Inspection on 11/06/08 for Apthorp Lodge

This inspection was carried out on 11th June 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Apthorp Lodge 09/03/10

Apthorp Lodge 21/01/10

Apthorp Lodge 03/11/09

Apthorp Lodge 17/08/09

Apthorp Lodge 19/06/09

Apthorp Lodge 04/12/07

Apthorp Lodge 22/05/07

Apthorp Lodge 14/08/06

Apthorp Lodge 12/12/05

Apthorp Lodge 09/08/05

Apthorp Lodge 13/01/05

Apthorp Lodge 22/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Henry Nihill House

Birchwood

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

The Infirmary

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Apthorp Lodge Nurserymans Road off Brunswick Park Road London N11 1EQ Lead Inspector Duncan Paterson Key Unannounced Inspection 09:30 11 , 12 & 16th June 2008 th th 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 Apthorp Lodge DS0000051441.V364580.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. Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Apthorp Lodge Address Nurserymans Road off Brunswick Park Road London N11 1EQ 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) 020 8211 4000 020 8211 4109 manager.apthorplodge@fremantletrust.org admin@fremantletrust.org The Fremantle Trust Mrs Irene S Rondell Care Home 108 Category(ies) of Dementia - over 65 years of age (50), Learning registration, with number disability (1), Learning disability over 65 years of places of age (6), Old age, not falling within any other category (52) Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Consideration must be made in respect of the demography of the building. Staffing levels must meet the needs of the service users at all times of the day and night. As agreed on the 18th October 2006, one (1) named service user under the age of 65 can be accommodated until they are discharged. The Commission must be informed when this occurs. 4th December 2007 Date of last inspection Brief Description of the Service: Apthorp Lodge is a care home, which was first registered in August 2003 to provide personal care for 54 people, some of whom had dementia and a learning disability. Following the closure of two other homes, which were also managed by Fremantle Trust, a further 54 places were commissioned in October 2004, bringing the total capacity of the home to 108 residents. In December 2006 the registration for the service was amended to enable it to offer care to more people with dementia. The home can now accommodate up to 50 people with dementia, 52 older people and 6 people with a learning disability. The home is a large detached three-storey building. It is purpose built and organised on three levels, with lift access to all floors. It is divided into ten units or flats. Four units are dedicated to residents who have dementia and one unit to service users who have learning disabilities. The remaining five units are for mainstream services for older people. People with dementia can also be accommodated in the mainstream units if this is where their needs can most appropriately be met. There is a kitchen, lounge and dining room in each flat. All bedrooms are single with en-suite facilities. There is also an additional assisted bathroom in each unit. There is a car park to the side of the building and gardens to the side and rear, which are partly paved and accessible to the residents. The home is situated off Brunswick Park Road. It is well served with community services and facilities located along Russell Lane and East Barnet Road. The home has a day centre, which provides services to twenty-six service users specifically from the outside community. There is a registered manager in overall charge of the service, supported by one deputy manager. Each unit has its own staff team, with a unit leader in charge. Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 5 The current fees for residents living in the home range from £566.51 to £650 per week. The most recent inspection report plus other relevant information about the service is on display in the reception area. Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection took place on 11, 12 and 16 June 2008. The inspection involved two inspection officers on the first day. The lead inspector returned to complete the inspection on the other days. Feedback was provided to the manager and Freemantle Operations Manager on the third day. The inspectors spent time at the home talking with residents, staff, relatives, visiting professionals and the manager. A standard form, the Annual Quality Assurance Assessment (AQAA), was returned to CSCI by the manager. This was taken into consideration. Five of the 10 flats were visited with a sample of care plans inspected in each flat. Staff and residents were spoken with in each flat and observation carried out. Surveys were received from staff, residents, relatives and visiting professionals. The inspection also involved the assessment of a range of the home’s records, procedures and forms as well as observation and a tour of the premises. The inspectors would like to thank the manager, staff and residents for their help and co-operation with the inspection. What the service does well: There is a pleasant and friendly atmosphere. The manager and staff have created an open, welcoming home where residents are treated kindly and sensitively. The manager provides clear and effective leadership. Many positive comments were received from residents and relatives. One resident said that the staff are helpful and will, “do what you ask”. Another described a care worker as, “a little treasure”. A relative said that staff were “kind and considerate” and were, “always there to answer questions”. Another relative said that, “many staff go out of their way to meet residents needs”. The information available for residents and relatives has been redesigned and updated and is clear, attractive and easy to follow. Staff are caring and kind and work well with residents including people with dementia. The approach to dementia care is well considered with staff receiving relevant training which they value and specific staff working as dementia care advisors. The dementia care advisors work well with relatives and act as a resource for staff and others at the home. Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 7 The physical standards are generally good with benefits coming from a purpose built and well designed home. The separation into 10 self-contained flats retains the feel of a smaller setting within the larger home. Each bedroom has en suite facilities and is a good size and there are comfortable communal rooms as well as a pleasant garden and large grounds. Staff recruitment is to a good standard. Many of the staff hold NVQ qualifications. The manager has lots of experience and is knowledgeable about all aspects of the care home. She has been able to assemble a supportive team of managers who take the lead for aspects of the home such as the catering, maintenance and activities. Each of these areas are managed well. Probably the best aspect of the home is the positive, caring and supportive culture into which new staff and residents enter. What has improved since the last inspection? What they could do better: There is an ongoing need to recruit more staff and reduce further the reliance on bank and agency staff. Comments received during the inspection from relatives and staff indicated that continuity of care was still sometimes a problem. Staffing should be reviewed to identify and address arising issues. The care planning documentation needs a review and some development to make more streamlined and easier to complete. It was not always clear that important recording areas such as reviews and weight records were always recorded. Freemantle are currently piloting a new care planning system. Retaining staff training records on computer will assist with data analysis and a more efficient assessment of staff training needs. Again, Freemantle have plans in this area to develop such a system. The learning disabilities service would benefit from a separate section in the statement of purpose and service users’ guide so that the aims and objectives for this part of the service can be detailed. Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 123&4 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Good quality information about the service is available although a separate section in the service users’ guide would be useful for the residents who have learning disabilities. Relevant assessment information has been gathered to enable staff to meet residents needs. EVIDENCE: We were shown the home’s statement of purpose and service users’ guide which has been redesigned since the last key inspection. The documents are attractive, clearly written and use colour and photographs to produce a user friendly guide to the home. Information is also provided about the aims of the service, the staff delivering the service and people’s rights. The documents are provided to all residents as well as being on display in the reception area. The home is also registered to provide a service for six people with learning disabilities. There is a separate flat and staff for this. There are references to this service in the home’s statement of purpose and service users’ guide. Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 11 However, having a section for learning disabilities in the documents will allow the plans and aims for the service to be set out. For example, the manager is planning to obtain transport to assist with outings and details can be provided about this. We spoke to two relatives who told us that they had specifically chosen this home for their relatives after having been to see other homes. A relative told us that, “they are nice to us and good to mum”. In the 12 care plans viewed there was evidence that the residents had been fully assessed by the home as well as having detailed assessments from the placing authorities. We included an inspection of files for people who had recently moved to the home. There were up-to-date assessments on file. We were able to speak to a relative of a new resident. The relative said that the admission arrangements had, “gone well” and she was happy that she was kept informed about her relative and what staff were doing. We saw signed contracts on the files we looked at. We identified that there had been consideration of equality and diversity in the care for people. We noted, for example, that the chef was making Chinese meals especially for a resident. We saw that resident’s culture and religion had been identified and that religions ministers regularly visited the home. A Jewish relative told us that the activities organiser had put on a special event to mark the Jewish festival of Hanukkah. The activities organiser took special days and religious days in order to put on themed activities. The Operations Manager told us that there were plans to draw up more individual biographies for residents especially for people with dementia. Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A positive, caring culture has been developed. There are considered arrangements for dementia care. Generally, care plans are detailed but include a number of separate forms which require a lot of input from staff. There are plans to redesign the care plans. This should bring benefits to people using the service. EVIDENCE: To assess this set of standards we visited five of the ten flats. These included two of the dementia care flats, two of the older person’s flats and the learning disabilities flat. We spoke to staff, residents and relatives, inspected a sample of care plans and observed practice. The pleasant, friendly atmosphere already mentioned was evident in each flat. For example, we observed staff working in a kindly patient way with residents. One visiting relative told us that staff were always helpful and took time out to tell her how her husband had been. Staff clearly knew the residents well and Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 13 were able to describe what they were doing with each individual. We saw clear, calming and diversionary procedures being followed by staff. We discussed dementia care arrangements with the manager and staff. We were told that there are two dementia care advisors amongst the senior staff. These advisors are involved with working within the organisation to develop dementia services as well as working with staff, residents and relatives. We spoke with one of the advisors and she explained the work she had completed with relatives. Staff we spoke with told us that they had had dementia care training and that it had been helpful. We spoke with the relatives of one resident who had dementia. They said that they liked the home and found the staff helpful. They said that their relative had improved since living at the home with the help of staff and the care of the GP and psycho geriatrician. We inspected a sample of care plans in each flat we visited. The files contained comprehensive information on each person as well as assessments in relation to pressure care, moving and handling and nutrition. Some had a life story and each had a personal lifestyle summary. However, it was sometimes difficult to tell whether they had been reviewed. We were informed that there was a checklist in the file which recorded on a monthly basis when care plans, risk assessments and weight were reviewed. The files also included separate records of social activities, key worker contact and daily records which staff had to complete. The records were not consistent in content as we found some gaps between entries for activities and key worker contact. We also found some of the daily records inconsistent. For example, some records provided information about residents moods, activities and visitors whilst others concentrated on recording personal care provision, medication and sleeping patterns. We also found that a care plan for one resident was incomplete. Another matter we identified was that although action had been taken to address one resident’s weight loss it had not been recorded. We noted that although there were good examples of equality and diversity work in action and in care plans not all of the relevant sections of care plans had been completed. A more streamlined care planning system will benefit staff and residents. We discussed the care planning arrangements with the manager and Operations Manager. We were told that the Freemantle organisation is currently piloting a new care planning model for a period of 4-5 months. A new care planning system is envisaged after the pilot has been completed and analysed. Records seen indicated that the home ensures that residents see health care professionals on a regular basis for both regular or specialist input. The home has a number of GPs who visit as well as the district nurse. Optician, dental Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 14 and chiropodist appointments are clearly recorded as are any accidents/ falls with any action taken also recorded. We discussed GP arrangements with the senior staff and the manager. There are a number of GPs visiting the home. We were told that the GP arrangements are generally good and that where needed the manager took action to address arising matters. We were able to speak with a visiting psycho geriatrician who provided positive comments about the service. She said she had good links with the home and that staff acted well to work with residents. Medication administration was observed during lunchtime in one of the flats. Medication is supplied through the Boots blister pack system, which is clearly labelled with the name and dosage. Trolleys are used which are stored in cool locked rooms when not in use. We inspected the records for two of the flats. We found that records were clear with details of medication checked into the home and administered. One person informed us that he felt that the staff should know what medication he took and what it was for. He said that he asked a staff member recently and they were unable to say what the tablets were for. This comment was discussed with the manager who stated that staff do have information about medication types and that this had been covered during their training. It is recommended that the flats should have a list of the medication people are receiving with a description so they are more aware of what the medication is for. We visited the learning disabilities flat, spoke with staff and residents, observed lunch and inspected two of the care plans. Some of the feedback from one resident was that more trips out were wanted. It was not clear to us what the overall aims of the service were. Unfortunately, the unit leader was on leave but we were able to discuss these matters with the manager. She advised that one of the ways forward was to obtain access to transport so that more trips out could be offered as well as establishing more links in the community. Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 &15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. There have been improvements to activities provision for people with dementia with more improvements planned. The appointment of a specific dementia care activities officer will extend opportunities for residents. The food provided is well liked and varied. Catering staff are informed about residents dietary needs and able to meet them. EVIDENCE: We spoke to the activities organiser, the manager, staff, residents and relatives as well as observing what was going on throughout the day. The manager informed us that a new dementia activities organiser is to be appointed to work at the home. The current activities organiser works only with the older person flats although activities are put on to which people with dementia can attend. We were told that since the last key inspection three new activities rooms had been created in the dementia care flats. These flats have two lounges each and the second lounge has now been equipped so that they can also be used for activities specifically for people with dementia. We saw these lounge areas Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 16 being used with staff leading activity sessions. We also saw staff leading a group music session in one of the flats. The activities organiser told us about his work. There are regular events based on special days such as St Patrick’s Day and religious events. There are also regular sessions each week such as bingo sessions and quizzes. He said that religious representatives come to the home on a regular basis. A new development is the purchase of a cinema style projector and screen which is used to show films to residents in the home’s main lounge. This area is equipped with a bar and a wide screen TV. We were told that residents were currently watching the Euro 2008 football competition on this in the evenings. The activities organiser told us that he is part of a Freemantle network of activities organisers who take part in regular meetings. He has also had relevant training. On one of the days of the inspection he had arranged a trip for a small number of residents for a pub lunch. There is an activities noticeboard which confirmed many of the events that he told us about. Residents and relatives also confirmed that they took part in activities. They were also photographs around the home showing residents taking part in activities. A resident to whom we spoke told us that she had friends visiting at times to suit her as well as a regular religious minister. Some of the feedback we received from relatives included the fact that people felt that more activities were needed, particularly for people with dementia. This inspection has identified that this is something which the manager and staff are responding to. There should be further developments for people with dementia when the dementia activities person is in post. We observed lunch being served on two of the days of the inspection. We also spoke to the chef manager about the process of serving the meals and residents dietary requirements. There is an efficient system of ensuring that the meals once ready are swiftly transferred to the ten flats. The catering staff prepare meals for up to 150 people at lunchtime as they also provide meals for people using the day centre. Heated trolleys are used with staff in the flats serving when the food arrives. One of the inspectors had lunch with residents. The meal of lasagne with vegetables followed by apple crumble and ice cream looked tasty and appetising. Residents said it was lovely and ate well. Residents sat in their preferred seats with their friends. They spent time chatting to us about the home, their families and about each other. It was a lively and informative meal. One person required some assistance to eat their meal which was carried out discretely by staff. Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 17 In one of the flats we looked at staff demonstrated a good understanding of residents needs and how best to serve lunch. Staff were efficient about serving the meal and assisting residents to eat where needed. Staff were very busy here and needed to be hard working and well organised. We were told that should there be a need for additional staff help the duty officer could assist. There was some very positive feedback about the food from relatives and residents. Residents to whom we spoke said that they liked the food. A resident told us that the, “food is excellent”, and that you, “can get too much at times.” A relative described it as, “superb”, and another relative that, “there is a good choice of food”. Another relative said that once she had spoken with staff her relative was provided with a choice of food. The chef manager was knowledgeable about residents dietary requirements, likes and dislikes. He was able to tell us about each resident that may have a special diet such as the need to have meals pureed. He was also able to show us meals which he prepared specifically for a small number of residents. For example, he had prepared a range of Chinese meals for one of the residents which were stored in the freezer and given as required. The chef manager was also clear about the serving of meals and getting them to the individual flats. We were shown a Barnet Council food hygiene certificate which had awarded the home 5 star status. 5 stars is the maximum awarded. The Chef Manager showed us food hygiene training certificates for himself and the catering staff. There were four staff working in the early shift and one in the afternoon with the Chef Manager working until 4pm. We were shown copies of the menus. They are varied with 12 alternatives being available for people each day. A new summer menu was to be started in the week following the inspection. Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents and relatives are provided with clear information about how to complain. The complaints records show that complaints are responded to carefully. The safeguarding arrangements are clear and guided by a detailed policy. EVIDENCE: One relative told us that she had made a complaint and she felt that it had been properly responded to. Information as to how complaints can be made is available to people in the home’s information packs as well as on display. We asked residents if they knew how to raise concerns and if they had any they wished to discuss with us. All said they had no complaints and that they would talk to the person in charge should they need to. We were shown the complaints records and we could see that the complaints received had been clearly recorded with details of action taken. One complaint, which had also been a safeguarding matter, had been addressed but was not yet concluded. However, the actions needed to conclude the matter had been agreed. We were shown the home’s safeguarding policy and procedure. This is clear and sets out how staff should respond to safeguarding matters. Staff told us that they would report safeguarding matters to the manager. Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 & 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are good, modern facilities for residents with each person having their own room with en suite facilities. The home is well equipped with adaptations for people who may have disabilities. There is a good standard of cleanliness and presentation throughout. EVIDENCE: The home is purpose built, modern having opened in 2003. Although large in terms of registered places, the home is arranged over three floors within 10 separate flats. Each flat has it’s own separate front door as well as dedicated bedrooms, dining room, lounge areas, toilets and bathrooms. With the home divided in such a way there is a smaller feel to each flat. Each bedroom is relatively large with en suite facilities. There are extensive grounds and the home is next to the Brunswick Park open area so that there is a feeling of space and tranquillity. There is a central garden area which provides a Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 20 pleasant area for residents to sit. Many of the bedrooms overlook this area provides pleasant views. Many people commented on the pleasant environment. One relative, for example, said that he had been attracted to the home because of the en suite facilities. This was a factor in choosing this home. A resident told us that the home was kept very clean with, “never a day passing without the flat being hoovered”. A relative said that the home is, “always clean, tidy and free of smells”. We identified that the home was equipped with mobile hoists as well as bathrooms with accessible baths. There are also wide corridors and passenger lifts. The manager reported via the AQAA that there were some problems with the building. For example, some water damage from the roof and a problem with pigeons roosting on the building. There was also the need for some renewal and repair to the communal areas as there had now been five years of use since the home opened. There were discussions with the housing suing association as to how these matters were to be addressed. There is a three way partnership in the running of this service with Barnet Council and the Catalyst Housing Association. Freemantle have responsibility for decoration of bedrooms whilst the housing association the communal areas. The manager informed us that there had been some decorative work completed such as the laying of a new carpet in one of the flats and that more work was planned in this year’s budget. We visited the laundry. There are three industrial style washing machines and three dryers. One of the washing machines was not working but the facilities manager told us later that it had been repaired. The laundry assistant present, who was new to the home, described the procedure as to how she worked. This involved having a clear system for washing clothes and bedding and then taking clean laundry back to residents rooms. Staff helped with this. There were no adverse comments about laundry received either in person or via surveys. Apthorp Lodge DS0000051441.V364580.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 & 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. New staff have been recruited thereby reducing the need for bank and agency staff. Further recruitment is needed to make sure that residents receive continuity of care. Recruitment checks are carried out robustly to a good standard and staff are provided with a range of training with many holding NVQ qualifications. Transferring staff training records to a computer system will assist with the efficient management of training. EVIDENCE: We received a great deal of positive comments about the staff. The following is a sample of comments either received in person from relatives or residents or through surveys. “95 of staff are extremely caring and respectful”. “Staff always welcome you when you visit the home”. “Senior staff helped my relative settle in”. “Staff are always cheerful even when under pressure”. These comments were endorsed by our findings. The staff we spoke to were all helpful, friendly and welcoming. Many stressed the good team work they used and the fact that they felt supported by senior staff and the manager. Staff liked the fact that they were given training opportunities. We also Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 22 observed staff in their work with residents. Interactions were positive and kind with staff speaking to residents in a pleasant and caring manner. However, we also received some less positive comments. The need for extra staff was noted by relatives and staff. One relative thought that often shortages of staff and too many agency staff lead to, “a lack of continuity of care for residents”. Another relative said that “staff do not always have time to encourage”, her relative. Two adverse comments were provided about the night staff with a small number of staff seen as not as good or as caring as other staff. We noted that there were a number of bank and agency staff working during the inspection. We discussed the staffing complement with the manager and looked at the staff rota. We saw that there are three staff on duty in the dementia care flats throughout the day and two staff on duty in the older person and learning disability flats. This is in addition to the manager and two senior staff who provide a duty service. At night there are eight waking night staff. The manager told us that recruitment had been carried out a number of times this year with new staff appointed with more new staff to follow. She said that there had been an improvement in that there was much less reliance on agency staff than there had been one year ago. And that many of the bank or agency staff had worked at the home for a lengthy period and so become familiar with residents and the operation of the home. Given the comments received from relatives and staff it is important that the manager retains an overview of staffing levels and how changes such as reliance on agency staff and the current staffing numbers may affect the quality of life experienced by residents. A recommendation has therefore been given to review staffing levels currently in use over the coming months, keeping records and taking any remedial action as required. We inspected the files for the three most recent staff appointees. We identified that recruitment was being completed to a good standard. The required references and CRB checks had been completed and the detail on the application form, as well as records of interviews, was clear and informative. We inspected the staff training records with the deputy manager. He takes the lead in this area. There were two outstanding requirements from the last key inspection of 4 December 2007. These related to staff receiving specific training and the need to complete training needs assessment for the whole staff team. We identified that staff had completed the specific training in first aid, fire safety and health and safety matters. We also identified that there were a number of training opportunities available for staff such as dementia care training. Staff confirmed to us that they had completed this training as well as NVQ training. The deputy manager was also able to show us how he put forward people for relevant training. A great deal was provided internally Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 23 by Freemantle. The AQAA provided to us stated that well over 50 of the care staff had completed NVQ Level 2 or above and that others were working towards this. We identified that there were records of the training needs for staff. However, we noted that the existing records were paper based and difficult to use. The deputy manager, for example, had been working on an exercise to bring all the data together in one paper based file. This had been a difficult and time consuming task and could have been much more easily achieved had a computer based system been used. The data could then be retrieved and analysed much more efficiently once inputted. It would also be much easier to evidence that staff had completed the relevant training. This was discussed with the manager and Operations Manager. They advised that Freemantle had plans to adopt a computer based system for retaining staff training data. This will greatly benefit the service and ultimately the residents. A recommendation is given about this as the timescale for completion by Freemantle for this work had not yet been identified. Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 35 36 37 & 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager provides supportive leadership for staff and a clear understanding of the needs of residents and how best to meet them. Key areas such as catering and maintenance have effective managers in place to ensure that the service runs smoothly. Quality assurance initiatives generate reliable findings about the impact of the service. Health and safety is well managed. EVIDENCE: The manager is very experienced and brings strong leadership and direction as well as support for staff. The manager displayed a good knowledge of people, both staff and residents, in the home as well as current issues facing the service. She has been the manager of the home for many years and has effectively lead the home through periods of change. Many of the staff and Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 25 residents told us positive things about the manager and how she was supportive and helpful. The manager was also able to place into context many findings of the inspections or questions that were raised throughout the process. She was also able to demonstrate good and positive links with other professionals such as visiting healthcare professionals. Quality assurance initiatives were discussed with the manager. These include an internal annual quality audit of the service which is completed by the Operations Manager and another Freemantle manager. We were shown the most recent audit which had been completed in August 2007. This was a detailed report which set out the findings including findings from use of surveys. Analysis was based around the same national minimum standards used by CSCI. Other quality assurance initiatives include: a Home Business Plan which is developed from the organisation’s overall business plan; monthly visits from the Operations Manager; annual consultation meetings with residents, and; monthly residents meetings. We spoke with the home’s administrative staff who complete the administrative work for looking after residents money. There were detailed records which we were able to follow. There are relatively small amounts of money looked after in a resident’s account. However, a small number of residents have accumulated a lot of money which would be better placed in higher interest bearing accounts. We were told that there had been arrangements to do this in the past but there had been some problems with the operation of the system. We were told that new arrangements for this were being made. The manager told us about the staff supervision arrangements and progress that had been made since the last key inspection. The manager supervises the deputy manager and senior staff as well as support staff such as the catering manager. The deputy supervises other senior staff. In turn the senior staff (who have dedicated responsibility for the flats) supervise care staff in each flat. The manager showed us her records of staff supervision. She was keeping separate records in order to have overall information about progress with supervision. She showed us letters that had been sent to staff reminding them of their responsibility for completing supervisions on time. We identified some gaps that remained in the records of supervision where two staff had not received supervision since February 2008. However, the manager and Operations Manager outlined how they were to tackle this issue which involved allowing extra time for senior staff to complete supervision sessions. We felt confident that this would ease difficulties with arranging staff supervision sessions. We met with the manager and facilities manager to inspect the records kept for the maintenance of the building, the servicing of equipment and checks of Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 26 fire safety and other building related matters. Many of the maintenance functions for the home have been contracted out to the Kier company. The records they kept were shown to us. We identified the essential areas, such as fire safety checks and drills and the servicing of equipment, the lifts and water storage safety had all been completed. We were shown relevant certificates. We were also shown updated risk assessments for fire safety and the general building risk assessment. We identified that there was a thorough approach taken to health and safety and maintenance matters. The facilities manager is well organised and knowledgeable about his role and his responsibilities. Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 27 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 3 3 3 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 4 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 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 28 No 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 OP7 Regulation 15 Requirement Ensure that care plans clearly confirm that reviews have been carried out and that actions taken to address residents care or health needs have been recorded. Timescale for action 01/09/08 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 3 4 Refer to Standard OP1 OP7 OP9 OP27 Good Practice Recommendations The statement of purpose and service users’ guide should be extended to include a dedicated section about the learning disabilities service. The care planning system should be reviewed to make more streamlined and user friendly. There should be consistent recording of residents progress notes. To assist staff with familiarity with residents prescribed medication have a list of such medication available for staff in each flat. Review staffing levels in use (day and night) to assess whether changes in personnel or staffing numbers affect residents quality of life. Take remedial action as indicated. DS0000051441.V364580.R01.S.doc Version 5.2 Page 29 Apthorp Lodge 5 6 OP30 OP35 Establish a computer based system for the recording and analysing of staff training records. Establish a new arrangement where residents with high levels of savings can deposit such funds in a higher interest bearing account. Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Apthorp Lodge DS0000051441.V364580.R01.S.doc Version 5.2 Page 31 - 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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