Inspection on 14/08/06 for Apthorp Lodge

This inspection was carried out on 14th August 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

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 11/06/08

Apthorp Lodge 04/12/07

Apthorp Lodge 22/05/07

Apthorp Lodge 12/12/05

Apthorp Lodge 09/08/05

Apthorp Lodge 13/01/05

Apthorp Lodge 22/07/04

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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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Apthorp Lodge Nurserymans Road off Brunswick Park Road London N11 1EQ Lead Inspector Anthony Lewis Key Unannounced Inspection 08:50 14th and 16th August 2006 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.V303567.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.V303567.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 admin@fremantletrust.org The Fremantle Trust Mrs Irene S Rondell Care Home 108 Category(ies) of Dementia - over 65 years of age (37), Learning registration, with number disability over 65 years of age (6), Old age, not of places falling within any other category (65) Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. 12th December 2005 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 may have 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. 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. Each unit has its own staff team, with a unit leader in charge. There is a kitchen, lounge and dining room in each unit. All bedrooms are single with en-suite facilities. There is also an additional assisted bathroom in each unit. Three units are dedicated to residents who have dementia and one unit to service users who have learning disabilities. The remaining six units are for mainstream services for older people. There is a registered manager in overall charge of the service, supported by one deputy manager and six members of staff. The home also has a small licensed bar available for residents. 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. The fees for residents living in the home are £498.48 per week for residents on respite care and £496.48 to £509.60 per week for other residents. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which was conducted in two parts over two days. The first part of the inspection was on Monday 14 August 2006 at 08.50am and was completed at 4.30pm. Much of the inspection on the first day was spent speaking to residents, members of their family and having lengthy discussions with staff. The registered manager and another temporary seconded manager to the home were available throughout the first day of the inspection and were very helpful and accommodating. The service manager was available on the second day of the inspection. The second part of the inspection took place on Wednesday 16 August 2006 at 1pm and was completed at 6.40pm. Again residents, staff and family members were spoken to. In addition, twenty-five residents’ files and seventeen staff files were viewed along with various safety certificates, documents and other files. Due to the size of the home, two additional inspectors provided help on the first inspection day. One of the Commission’s pharmacist inspectors, Vashti Maharaj, inspected the medication within the home on all of the units and David Hasting inspected the dementia units. In total, thirty-five residents were spoken to in private at various times throughout the two days. Fifteen members of staff and a community nurse were also spoken to throughout the two days. In addition, fourteen relatives were spoken to in private, some briefly and some at length. Also, residents and staff were indirectly observed and overheard as a matter of course over the two days. A comprehensive and lengthy internal and external tour of the home was conducted with the assistant manager and later with the registered manager on the first day of the inspection. Since the previous inspection, there has been substantial organisational restructuring within Fremantle, which has had an impact on staffing within the home. Many of the assistant managers have left creating a void and impacting on managerial and administration duties on the units, which, has also partially affected some of the standards within the home. Many of the staff and two relatives spoken to stated that staff moral is quite low due to staffing restructuring throughout Fremantle and within the home in general. The implications of the staffing issues within the home and the impact that this may have in the quality of care was discussed at length with the registered manager over the two days and with the service manager on the final day of the inspection. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Ten requirements have been made at this inspection, three of which are restated requirements from the previous inspection. The requirements relate mainly to administrative and recording issues and staff training. Four recommendations have also been made all relating to medication issues. Further information about unmet requirements can be found in the relevant standard. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. A robust ordering and checking system must be in place to avoid any medicines being unavailable in the home and that all medication received into the home are checked and signed for on residents’ Medication Administration Record (MAR) charts. To ensure that residents are safe and that staff can meet the needs of all of the residents within the home, no further residents must be admitted to the home who have been assessed prior to entry, with a diagnosis of dementia. Resident’s medication profiles must be up to date to ensure that their current medication circumstances are correct. Staff must ensure that they sign the (MAR) charts after administering medication to residents to ensure that residents are not put at risk. All areas of the home must be free from offensive odours. Staff must receive mandatory training for the work that they do to ensure that the have the necessary skills to meet the needs of the residents. To ensure that staff have the time to meet all of the needs of the residents, Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 7 staffing levels must be reviewed. Staff must receive dementia training to enable them to fully support and meet the needs of the residents with dementia. Staff must receive regular supervision to ensure that they are being supported and that their personal development is being monitored. It is recommended that staff record the use of certain external products on the (MAR) chart e.g. steroid creams. The staff should produce a system for ensuring that when any external products are applied, a record of use is kept, if not on the (MAR) chart, then in the daily care notes. A recommendation is also made that the staff should ensure that the GP carries out regular medication reviews, which are needed at least six monthly for all residents over the age of seventy-five who are taking four or more medicines. The home should ensure that medicines, which have not been needed for several weeks are reviewed promptly. In addition, a recommendation is made that the (MAR) charts contain many items, which are no longer used. Although the pharmacy has stamped “not supplied this month.” It is not clear whether these items have been stopped, or whether none have been supplied as the home has stock remaining from a previous month. This is potentially dangerous. Finally, it is recommended that staff notify the social worker as well as the GP and next of kin if medicines are given covertly. The covert administration authorisation sheet requests a review after six months. This was not done for one resident. 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. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6. Qualities in these outcome areas are adequate. This judgement has been made from evidence gathered during the visit to this service. Residents are being supplied with information regarding the terms of their residency and they are being supported to be as independent as possible. However, the home’s practice of admitting residents with dementia above the registered limit is putting residents and others at risk and this practice must cease. EVIDENCE: Each resident is given the terms and conditions of their residency when they first arrive at the home, in accordance with a requirement at the previous inspection. When viewed, the terms and conditions contained information on the: date of the contract starting and details of the room to be occupied. In addition, there is information regarding the fees and financial advice from a specialist source such as a solicitor, bank or an accountant. The terms of conditions are signed by the resident or on their behalf. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 10 According to the registered manager, senior staff carry out assessments of prospective residents to the home. She said that prospective resident’s social worker would also carry out a comprehensive assessment. Some preadmission assessment forms were viewed and contained comprehensive information such as: the present situation of the resident, background history, funding arrangements, health care issues, dependency levels and staff support to the resident. However, the dementia units are at capacity level at present yet prospective residents to the home who have been assessed to have a diagnosis of dementia are still being admitted to the home even though the home is registered for only thirty-seven residents with dementia on the three dedicated dementia units. According to the registered manager, there are forty-six residents residing in the home with a diagnosis of dementia, nine of whom are in mainstream units. This was discussed at length with the registered manager and the service manager and a requirement made that the registered persons must ensure that no further residents are admitted to the home who have been assessed prior to entry, with a diagnosis of dementia. Staff spoken to said that the home does admit residents for respite and transitional care but that they are integrated with the other residents in the mainstream units and supported with their health, personal and independent living skills by the staff, their keyworker and health care professionals as required. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Qualities in these outcome areas are adequate. This judgement has been made from evidence gathered during the visit to this service. Staff are ensuring that a comprehensive plan of residents’ care needs will be drawn up with their input or the input of their representative. Personal information is being comprehensively recorded and residents are being treated in a dignified and respectful manner. However, medication policies and procedures need to be adhered to, to ensure that residents are not put at risk. EVIDENCE: Individual care plans for twenty residents were seen in various units. The care plans have been compiled to ensure that comprehensive information is available on many aspects of individual resident’s care needs and support requirements. Information such as: health care needs, personal care needs, activities that the resident enjoys, religious and cultural requirements and likes and dislikes. The care plans seen were signed by a member of staff and the resident or their representative. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 12 Throughout the two day inspection, residents and their family were informally spoken to about various topics regarding the service provided in the home. A resident and his wife and daughter were spoken to at length. The wife said about the quality of care that her husband receives, “Oh, I’m satisfied with the quality of care that he receives, the staff really look after him well and his health’s ok.” A resident in the learning disability unit was briefly spoken to. He said, “My legs hurt.” When asked if he is receiving professional support he said, “Yes, a nurse sees me once or twice a week and puts a bandage on them, they’re getting better but it’s a slow process.” Another resident said, “I’m ok, mustn’t grumble.” Care plans contained comprehensive information on resident’s health care needs, their medication and what support they are receiving from health care professionals. On the first day of the inspection a community nurse, who was visiting several residents, was spoken to in private about the service that she provides. She said that she comes to the home twice a week to see several residents and support them with their health care needs and to give advice to the staff team when required. The Medication Administration Record (MAR) charts for all of the residents were inspected, together with medicine storage areas and training. Staff were observed giving medicines and three members of staff were interviewed. Unit leaders were aware of the issues for each resident without referring to care plans, and were aware of residents’ conditions and reasons for medication changes. All permanent staff have had appropriate training, and have a competence assessment before being allowed to administer medicines unsupervised. Agency staff do not administer medicines. Medication trolleys are being stored in air-conditioned rooms and medication is being checked and signed on residents’ (MAR) charts, in accordance with a requirement at the previous inspection. The vast majority of residents still receive their medicines regularly, there is evidence of good awareness and monitoring of residents conditions, the manager and staff were willing to make any improvements suggested on the day, however the standard has slipped slightly, in particular with regards to record-keeping. Four medicines were out of stock for between three and six days during the last four-week cycle. None of these were critical however this was a requirement at the previous inspection and is restated. The manager reported that the medicines had been ordered in time but not delivered. Staff had been chasing the order. Each resident has a medication profile, which is good practice, however these are not up to date for many residents. They do not correctly list all current medication, and the date which medicines were stopped or changed. A requirement is made regarding this. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 13 Ten gaps where found where staff had not signed for medication administered to residents. These were checked, and the doses had been given. A requirement is made regarding this. Throughout the two day inspection, staff were observed and overheard talking to and interacting with residents in a respectful and dignified manner. Residents seemed happy and comfortable around staff. The administration assistant said that when mail arrives at the home for residents, they are given to the resident or opened on behalf of the resident with the resident’s consent. A resident said, “I open my own letters and keep them in that drawer.” She pointed to a chest of drawers in her bedroom. Residents and their relatives were unanimous in their praise of the staff and the way in which they treat the residents with respect and in a dignified manner at all times. A relative spoken to said, “You can’t fault the staff, they are always respectful and patient with the residents, I can’t complain about that.” Staff spoken to were able to explain how they ensure that residents’ privacy is upheld and are treated with respect, especially when carrying out personal care and when residents wish to be alone in their room. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Qualities in these outcome areas are poor. This judgement has been made from evidence gathered during the visit to this service. The home’s practice of admitting too many residents into the home with a diagnosis of dementia and the staff not receiving the necessary training to enable them to be able to meet the needs of these residents and without sufficient facilities, is putting all of the residents and others in the home at risk. Residents are maintaining contact with family members and friends and are able to make their own choices, some with assistance and staff are ensuring that residents receive wholesome and appropriate meals in accordance with their individual health care needs and choices. EVIDENCE: All care plans viewed contained information on residents’ hobbies and interests and their preferred activities, such as: bingo, dancing and reading. Throughout the home there are notice boards in the hallways with details of forthcoming events for the year such as: the winter Olympics, Commonwealth Games, Football World Cup and various religious festivals, outings and in-house entertainment. The activities are organised by the home’s activities coordinator who is a member of the National Association for Providers of Activities for older people (NAPA), which provides training and gives advice and information on suitable activities for older people. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 15 The three dementia units were toured and some residents were spoken to. One resident said, “We all get on well.” Another resident said, “We’re looked after well.” One resident said, “There’s not enough going on here.” Although the home has many residents who have a diagnosis of dementia, there are no additional or alternative activities provided for them and the activities coordinator has not received any training to enable him to understand and best meet the activities needs of residents with dementia. A requirement is made regarding this. While discussing issues regarding dementia with the registered manager, she revealed that, although the home is registered to admit only thirty-seven residents with dementia, there were in fact forty-six residents living in the home with a diagnosis of dementia, some of whom have been placed in mainstream units and not all of the staff have received dementia training to enable them to best support and meet the needs of the residents with dementia. This was discussed at length with the registered manager and the service manager and a requirement made that no further residents are, at present, admitted into the home with a diagnosis of dementia. Throughout the two day inspection, residents’ family and friends were regularly seen arriving at and leaving the home. Lengthy discussions were had with many family members and friends. A resident’s friend said, “I’ve been visiting her ever since she moved into the home some years ago, we used to be next door neighbours.” A husband and wife stated, “We come about twice a week and the staff are very supportive and welcoming.” A husband who visits his wife said, “I come every afternoon and stay until the evening when she goes to bed.” Residents’ family and friends were observed either spending time with them in the lounge or the resident’s bedroom. When spoken to, the administration assistant said that their family or representative handles the finances of most of the residents’. A resident spoken to said, “I don’t have anything to do with money, my wife and daughter take care of that.” Another resident said, I don’t want anything to do with money, my family take care of it” Staff spoken to said that many of the residents are able to make their own choices and those who do not, have family or friends who would represent them when required. The home has a large safe, where residents’ personal possessions, are kept on request from the resident. There is a logbook for logging in and out all personal possessions. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 16 A comprehensive tour of the kitchen was conducted and the head chef was spoken to at length about food preparation, safety and hygiene. The chef was able to explain how residents with special dietary needs, such as diabetics and those who have their meals liquidised, are supported to ensure that they receive appropriate meals. The chef went on to say that the menu is arranged in accordance with residents’ preferences seen in their care plans or at unit meetings where meals are discussed. The minutes of a residents meeting on 24 February 2006 was seen and included comments on foods that residents like and dislike and their preferences. Dining areas in units were clean, tidy and tables contained tablecloths, coasters and condiments. Staff were observed supporting residents to eat in a supportive and patient manner. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Qualities in these outcome areas are adequate. This judgement has been made from evidence gathered during the visit to this service. Although residents and their family are confident that any complaints will be taken seriously, residents are vulnerable due to some staff not receiving adult protection training. EVIDENCE: The home has a complaints policy and procedure that sets out how complaints will be dealt with by the home. The complaints form contains details of the complaint, the action taken and the outcome. There is also information within the home’s brochure about the complaints procedures, which is given to prospective residents and other stakeholders. None of the residents spoken to or their family have made a complaint about the home and some relatives were complementary about the quality of staff and care provided. One resident said, “Oh, I would be the first to complain if I wasn’t happy with anything.” She went on to say, “They’re very good here, they’re very helpful and kind.” The daughter of one resident said, “We’ve been coming here ever since my dad moved in and we’ve never had any concerns or had to make a complaint.” She also said, “Anyway, the manager wouldn’t stand for any nonsense here.” The registered manager stated that she has completed the “Train the trainer” course in protection of vulnerable adults and produced her certificate. She went on to say that she is in the process of reviewing staff training in adult protection. When looked at, staff files and the training matrix did not show evidence that all of the staff have received training in adult protection. A requirement is made regarding this. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 18 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, 23 and 26. Qualities in these outcome areas are good. This judgement has been made from evidence gathered during the visit to this service. Robust maintenance monitoring and improvements ensure that residents are safe and accommodations suit their needs. However, staff are not ensuring that unpleasant odours are eliminated. This may give a negative assumption about overall cleanliness within the home. EVIDENCE: Although the home is very large, the staff have ensured that all areas are safe and well maintained. The home has a maintenance person who deals with small maintenance issues, ensuring that the maintenance issues identified at the previous inspection were rectified. The grounds, including the enclosed landscaped garden area, were found to be clean, tidy and well maintained. In addition, there is information in the quality audit report about maintenance issues that need to be brought up to a higher standard. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 19 All of the bedrooms in the home have en-suit facilities. The rooms are large and decorated to an adequate standard, with good quality furniture. Residents spoken to and their family were happy with their room and their facilities. While touring the home, all areas were found to be clean and tidy. The main laundry is based on the ground floor and the learning disability unit has its own laundry facilities. However, while touring the learning difficulties unit, there was a strong smell of urine. This was discussed with the registered manager and the service manager, who said that the unit has been earmarked for refurbishment. A requirement is made regarding the strong smell of urine. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 20 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. Qualities in these outcome areas are adequate. This judgement has been made from evidence gathered during the visit to this service. Although robust recruitment procedures are being followed, staffing levels in units may be too low for staff to provide quality time with residents. In addition, some staff not receiving mandatory training may mean that the needs of many of the resident may be overlooked and that residents may not be totally safe at all times. EVIDENCE: The rota for the month of August was seen and showed that there are about three staff on average in each unit. For instance, there is always a unit leader and at least two care workers in each unit. Throughout the two days, staff were indirectly observed. They seemed very busy either administering medication or cleaning in the unit kitchen. It seemed as though staff had to consciously pull themselves away from other duties to spend brief periods with residents, most of whom were observed sitting in the lounge watching television or laying on their bed or sitting in their bedroom. A resident who, when asked about staffing, replied, “They’re not always around when you want them.” Another resident said, “Theyre always busy.” A relative spoken to said, “We come here every Sunday and sometimes we have to wait ages for someone to answer the door.” Another relative spoken to said, “The staff are saints, they work so hard, they’re always busy and don’t seem to have time to sit down for a minute.” A requirement is made that the registered persons must review the staffing levels within the home and how staff are utilised in each unit. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 21 The registered manager stated that many staff are receiving National Vocational Qualifications (NVQ) training at various levels. The registered manager also stated that she is at present undertaking her (NVQ) level 4. Other staff spoken to are either undertaking their (NVQ) at either level 2 or 3 and the (NVQ) certificates of three staff were seen in their personal file. The manager has ensured that all staff files include the required information such as: two references, Criminal Records Bureau (CRB) check and a recent photograph. In addition, there is also information such as: a birth certificate, their passport, application form or information from the home office regarding residency and permission to work in the UK. Although the majority of staff working in the home have received sufficient training for the work that they do, while looking through the homes training matrix their were some gaps indicating that some staff may not have received mandatory training in areas such as health and safety, food hygiene or moving and handling. Also on some units some staff have not as yet received training in areas such as dementia or learning disabilities. There was also a lack of evidence in staffs’ personal files, such as their training certificates, to show that they had received sufficient training. This was a requirement at the previous inspection and is restated. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Qualities in these outcome areas are adequate. This judgement has been made from evidence gathered during the visit to this service. The manager has the skills and experience to understand and meet the needs of the residents and staff team and is ensuring that the safety of people in the home and the quality of service is being monitored and continually improved. Although, staff need to receive more regular supervision to ensure that they are being supported and their personal development monitored. EVIDENCE: Throughout the day, the registered manager, who stated that she has been in management for many years, demonstrated her knowledge and understanding of the needs of the residents and staff team and the impact of organisational restructuring and the implications of this to the residents and the staff team. She stated that she is a qualified counsellor and also has certificates in train the trainer, enabling her to train staff in adult protection and a Registered Managers Award (RMA), which were seen. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 23 Although the administrator was not available, her assistant was and was able to explain some of the financial procedures within the home. She stated that residents’ family or solicitor takes care of residents’ finances. The manager reported that the home does look after some residents finances in that the Fremantle Trust Chief Executive (registered person) acts as agent for pensions/benefits for residents without next of kin or representatives. Recording procedures were seen and were sufficient to ensure that residents’ finances are safeguarded. The supervision records for a number of staff were viewed and although there has been a marked improvement in that most staff are now receiving supervision more regularly, standards have recently slipped in that some staff are not receiving regular supervision. When discussed with the registered manager, she stated that this is due, in part, to the organisation’s management restructuring within the home. This was a requirement at the previous inspection and is restated. The staff are ensuring that all health and safety checks are carried out regularly. Fire drills and tests have been occurring regularly and all safety certificates such as gas, London Fire and Emergency Planning Authority (LFEPA) and the Portable Appliances Test (PAT), lift, environmental health and water/legionella were seen and were up to date and in order. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 24 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 3 1 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X 3 X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 25 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 OP3 Regulation 14 (1) (a) (d) 13(2) Requirement The registered persons must ensure that no further residents with a diagnosis of dementia are at present admitted to the home. The registered persons must ensure staff sign the (MAR) charts after administering medication and any nonadministration codes as to the reason why the medication was not administered. The registered persons must ensure that all residents’ medication profiles are up to date. The registered persons must ensure that a robust ordering and checking system is in place to avoid any medicines being unavailable in the home and that all medication received into the home are checked and signed for on the service user’s (MAR) sheet. (Timescale of 27/01/06 not met) This requirement is revised and restated. The registered persons must ensure that staff receive adequate training to enable them DS0000051441.V303567.R01.S.doc Timescale for action 23/08/06 2. OP9 22/09/06 3. OP9 13 (2) 22/09/06 4. OP9 13(2) 27/10/06 5. OP12 16 (2) (m) 18 (1) (a) (c) 27/10/06 Apthorp Lodge Version 5.2 Page 26 (i) 6. 7. OP18 OP26 18 (1) (c) (i) 16 (2) (k) 8. OP27 18 (1) (a) 9. OP30 18(1)(c) (i) 10. OP36 18 (2) to fully meet the needs of residents with dementia. The registered persons must ensure that all staff receive adult protection training. The registered persons must ensure that all areas of the home are kept free from offensive odours. The registered persons must ensure that there is a review of staffing levels within the home and in all units. The registered persons must ensure that all staff receive mandatory training to enable them to meet the changing needs of the residents. (Timescale of 24/03/06 not met) This requirement is revised and restated. The registered persons must ensure that all staff receive regular recorded supervision at least six times a year. (Timescale of 24/03/06 not met) This requirement is restated. 27/10/06 22/09/06 22/09/06 27/10/06 22/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that staff record the use of certain external products on the (MAR) chart e.g. steroid creams. The staff should produce a system for ensuring that when any external products are applied, a record of use is kept, if not on the (MAR) chart, then in the daily care notes. It is recommended that the staff should ensure that the GP carries out regular medication reviews, which are needed at least six monthly for all residents over the age of seventy-five who are taking four or more medicines. The DS0000051441.V303567.R01.S.doc Version 5.2 Page 27 2. OP9 Apthorp Lodge 3. OP9 4. OP9 home should ensure that medicines, which have not been needed for several weeks are reviewed promptly. A recommendation is made regarding the following. The (MAR) charts contain many items, which are no longer used. Although the pharmacy has stamped “not supplied this month.” It is not clear whether these items have been stopped, or whether none have been supplied as the home has stock remaining from a previous month. This is potentially dangerous and the supplying pharmacy should be encouraged to remove any items no longer current. It is recommended that staff notify the social worker as well as the GP and next of kin if medicines are given covertly. The covert administration authorisation sheet requests a review after six months. This was not done for one resident. Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Apthorp Lodge DS0000051441.V303567.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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