wasted. Dressings seen were well within their date of use. The registered manager had received training in the safe administration of medicines and she has supervised staff members before they are able to administer the medicines. Training has been arranged with a pharmacist for all staff and a long distance training course has also been organised. At the time of the inspection no residents were responsible for the administration of their own medicines. During the inspection staff were observed talking to residents in a friendly, caring manner. Three residents spoken with said that staff always treated them with respect. Bedroom and bathroom doors are fitted with locks to provide residents with privacy when required. Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 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): 12, 13, 14 and 14 Residents are able to participate in a programme of suitable activities, receive visitors as they wish and are offered well-balanced, appetising meals. EVIDENCE: Since the new registered manager has been in post, an activities programme has been put in place. The programme for the week was displayed in the reception area and activities attended by residents were recorded in their care plans. Activities available were Karaoke, visiting musicians, bingo, puzzles and games. The responsible individual stated that the organisation has a mini bus that is to be used for outings for residents in the near future. Residents spoken with said that they enjoyed the activities offered at the home. One resident said that they appreciated being able to join in or not as they wished. Some residents went out to spend time with family members and care plans seen for one resident recorded visits to church on a regular basis. The registered manager said that visitors were welcome at the home at any time provided the resident wished to receive visitors. The care plans for one resident recorded their refusal to receive visitors on one occasion. Two visitors spoken with said that they felt able to visit at any time. Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 Page 13 Menus seen indicated that residents were offered well-balanced meals. Residents spoken with said that the food provided was good and they enjoyed the lunch served on the day of the inspection which was chicken casserole, potatoes, cauliflower and cabbage followed by chocolate sponge and chocolate sauce. The evening meal was due to be cold meat and chips followed by strawberry blancmange. The home is able to cater for special diets such as diabetic diets. The menu for the day was displayed in the dining area. Although alternative meals are available this is not displayed on the menus. It was agreed with the registered manager that the menus would inform residents that alternatives were available. Bowls of fresh fruit were on each table in the dining area and fruit was available for residents who chose to eat in their rooms. Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 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 and 18 Residents feel that any complaints will be taken seriously and acted upon and they are protected by staff awareness of abuse issues. EVIDENCE: The home has a complaints procedure in place that informs people of how to make a complaint. The procedure states that complaints can be made to the commission if the complainant is unsatisfied with the investigation by the home. The procedure should indicate that the commission can be contacted at any stage and the registered manager said that the procedures would be changed to ensure this was made clear. At present any complaints are recorded in a book. The registered manager said that she was in the process of changing the recording of complaints to provide information on the complaint, the actions taken and the outcome. Records seen indicated that all complaints are taken seriously and acted upon. Residents spoken with knew how to make a complaint and said that they felt the registered manager would investigate any concerns and act to rectify the issue. Two staff members spoken with knew what to do should abuse be suspected. Records seen indicated that staff were receiving training in abuse issues and the registered manager said that she was discussing the home’s abuse procedures with staff during supervision meetings. Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 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, 20, 21, 23, 24, 25 and 26 Applewood provides a clean, homely, safe environment with cheerful communal rooms, personalised bedrooms, sufficient bathroom and toilet facilities and pleasant gardens. EVIDENCE: Applewood is a large detached property situated in a quiet residential area in the village of Bramley. The home has pleasant gardens and seating areas are provided for residents and their visitors. The local railway line runs alongside the home and this is fenced to safeguard residents who may wander towards it. There is a sloping area in front of the fence and the director of the organisation said that this had been risk assessed and the area would be made even when the building work commenced. Visitors to the home are admitted by a staff member and are required to complete the visitor records when entering and leaving the property. Visitors such as the inspector who was not known to the staff are asked for identification. Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 Page 16 A monitor alarm system has been fitted to a door to the side of the home to alert staff to residents leaving the home via this exit, to maximise their safety while allowing them independence. The director said that monitor alarms had also been purchased to ensure the safety of residents who may wander from their bedrooms at night. The system will not restrict their movements but will allow staff to assist them should they require help and to make them comfortable if they wish to spend time in one of the lounges. Care plans seen indicated that some residents did rise early and were prone to wander down the stairs to spend time in the lounges. Arrangements are in place for the call alarm system to be replaced with an improved system. The new organisation has plans for major building work to take place at the home and since taking over has been refurbishing rooms in the home. Refurbished bedrooms seen looked clean and cheerful and contained many personal items such as ornaments and pictures. Three residents spoken with during the tour of the home said that they liked their rooms and residents also said that they found the two communal lounges to be comfortable, pleasant rooms. The dining area that is located in the conservatory, adjoining one of the lounges provides a relaxing room for dining. There is also a small seating area that can be used as a quiet area or for residents to entertain their visitors. A passenger lift and a stair lift provide residents with access to all areas of the home. Some rooms have steps into them and risk assessments have been undertaken to ensure residents are safe to access the rooms. The home has sufficient bathrooms and toilet facilities. A washbasin is provided in the bedrooms and one has en-suite facilities. All bathroom and toilet facilities seen during the visit looked clean and in good order. At the time of the inspection the home looked clean, cheerful and homely. The home has recruited a full time handyman for the routine repair and redecoration of the home. During the inspection visit new carpet was fitted in one of the vacant bedrooms that has recently been redecorated. Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 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): 27, 28, 29 and 30 Residents’ needs are met by the number and skill mix of staff employed at the home and by staff who receive the training required to do their jobs. However the lack of robust recruitment procedures could put residents safety at risk. EVIDENCE: The home employs the registered manager, two senior carers, nine carers, two cooks, two domestics and a handy man. The registered manager and two carers were on duty at the time of the inspection plus a cook, domestic and handyman. Residents said that they felt enough staff were on duty, as they didn’t wait long if they requested assistance. Currently only one care staff member holds an NVQ. However the registered manager is aware of the requirement for fifty percent of care staff to hold or be in the process of obtaining the qualification and has arranged for seven staff members to commence training for the qualification in March 2006. The registered manager said that staff training had been intermittent prior to the organisation taking over the home and so she has been arranged for all staff members to attend training in mandatory topics such as moving and handling, infection control and food hygiene. Records seen indicated that eight staff members had attended training in dementia care and a video training session was being used for challenging behaviour. Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 Page 18 Staff records were seen for four care staff members, a cook and the handyman. Application forms completed by two of them did not contain a full employment history and although two written references were available one person did not have a reference from their last employer. The records seen for the handyman indicated that although an application had been completed, CRB and POVA checks had not been completed before he started work at the home. The registered manager is to obtain a POVA First check and notify the commission as soon as it is in place. Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 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, 32, 33, 35, 36 and 38 The registered manager has experience in providing care and residents are able to voice their opinions on the quality of care provided, their financial interests are protected and they benefit from the home’s open approach to management, staff supervision, clear financial procedures and the safe working practices operated in the home. EVIDENCE: The registered manager took up her post in December 2005. Natalie Betsworth has worked for the organisation for three years as a senior carer and prior to that she gained experience working for care agencies. She holds NVQ level 2 and 3 and is currently studying for the Registered Managers Award. Residents spoken with said that they liked the registered manager and found her to be very caring and a good listener and staff said that they received good Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 Page 20 support from her. Relatives said that they felt the staff were very good, kind and caring. A meeting was held for residents and their relatives in December 2005 when the organisation took over the home. Residents spoken with said that this meeting had been helpful and gave them an opportunity to ask questions and give feedback regarding the changes taking place at the home. The registered manager said that residents and their relatives were able to speak to her at any time and residents and visitors spoken with confirmed this. A general staff meeting was held in December following the organisation’s take over of the home. The registered manager said that arrangements were in place for further staff meetings in the next few months. Notes from the meeting were available for all staff members. At the time of the last inspection some residents were in receipt of Travel Tokens. The tokens were being pooled at the home and used for any resident and not just the residents to whom they belonged. A new system has been put in place by the new organisation. No money or travel tokens are kept at the home for residents and all monies and travel tokens are now the responsibility of the resident’s relatives or representatives. Invoices are provided for services provided at additional cost to the fees, such as hairdressing or newspapers. The registered manager has received training in providing formal supervision for care staff and has organised formal supervision sessions for the staff. Records for supervision meetings were seen in two staff members’ records. During the tour of the home hazardous substances such as cleaning fluids were stored securely. Health and safety information posters were displayed around the home. The kitchen looked clean and in good order with food stored appropriately. The laundry was also in good order. At the time of the last inspection the flooring was found to be broken and uneven. On this occasion the floor was even but an area did not have floor covering and may be difficult to keep clean. The area manager stated that the laundry was being re sited during the major building work due to start in the spring. Records seen indicated that all staff had received fire safety training. Although a record was kept of fire drills that were held on a weekly basis the staff who attended the drills was not documented. The registered manager said that she would arrange for an attendance record to be kept to ensure that all staff had attended fire drills. She also said that the fire alarms are held at different times and days of the week and staff are not made aware of the timetable, so that each fire alarm test is used as a fire drill. Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 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 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 3 3 Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 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 OP29 Regulation 18 Requirement The registered manager must ensure that all the information required in Schedule 2 of the Care Homes Regulations including a full employment history and at least a POVA First check are obtained for all staff members before they commence work at the home. This is an outstanding requirement of the inspection dated 16/05/05 (previous ownership of the home) Timescale for action 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Applewood Care Home DS0000064903.V284701.R01.S.doc Version 5.1 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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