Random inspection report
Care homes for older people
Name: Address: Apthorp Lodge Nurserymans Road off Brunswick Park Road London N11 1EQ two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jane Shaw Date: 1 7 0 8 2 0 0 9 Information about the care home
Name of care home: Address: Apthorp Lodge Nurserymans Road off Brunswick Park Road London N11 1EQ 02082114000 02082114109 manager.apthorplodge@fremantletrust.org www.fremantletrust.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Fremantle Trust care home 108 Number of places (if applicable): Under 65 Over 65 50 6 52 dementia learning disability old age, not falling within any other category Conditions of registration: 0 0 0 The maximum number of service users who can be accommodated is: 108 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP(maximum number of places:102),Dementia - Code DE (maximum number of places: 102), Learning Disability - Code LD (maximum number of places: 6) Date of last inspection Brief description of the care home Apthorp Lodge is a large care home registered to provide care for 108 residents. The registration for the service allows care to be provided to older people, people with
Care Homes for Older People Page 2 of 10 Brief description of the care home dementia and adults with learning disabilities. There are 50 places for people with dementia, 52 places for older people and 6 places for 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. The registered manager retired earlier this year and there are currently two interim managers providing a management presence until a new manager starts work. The interim managers are supported by a deputy manager. Seven unit leaders complete the care management team for the home. There are additional managers in charge of maintenance and catering. As a result of this inspection the Commission is taking enforcement action to secure compliance and ensure better outcomes for people who use the service. Care Homes for Older People Page 3 of 10 What we found:
This inspection was to check compliance with the Statutory Requirment Notice issued on 10/7/09 following concerns about the safe handling of medication in the home.The SRN required the home to:- Make suitable arrangements for the recording and safe administration of medicines received into the home. Ensure that all residents of Apthorpe Lodge are given their medication as prescribed. Ensure medication administration records (MAR) are complete and accurate at all times. We found that the home had made some progress and that the MAR were generally completed with no omissions.There were checks at handover so that any gaps were identified and medication checked. Only one flat had carried out an internal audit of stocks of medicines. We found stock discrepancies in two flats where there were too many tablets left for one resident each. This means that sometimes times medicines are not being given but signed that they are given. One flat had very poor practices and medicines had not been checked in properly for the start of the new medication cycle. As a result several residents had not received their medication because it had not been unpacked and care workers did not know what time to give it. We looked at the previous months records and it appeared that one resident had not received their antipsychotic for over 2 weeks. The manager investigated this after the inspection. She notified us the following day that she had phoned the GP and had been informed that the medication was stopped temporarily because of an infection. This was not recorded in the care plan or on the MAR. Because the Statutory Requirement Notice had not been met we issued another Code B notice and took evidence for discussion on further action to improve the safe handling of medication. Requirements had been given at the 19th June 2009 random inspection in relation to staffing levels and staff deployment. The staffing levels in the older persons units of the home had been reduced. The five older persons units were visited to check staffing levels. Staff on duty in these units were also spoken with. The staffing levels in three of the units have been increased and staff said that now the arrangements were much better. One member of staff said that there is now time, to spend with residents. The night care staffing levels have also been changed so that two night stfaf are located on the second floor of the home. The requirement about increasing staff levels has been complied with. One of the requirements given at the 19th June 2009 random inspection was to review the deployment of unit leaders so that there were sufficent senior staff on duty. We were told by the manager that the senior team rota had been changed so that the seniors on duty were more evenly spread. The new staff rota is to start in September 2009. In addition, there are vacancies for two senior staff although recruitment is planned. However, when we visited, although there were three senior staff working in the units in the morning, plus a senior on duty, there was only one senior worker working in the units in the afternoon. In addition, the manager advised that there is a review ongoing of staffing levels and staff deployment. As the planned changes have not yet been introduced and because there is a review ongoing, this requirement is repeated. Care Homes for Older People Page 4 of 10 What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 5 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 4 12 Produce a business or action 01/09/2009 plan for the learning disabilities unit setting out the planned improvements for the service with agreed timescales. The plan to include actions arising from the local authority resident reviews. This will provide a detailed action plan setting out how residents needs will be met. 2 7 12 Introduce the new care planning system. This will improve the care planning arrangements and provide clearer plans for residents and staff. 01/09/2009 3 9 13 Risk assessments for residents who self-medicate must be regularly reviewed and updated. This is to support the well being of residents and maintain their independence. 30/07/2009 4 9 13 Ensure medication administration records (MAR charts) are complete and accurate at all times. This was subject to a statutory requirement notice and has
Page 6 of 10 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action not been complied with. To ensure better outcomes for people who use the service. 5 9 13 Dosage changes must be clearly re-written on the MAR. This is to prevent the risk of error particularly with complex doses and medicines such as Warfarin. 6 9 13 Ensure that all residents of Apthorp Lodge are given their medication as prescribed. This was subject to a statutory requirement notice and has not been complied with. To ensure better outcomes for people who use the service. 7 9 13 Make suitable arrangements for the recording and safe administration of medicines received into the care home. This was subject to a statutory requirement notice and has not been complied with. To ensure better outcomes for people using the service. 8 27 18 Review the deployment of 30/07/2009 unit leaders so that there are sufficient senior staff on duty to efficiently manage the home and meet the needs of
Page 7 of 10 30/07/2009 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action residents. The current arrangements do not provide for the adequate monitoring and support for care staff throughout the home. Care Homes for Older People Page 8 of 10 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 27 18 Review the deployment of 15/09/2009 unit leaders so that there are sufficient senior staff on duty to efficiently manager the home and meet the needs of residents. The current arrangements do not provide for the adequate monitoring and support for care staff throughout the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 10 of 10 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
