Inspection on 22/05/07 for Apthorp Lodge

This inspection was carried out on 22nd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 11/06/08

Apthorp Lodge 04/12/07

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

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Henry Nihill House

Birchwood

Edenvale

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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 Jane Ray Key Unannounced Inspection 09:30 22nd and 23rd May 2007 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.V333464.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.V333464.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.Millhouse@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.V333464.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. 21 December 2006 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. Apthorp Lodge DS0000051441.V333464.R01.S.doc Version 5.2 Page 5 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. The current fees for residents living in the home are £525.84 per week. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. Apthorp Lodge DS0000051441.V333464.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 22 and 23 May 2007 and was unannounced. The inspection took 14 hours to complete. The inspector did a tour of the entire service accompanied by the deputy manager. The inspector then spent the majority of the inspection focusing on four of the flats of which two were for people with dementia, one for older people and one for people with a learning disability. In each flat the inspector spoke at length to at least one or two of the residents and relatives where they had time available. The inspector also interviewed at least one member of the care staff in each flat and spoke at length as well as observing the work of the activity co-ordinator. The inspector also looked at two care plans and the medication systems in each of the four flats. The inspector was also able to spend time on the second day with the registered manager and also spoke to the catering, laundry and administrative staff. The inspector also looked at all the relevant records including service user finance records, staff files and health and safety information. The inspection is the annual key inspection and the aim is to look at how well the service is meeting the key National Minimum Standards for Older People. The inspector would like to thank the service users and staff for their assistance with the inspection process. What the service does well: The people living in the home were very positive about the service they receive and one person told the inspector “I feel very happy in the home”. There was a very warm and friendly atmosphere in the home and it was observed that the staff related very positively to the residents. The inspector could observe that the staff were very positive about their work and had a good knowledge of the individual needs of each of the people living in the home. The physical environment throughout the home was clean and comfortable and the bedrooms are very spacious. On the days of the inspection the weather was warm and sunny and the gardens were well maintained and a source of pleasure for the residents. Apthorp Lodge DS0000051441.V333464.R01.S.doc Version 5.2 Page 7 The home has a very enthusiastic activity co-ordinator who provides a service across the flats. The residents in the home were seen enjoying and being stimulated by his input. The laundry service was well organised and several residents commented on how well their clothes were cleaned. Many of the people said how much they enjoyed the food provided in the home and felt able to ask for an alternative if they did not want what was on the menu. The care plans and risk assessments for each person were updated and reflected the needs of each individual. These showed that the home works closely with other healthcare professionals when this is needed. What has improved since the last inspection? What they could do better: Fourteen requirements and six recommendations have been made at this inspection. Two requirements were made under the section choice of home and this was to ensure staff receive training on pressure care and diabetes so they can meet the specific needs of the people living in the home and to ensure contracts are in place between the home and the service user and that these are appropriately completed. Three requirements and three recommendations were made under the heading health and personal care. This was to check each person has had a dental check and book appointments where needed, to ensure that where a resident has a pressure sore that an appropriate care plan is in place and to have a procedure in place to ensure medication does not run out for any resident. Three recommendations were also made to keep an accurate record of healthcare appointments attended and to record where and how creams should be administered and to support the people living in the home to have a regular bath or shower. Two recommendations were made under the heading of daily life and social activities to extend the use of volunteers to support the work of the activity coApthorp Lodge DS0000051441.V333464.R01.S.doc Version 5.2 Page 8 ordinator and to review the residents meeting to facilitate discussion on a wider range of topics. A requirement was made in the section complaints and protection to ensure all the staff have received training on the protection of vulnerable adults. The section on the environment included one requirement and this was to replace the dishwasher in the main kitchen. In the section on staffing four requirements were made to employ permanent staff and reduce the use of agency staff to provide consistency of care, to review staffing levels in the afternoon to provide a safe service that meets the needs of the residents in terms of their personal care and social activities, to ensure all staff files include an photo ID and to provide an ongoing programme of training to meet staff training needs. Three requirements and one recommendation were made in the section called management and administration of the home to offer all staff regular supervision of an appropriate standard, to review the homes fire safety risk assessment and carry out regular fire drills and to ensure all staff have received food hygiene and infection control training. The recommendation was to liaise with social services to address the issues linked to the personal finances for two residents in flat 10. 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.V333464.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.V333464.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): Standards 1,2,3,4 and 5 were inspected. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People moving to the home can be assured that they will be assessed, given information about the home and be able to visit the service to decide if they want to move there. The staff team have great deal of skill and experience but have some areas where they need additional training to meet the needs of the residents including pressure care and diabetes. EVIDENCE: I read the homes statement of purpose and service user guide. Both these documents are comprehensive and up to date. They provide adequate information to people thinking of moving to the service, relatives or other care professionals. Apthorp Lodge DS0000051441.V333464.R01.S.doc Version 5.2 Page 11 I looked at the assessments completed for four people living in the home. They all had a detailed assessment prepared by social services at the time of their admission. Prior to their admission they had been visited by the deputy manager or senior carer to be assessed as part of the admission process. Once they had arrived at the home an assessment was completed covering all their individual needs. This also included information such as their preferred routine and their life story. I discussed the process of moving to the home with the residents and care staff. The residents struggled to remember the details of the time they moved to the home. The care staff however explained that the people who live in the home normally are able to visit often with their relatives and some may come for a day visit. I looked at the contracts between the home and the residents for four people living in the home. One of these had not been signed and one had a page missing. I discussed respite care with the manager. The home provides two respite beds, both of which were empty at the time of the inspection although one resident was due to arrive. The home also offers two “step down” beds for people coming out of hospital or waiting for adaptations to take place to their homes. These beds do not offer rehabilitation and are therefore not an intermediate care service. I spoke to the staff about the needs of the people living in the home and then looked at the training they had been offered. Nearly half the beds in the home are for people with dementia and most of the staff have now been trained on how to work with people who have dementia which they said they had found very useful. The manager explained that she has spoken to the district nurses about arranging training on pressure care including the nutritional needs of people with pressure sores and the care of people with diabetes. I certainly had concerns in the inspection about pressure care and this training needs to be made available as a high priority. Apthorp Lodge DS0000051441.V333464.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): Standards 7,8,9 and 10 were inspected. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People loving in the home will have an individual care plan, be offered access to healthcare professionals and be treated with care and respect by the staff team. Individuals health and care is compromised by the service needing to ensure that dental treatment is provided to everyone, pressure care is of an appropriate standard and residents are never in a situation where their medication runs out. EVIDENCE: I looked in detail at one care plan and a second care plan more briefly in each of the flats. Each care plan focuses on all the individual areas of need for each resident. The care plans were holistic and not only covered the persons healthcare and support needs but also looked at their emotional needs including significant relationships. The care plans had been reviewed on a Apthorp Lodge DS0000051441.V333464.R01.S.doc Version 5.2 Page 13 monthly basis. Each care plan included an individual risk assessment that always included a moving and handling assessment. Other areas of risk were also covered such as wandering or complex behaviours. The home operates a key-working system and the staff who were interviewed showed a good understanding of their key-working role. The residents had each had a review meeting with their care manager in the previous year and it could be seen that action agreed at that meeting was being addressed. I looked at the healthcare records for each person whose care plan was inspected. Each person has a record of the healthcare appointments they attend. From discussions with staff it would appear that these records are not always completed after an appointment. The records indicated that the people living in the home see the GP, district nurse and optician on a regular basis. They are also supported to see appropriate specialists where required, for example one person in flat 10 was having input from the physiotherapist from the learning disability team on the day of the inspection and the consultant psychiatrist was also visiting some residents in the dementia units. I was however concerned about whether the people living in the home had received dental checks. None of the four people whose records were inspected had any record of a dental check in the last year. One of the residents I spoke to in flat 6 said she had all her own teeth and would really like a dental appointment. The manager explained that the dental service that came to the home is now only available for people who cannot go to the dentist and anyone who is able to leave the home needs to go to the dental surgery. Each person had a nutritional assessment and had been supported to have their weight checked on a monthly basis. I was however concerned about the standards of care for people who have pressure sores within the home. One resident who had come to the home for “step down” care had been found to have a pressure sore on his arrival at the home. This resident had been at the home for 20 days and was being seen by the district nurse. He did not have a pressure relieving mattress although the staff said one had been ordered, the waterlow assessment had not been completed and there was no pressure care plan in place including regular turning and monitoring of fluid and food intake. Two other people on flats 8 and 10 also had pressure sores. They both had care plans that addressed some of the measures in place to meet this healthcare need but these plans were not comprehensive. The staff spoken to on the three units accommodating people with pressure sores all said they had not received training on pressure care. The manager explained that she was liaising with the district nurse to arrange training but no dates for this was available at the time of the inspection. The medication and the administration records were inspected in the four flats. The home uses the Boots blister pack administration system. Each flat has their own trolley and the trolleys are stored in air-conditioned rooms. Staff were observed administering the medication appropriately during the inspection. The permanent staff have received medication training and have Apthorp Lodge DS0000051441.V333464.R01.S.doc Version 5.2 Page 14 their competence assessed as seen in the staff training records. I looked at the medication records. These showed that the medication administration records were being completed and signed appropriately. The only area for improvement relates to the administration of creams which just say to “use as directed” rather then explaining where and how they need to be applied. The individual medication profiles for each person where up to date. One person who occasionally needs to have her medication in a covert manner had a signed protocol in place agreed with the GP and relatives. All medication received and returned is recorded on the administration records and so there is a clear audit trail available of the medication. The only serious concern was that on flat 3 one person had run out of some of her medication and this had not been administered for 24 hours. This had been due to the GP not preparing the script even though they had been reminded. The manager explained that the people living in the home are registered with 13 different GP surgeries and there can be occasional problems with obtaining the scripts. There is a system in place to monitor the medication but there needs to be an emergency plan in place for when scripts do not arrive on time including the use of the out of hours GP service. The people living in the home and the relatives spoken to during the inspection were full of praise for the staff. One relative said “the regular staff are fantastic” and another resident said “I like all the staff”. The inspector observed that all the personal care was given in a manner that preserved the privacy and dignity of the people living in the home. Everyone was appropriately dressed and were able to access the hairdresser who visits the home. Payphones are available in the home and some people have their own phone in their bedroom. The staff were observed to be friendly and able to share a joke, whilst treating people in a respectful manner. The only concern was on flat 8 where I looked at the record of when people had been offered a bath or shower. Some people appeared to have a bath or shower only once a week and in a couple of cases less frequently. The staff said they may not be recording when people have a bath or shower. The people living in the home appeared clean and there were no unpleasant odours. Apthorp Lodge DS0000051441.V333464.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): Standards 12,13,14 and 15 were inspected. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living in the home will find that the service can meet their cultural and religious needs, support them to maintain contact with their relatives and offer them a healthy diet. The residents meetings could be developed further to enable the residents to contribute more to the operation of the home. EVIDENCE: It was observed during the inspection that people living in the home were able to follow their own routine, getting up more slowly if they wished to do so and spending time in their bedrooms if they preferred. The home has a full-time activity co-ordinator who I was able to speak to and observe doing his work. He provides a range of stimulating activities for the people in the home. He spends part of his time doing activities on individual flats and then organises activities in the communal lounge in the home to which everyone can attend. An entertainer is booked each month and this is very popular. He had just finished helping with the annual fete, which also Apthorp Lodge DS0000051441.V333464.R01.S.doc Version 5.2 Page 16 involves a number of the relatives. His work includes linking in with various community resources including local churches and schools. He explained that his work with people who have dementia includes supporting them mainly on a one to one basis and he has a number of resources including music and reminiscence materials. He also organises for suppliers of clothes and shoes to provide sales in the home and arranges for small groups of people to go out for pub lunches. He has recently had a social work student working with him as part of her work experience and it would be good to see more input like this as it is difficult for one person to meet the needs of everyone in the home. The home strives to meet peoples religious and cultural needs in line with their individual wishes. The Catholic and Anglican churches both conduct services each month in the home and a number of people also go out to church each week supported by volunteers. The catering staff explained that they can provide different food according to peoples religious or cultural needs. One person living in the home who is Caribbean said she enjoyed her rice meals. At the time of the inspection all the people living in the home spoke English but the manager explained that in the past the staff who speak a diverse number of languages have been able to communicate with people where English is not their first language. Relatives were observed visiting the home throughout the inspection and were able to spend time with people in the lounge or their bedrooms. They all said they felt welcome in the home. One person living in the home told me how she had been out with a friend that morning to go shopping in North Finchley. It was observed that most of the rooms were personalised and that people had brought with their possessions into the home. One person explained that she chooses to use her own bed linen. The inspector observed that the people living in the home were able to talk to the staff and express their wishes about their daily lives. The home also has a monthly residents meeting usually led by the manager or activity co-ordinator. The minutes of these meetings were inspected and they looked rather repetitive discussing changes in the home, activities and meals. There may be some scope to make these more inclusive and varied. The manager explained that most of the people living in the home have relatives who act on their behalf if needed but one resident has an advocate from Mind. The home follows a four-week rolling menu and I was able to see the lunch being served on the first day. Three meals are provided each day and regular hot drinks in between. The people living in the home were very positive about the food and said alternatives are always available if they want something different. The food was nicely presented with vegetables in a separate dish and condiments available on the table. The needs of people who need a pureed or diabetic diet were appropriately met. Apthorp Lodge DS0000051441.V333464.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were inspected. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people living in the home have access to an effective complaints procedure. They are also protected by most of the staff having completed training on the protection of vulnerable adults, although the last few staff need to receive this training. EVIDENCE: I looked at the complaints procedure, which forms part of the Fremantle feedback process. This process is clearly explained and is given to every person in the home as part of the pack containing the service user guide and statement of purpose. I also looked at the record of complaints and in the last year there have been approximately 20 complaints which have mainly been substantiated or partly substantiated. I felt that it was positive that the complaints were being appropriately acknowledged and addressed. The outcomes of the complaints were clearly recorded. The home has an appropriate policy and procedure in place for the protection of vulnerable adults. Most of the staff spoken to said they had completed the training and the manager explained that the deputy manager had now been Apthorp Lodge DS0000051441.V333464.R01.S.doc Version 5.2 Page 18 trained to undertake the protection of vulnerable adult training for the remaining staff who need to receive training in this area. The dates for this training to take place had not yet been arranged. Apthorp Lodge DS0000051441.V333464.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): Standards 19,20,21,22,23,24,25 and 26 were inspected. Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Apthorp Lodge is a purpose built service and provides a comfortable and safe environment for the people who live in the home. EVIDENCE: Apthorp Lodge is a purpose built home with accommodation available on the three floors. The building is divided into ten flats and also has a day centre. Each flat consists of a lounge, dining area and small kitchen as well as all the bedrooms. Some of the larger flats include a second small lounge. Whilst the building is very large the design helps people to find their way around. In addition each flat has a different colour scheme that helps people to Apthorp Lodge DS0000051441.V333464.R01.S.doc Version 5.2 Page 20 orientate themselves. Whilst the home is not designed to be a secure unit the flats and the front door do have number pads or exit buttons that need to be pressed in order to open the doors and this safeguards people with dementia who may be at risk of wandering. Staff do however also need to be vigilant as residents may be able to operate the doors or could leave with visitors when they exit the flat. Apthorp Lodge is designed around a central courtyard and the gardens in this courtyard and around the building are attractively landscaped and well maintained. The building appeared well maintained and the home employs its own handyman. Where the fabric was becoming worn such as in flat 10 plans are in place for refurbishment. A communal lounge area is available on the first floor that has a large television with access to sky sport. This area is also used for meetings and activities. All the bedrooms in the home are single and very spacious with en-suite shower and toilet facilities. The bedrooms are all appropriately equipped. Each flat also has a bathroom with a bath that is accessible for people with limited mobility. I could see that additional aids and adaptations including hoists are provided according to the individual needs of the people living in the home. The heating and lighting throughout the home was appropriate although the inspector was unable to tell what the temperatures would be like during the very hot weather, but did note that fans were in use in some areas. The premises was clean and tidy throughout and there were no unpleasant odours. The laundry was appropriately equipped and suitable arrangements were in place for the washing of foul laundry. The kitchen was also appropriately equipped although it was noted that the dishwasher had been broken for several weeks and no replacement had yet been ordered. The manager explained that this delay was linked to the introduction of a new property maintenance contract which has a few teething problems. Apthorp Lodge DS0000051441.V333464.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): Standards 27,28,29 and 30 were inspected. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. High numbers of staff vacancies and the use of agency staff is compromising standards of consistency and care in the home. Low staffing levels on some units in the afternoons is affecting the quality of care and potentially placing people at risk. EVIDENCE: I looked at the staff rota’s, spent time on four flats and spoke to staff and relatives in order to inspect staffing levels. Each flat has a separate team of staff. The manager explained that at the time of the inspection there were 635 vacant care staff out of a total staff establishment of approximately 3426 hours a week. A recruitment campaign has taken place and 551 of these hours have been offered to applicants and recruitment checks are now taking place. Large numbers of agency hours have been used in the last three weeks ranging from 800 to 300 hours a week. The manager explained that the use of agency staff is reducing. The staff spoken to stated that it can be very difficult to work alongside agency staff as they may not know the residents and have a different approach to the care. One relative said the use of agency staff has affected the care received by his mother and he told me how he found his Apthorp Lodge DS0000051441.V333464.R01.S.doc Version 5.2 Page 22 mother being offered a cup of tea with sugar because the agency staff did not know his mother was diabetic. The home has recently introduced a new shift system that has reduced the staffing levels in some flats for two hours in the afternoon. I spent time on flat 8 which at the time of the inspection had 10 residents of which four of the residents had a diagnosis of dementia. I could see that at least one person needed two staff for moving and handling and several of the other people had high care needs. In addition there is one resident who needs to be closely observed as he is at high risk of wandering. This flat currently has only one member of staff working between 2.30 – 4.30pm. This flat had two empty beds. I then spent time on flat 6, which at the time of the inspection had 10 residents. This flat is designated for people with dementia but has people with very high care needs. The staff describe some of the people in the unit as having borderline nursing needs. This flat currently only has two staff working between 2.30 – 4.30pm. This flat had three empty beds. In flat 3, there are 13 people with dementia and one empty bed. A number of the people living in this flat have very complex and at times aggressive behaviours associated with their dementia. One person needs to be closely monitored as he could place female residents at risk of assault. This group of residents are very active and mobile. This flat has only two staff working between 2.30 – 4.30pm and from spending time in the flat I could see that even with very experienced staff that the situation was very hard to manage. This flat had one empty bed. In flat 10. there are 5 residents with a learning disability. This flat has one resident who needs two staff for moving and handling. This flat has only one member of staff working from 2.30 – 4.30pm. The activity co-ordinator explained that this means that none of the residents can go to communal activities in the afternoon as they all need to be accompanied by a member of staff and the one member of staff has to remain in the flat. This flat has one empty bed. I am concerned that the afternoon staffing levels have affected the quality of care and could possibly place the residents at risk. The manager explained that at the time of the inspection 32 care staff had completed the NVQ in care and 15 care staff are working towards the qualification. This means that over 50 of the staff have completed or are studying for an NVQ in care, most of whom are being supported by the Fremantle NVQ assessment centre. Apthorp Lodge DS0000051441.V333464.R01.S.doc Version 5.2 Page 23 I looked at the recruitment checks for four members of staff. They all had an application form, two written references and a CRB check. Two of the four staff did not have photographic ID in their records. All the staff had completed and signed contracts of employment. I looked at the training records for four members of staff and at the staff training matrix for the whole staff team. The staff employed in the last few years all have a record of a completed induction but staff employed many years ago do not have an induction record. The manager explained that the only training booked for the next few months is the outstanding dementia training and fire safety training. She explained that they will be undertaking an annual development review for all staff to identify all their training needs. An ongoing programme of training needs to be arranged. Apthorp Lodge DS0000051441.V333464.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): Standards 31,32,33,35,36 and 38 were inspected. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People living in this home will benefit from the service being well managed. They will also have an opportunity to contribute their point of view through the quality assurance process. Additional work is required on fire safety and staff health and safety training to ensure the safety of the residents. EVIDENCE: The registered manager has worked in the service for eleven years and has extensive skills and experience. She has completed the Registered Managers award and is working towards her NVQ level 4. Apthorp Lodge DS0000051441.V333464.R01.S.doc Version 5.2 Page 25 The manager during the inspection demonstrated an excellent knowledge of all aspects of the service she manages and was observed to have an open and inclusive style of management with the senior management team in the home. There is a clear management structure within the home. A number of meetings take place to maintain communication with the staff team including a monthly seniors staff meeting, a meeting of all staff once every two months and a meeting with the night staff once every three months. I looked at the quality assurance exercise that was completed in November 2006. This consisted of a detailed quality audit completed by Fremantle senior managers looking at all aspects of the operation of the home, and questionnaires that went to residents, relatives, staff and care professionals. There had been a good response to this exercise and the results and comments received had been collated into an action plan. I looked at the current insurance certificate and this is satisfactory. I met with one of the administrators and looked at the personal finances for four of the people living in the home. Three of them had relatives who supported them to manage their finances and one received support from social services. They all had money deposited with the company and each persons account is kept up to date and accessed through the computer. I was able to see the financial balances for each person and their record of expenditure. The only financial issue that arose during the inspection related to two of the people living in flat 10, which is the service for people with a learning disability. In this flat some of the residents receive a weekly spending allowance that they hold for themselves. The staff expressed concerns that one of the residents might be misappropriating another residents monies. This needs to be discussed with the residents care manager to agree a process to safeguard the residents finances. I looked at the supervision records for four members of staff and at the records kept by the manager to monitor supervision across the whole staff team. These show that whilst individual supervisions are taking place they are not yet happening regularly. The supervision records were also inspected and these showed that the standards of supervision taking place are very variable. The health and safety records were inspected. In terms of fire safety the fire alarm, emergency lights and fire extinguishers had all been serviced. The emergency plan is in place and the fire alarm is being checked on a weekly basis. The fire safety risk assessment is generic and does not apply specifically to the home and no fire drills have been held in 2007. The manager explained that she has arranged professional advice to review the fire safety risk assessment and reviewing fire drills is part of that process. Three of the four staff whose training records were inspected had all received fire safety training and the manager explained that further fire training sessions had been arranged. Apthorp Lodge DS0000051441.V333464.R01.S.doc Version 5.2 Page 26 The maintenance certificates for the electrical appliances, electrical installations, gas boilers, lifts, hoists and water system check for legionnaires were all in place. The staff training records for health and safety were inspected. The senior staff team had received first aid training although some need this updated and most of the staff had completed moving and handling training. Additional training was needed on food hygiene and infection control. Apthorp Lodge DS0000051441.V333464.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 2 4 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 4 3 3 3 4 3 3 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 2 x 1 Apthorp Lodge DS0000051441.V333464.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO 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 OP2 Regulation 5(1)(c) Requirement The registered person must ensure each person living in the home has a contract between themselves and the home stating the terms and conditions of the service provided. These contracts must be completed and signed. The registered person must book training to ensure the staff have all received the preparation they require to meet the specific needs of the people living in the home including training sessions on pressure care and diabetes. The registered person must ensure all the people living in the home have received an up to date dental check and arrange dental appointments as required. The registered person must ensure all the people living in the home who have a pressure sore have an appropriate care plan in place in consultation with an appropriate care professional such as a tissue viability nurse. The registered person must ensure a system is in place to DS0000051441.V333464.R01.S.doc Timescale for action 31/07/07 2. OP4 18(1)(c) 31/07/07 3. OP8 13(1)(b) 31/07/07 4. OP8 12(1) 30/06/07 5. OP9 13(2) 30/06/07 Apthorp Lodge Version 5.2 Page 29 6. OP18 13(6) 7. 8. OP19 OP27 23(2)(c) 18(1)(b) 9. OP27 18(1)(a) 10. OP29 17(2) 11. OP30 18(1)(c) 12. OP36 18(2) 13. OP38 23(4) 14. OP38 13(4) prevent medication running out for any of the people living in the home. The registered person must ensure that all care staff have completed the protection of vulnerable adults training. The registered person must ensure the dishwasher in the kitchen is replaced. The registered provider must ensure permanent staff come into post and the use of agency staff reduces. The registered provider must ensure adequate numbers of staff work in the afternoon across all the flats to ensure a safe service that meets the needs of the residents in terms of their personal care and social activities. The registered person must ensure that each member of staff has a copy of their photo ID in their staff record. The registered person must ensure an ongoing training programme is in place to meet the training needs of the staff in the home. The registered person must ensure all the staff receive regular individual supervision and that the supervisors have been trained to carry out this role adequately. The registered person must ensure the fire safety risk assessment is up to date and that regular fire drills are taking place. The registered person must ensure all the staff have received up to date training on food hygiene and infection control. 31/07/07 15/06/07 30/06/07 30/06/07 30/06/07 31/07/07 15/08/07 31/07/07 15/08/07 Apthorp Lodge DS0000051441.V333464.R01.S.doc Version 5.2 Page 30 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. 5. 6. Refer to Standard OP8 OP9 OP10 OP12 OP14 OP35 Good Practice Recommendations The registered person should ensure all healthcare appointments are recorded. The registered person should ensure that there are clear directions for the administration of creams. The registered person should ensure that everyone in the home is offered a regular bath or shower. The registered person should aim to increase the use of volunteers to assist with activities. The registered person should review the residents meetings in order to facilitate a wider range of issues discussed. The registered person should ensure the staff liaise with the appropriate care managers to address the financial issues for two of the residents in flat 10. Apthorp Lodge DS0000051441.V333464.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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.V333464.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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