Inspection on 03/11/09 for Apthorp Lodge

This inspection was carried out on 3rd November 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Apthorp Lodge 09/03/10

Apthorp Lodge 21/01/10

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 14/08/06

Apthorp Lodge 12/12/05

Apthorp Lodge 09/08/05

Apthorp Lodge 13/01/05

Apthorp Lodge 22/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Henry Nihill House

Birchwood

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

The Infirmary

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Apthorp Lodge Nurserymans Road off Brunswick Park Road London N11 1EQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Julie Schofield     Date: 0 6 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 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 The Fremantle Trust Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 108 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category Additional conditions: 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 4 of 37 Over 65 50 6 52 0 0 0 1 9 0 6 2 0 0 9 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 a new manager has been appointed. They 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. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The key inspection of the home took place over 2 visits in November 2009. The first visit took place on the 3rd November and was carried out by 3 inspectors, one of whom is a pharmacy inspector. The visit started at 9.45am and finished at 6.15pm. The second visit took place on the 6th November and was carried out by the lead inspector. The visit started at 8.30am and finished at 5.15pm. Carrying out the inspection included conducting a tour of the premises, examination of records (including residents records, staffing records and those associated with the day to day running of the home) and referring to policies and procedures. The preparation of and the serving of the midday meal was observed. Two Statutory Requirement Notices have been served since the last key inspection. One was issued on the 20th July 2009. A random inspection on the 17th August 2009 found that this notice had not been fully complied with. A statutory notice was issued Care Homes for Older People Page 6 of 37 on the 12th October 2009. We checked compliance with this Notice during the inspection. We spoke with managers and senior staff. We also spoke with carers and residents. We would like to thank everyone for their assistance with and participation in the inspection. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: When compliance was checked with the Statutory Requirement Notice that had been issued on the 12th October 2009 it was noted that the statutory requirements remained outstanding. A Statutory Requirement Notice was issued on the 20th November 2009. Sixteen additional statutory requirements were identified as a result of this inspection. There is a need to carry out mental capacity assessments, as necessary, and to update care plans as changes occur so that the needs of the residents continue to be met. This would include ensuring that the minutes of review meetings are received within a reasonable time of the meeting taking place so that the information in the care plan is up to date and in accordance with any decisions made. Requirements were made in respect of the physical environment so that surroundings remain enjoyable and pleasant for the residents and these include having effective odour control systems in place. As staffing levels must keep pace with the dependency levels of residents and take into account their wishes and preferences the levels must be kept under review and amended when needed. Residents must have opportunities to take part in activities inside and outside the home and activities must be provided to meet the needs of all residents in the home. Similarly the management structure must be robust and sufficient in numbers to ensure the efficient running of a large care home. Training for carers, particularly those supporting residents with dementia, needs to build on the current training that is given so that carers are able to develop their skills and understanding. Knowledge of safe working practice topics needs to be kept up to date by the provision of refresher training at the recommended intervals. Carers also need to be supported by the provision of regular individual supervision sessions so that Care Homes for Older People Page 8 of 37 standards of care are monitored. The format for Regulation 26 visit reports needs strengthening so that it is more detailed and more informative. They could then be a useful tool for confirming that monitoring of compliance with regulatory requirements is taking place. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Carrying out an assessment of the resident, prior to admission, ensures that the needs of the resident are identified and that the home is able to determine whether these can be met. Building on the dementia care awareness training that forms part of the induction would enhance the skills and knowledge of the carer and the quality of service provided. Evidence: We examined 4 residents case files. We noted that a file belonging to a resident that had been admitted 3 weeks previously contained a copy of the FACE Rapid Assessment and other documents from the local authority social services department. The assessment process also included an assessment of need of the prospective resident, carried out by a representative of the home. The manager showed us a copy of the new documents to be used in the assessment process, prior to the admission of the prospective resident. We were told that the Care Homes for Older People Page 11 of 37 Evidence: documents are now in use. We were told that a senior member of staff and the key worker would be responsible for carrying out the assessment. We saw that the process included a very detailed record about the resident that included the care category, legal status, key contacts, significant areas of risk, health details, allergies etc. The process also included a record of the outcome of the assessment and if the referral was unsuccessful there was a need to record the reasons for declining the referral. We discussed the care of the residents with learning disabilities with the acting manager and with a manager from one of the companys care homes for adults with learning disabilities, who is currently acting as an adviser to Apthorp. The adviser is introducing a pathway scheme and gave a copy of the plan to us. This sets out improvements for the service but it does not include any recommendations arising from the local authority resident reviews, as the minutes of these meetings that took place in March 2009 have still not been received in the home. The plan was drawn up by the adviser, following her discussions with residents. Some of the comments by residents have already been acted upon e.g. making the door to the unit more like the front door of a house where the bell is rung by visitors, having a more flexible breakfast time, encouraging residents to do things around the house etc. It was also agreed that members of staff working on this unit no longer wear a uniform. We discussed dementia care. The acting manager said that one of the senior staff is the dementia care adviser for the care home and that the acting manager and dementia care adviser are currently undertaking training to enable them to give more in depth dementia care training to carers. They have identified the need for the carers working on the dementia care units to receive this training in the first batch of carers to be trained. At present the manager has been trained to give basic dementia care awareness training and the training package that is used is called Tomorrow is Another Day. The home does not provide an intermediate care service. Care Homes for Older People Page 12 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessing the needs of a resident and identifying these in a care plan enables the resident to receive a service tailored to meet their needs. However, care plans lack an assessment of capacity and plans may not have changed according to changes in residents likes and dislikes. Supporting residents to attend health care appointments helps residents in maintaining a healthy lifestyle. However, residents can not be confident that the arrangements for administering medication are satisfactory. Discreet and caring support is given to residents by staff so that the privacy and dignity of the resident is respected. Evidence: The need for more detailed and informative care plans, person centred and where the support needed from staff for residents to achieve their goals and targets is recorded has been an outstanding statutory requirement. We were told that the new format for the care plans is now ready and we saw a copy of these during the inspection. The format lacked an assessment of capacity. Apthorp has been identified as the first of the companys homes in the London Borough of Barnet to introduce the new format and the training for seniors took place on the 5th November. The manager said that Care Homes for Older People Page 13 of 37 Evidence: the seniors will be responsible for cascading this information to carers during meetings with small groups of carers. We looked at 4 residents case files. We noted that files contained a personal lifestyle summary and a summary of the care plan assessment. Files contained manual handling and nutritional risk assessments. One of the files contained a risk assessment in respect of pressure sores for a resident who continues to have problems and who complained of discomfort. We noted that dislikes - fish was recorded on one of the files. We were told that the resident had fish and chips for lunch on the second day that we visited the home. When we spoke with a member of staff they said that they had worked in the home for about 4 years and the resident had eaten fish for as long as they could remember. Case files containing information regarding access to health care services were viewed. We saw that appointments had taken place with the psychiatrist, the GP, the chiropodist, the district nurse, the nurse supporting people with learning disabilities, the optician and the dietitian etc. Residents were able to have a flu jab, if they wished. There were also given support to attend appointments at out patient clinics and there were also appointments for x-rays and ultrasound scans. One resident had a care plan that contained a risk assessment in respect of pressure sores. When a resident had a sacral pressure sore the District Nurses had provided nursing care. An air flow cushion and special mattress had been provided to make the resident more comfortable and to assist healing. This inspection was to check compliance with a Statutory Requirement Notice issued on the 12/10/09. This was the second notice issued and we required the home by 25/10/2009 to ensure that systems are in place so that all residents are given their medication at the time and in the dose prescribed as we considered residents were at risk of their medication and health needs not being met. The home was also required to have systems in place to ensure medication administration records (MAR) are completed at the time of administering the medication and are accurate at all times. We also received a report of a medication error in the home on 27 October where one resident took another residents medicines in error. We inspected the safe handling and recording of medication in all flats in the home and audited several samples to see if it was being given as prescribed. We noticed an improvement in recording and that mostly, records were complete. We noticed in one flat that medicines were not recorded the morning of the inspection but that they were given. An internal audit at lunchtime identified the gap. In another flat we noticed two omissions in the recording Care Homes for Older People Page 14 of 37 Evidence: of an evening dose of an antibiotic. On counting capsules we were able to verify that they were not given. We were concerned for this residents health because the home had run out of a prescribed skin soak and also had administered in error two doses of a calcium tablet which the GP had said to stop temporarily because it prevented the absorption of the antibiotic. We counted several tablets and examined the Monitored Dosage System on the two upper floors. Records of administration could be reconciled against supplies in all cases. This means that these residents were receiving their medication as prescribed. We noticed on the top floor that four residents were recorded as not receiving their medication at night on 28/10 because the key was missing. Three of these medicines were for regular pain relief. On the ground floor we noticed a discrepancy in audit of an antipsychotic prescribed one in the morning and two at night. There were two too many tablets left on counting, which indicated that only one had been given instead of two on two occasions. We noticed on the first floor that a resident did not receive their thiamine on the morning of the inspection and that calogen was recorded out of stock for 4 days. Lack of supplies of medicines for this resident was recorded on the MAR at a previous inspection. Yet again, a supply was located when brought to the attention of the manager by the inspector. We were told by a care worker on this floor that a laxative prescribed two sachets daily was only being given as one sachet daily. There was no record of this on the MAR or in the care plan. Records showed that another resident did not receive some of their medication the first day of the cycle because the pharmacist did not deliver in time. We were told that an emergency supply was obtained from the local hospital but we could find no record of this transaction or a record of it being administered on the current MAR. A record was eventually found on the previous months MAR and given to the lead inspector on the second day of the inspection. We looked at the audits that managers and care workers were doing to improve the safe handling of medication. There was inconsistent signing of the regular checks by care workers in the individual flats. Managers were identifying some issues but not all problems were identified and addressed. The managers audits were also being carried out inconsistently with no checks being made in September and only two floors audited in November. There were medication profiles in use throughout the home and we went to see two Care Homes for Older People Page 15 of 37 Evidence: residents who were able to maintain their independence by self administering some of their medication. The home had done some work in updating risk assessments to self medicate but one resident had not had her agreement reviewed since 2007. We checked the controlled drugs and balances were correct. Overall therefore, we were able to appreciate that the home was making some improvements to safely handle medication. However, because of the repeated issues identified, and new areas of concern, we were able to confirm that the home had not complied with the Statutory Requirement Notice. As the Statutory Notice was not complied with and residents were at risk of not having their medication and health needs met a further Statutory Requirement Notice was issued on the 20th November 2009. We discussed privacy and dignity with residents and they confirmed that these were respected when carers assisted them with personal care tasks although 1 resident commented that having to use a hoist was not very dignified. During the inspection we saw that assistance was offered by carers in a manner which was discreet and tactful. We noted that members of staff used the term of address preferred by the resident and the preferred term of address was noted in the care plan. There was a good rapport between residents and members of staff. Care Homes for Older People Page 16 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A programme of activities provides residents with opportunities for stimulation and enjoyment and this must be available to all residents. Residents said that they enjoyed the company of their visitors, who were made welcome by the staff when they visited the home. Residents have more opportunities now to exercise choice in their daily lives. Residents nutritional needs are met through the provision of a diet that is wholesome and varied and which meets their needs. Evidence: We spoke with the activities coordinator, who works with the elderly care units. He told us that an appointment has not yet been made to the post of dementia care activities coordinator. Rooms have been set aside on the dementia care units to use as activities rooms and staff are encouraged to make use of these with the residents. However, this is dependent on staffing levels being sufficient to facilitate this. (See Staffing section of report). There is an area near the bar where activities take place and where there is a large television, ideal for watching sports programmes. We were told that when tennis from Wimbledon was showing they had served strawberries and cakes. We were also told about casino evenings that have been held in the home. A resident said that they had Care Homes for Older People Page 17 of 37 Evidence: been on a trip to Brent Cross and had been to the pub. On the second visit to the home a coffee morning had taken place and we spoke with a resident that had enjoyed taking part. Reminiscence sessions and communication sessions take place and the home has a Wii game (tennis) for exercise and fun. Entertainers visit the home approximately 2 a month. In 2008 a group of residents had taken a holiday to Blackpool and one of the residents said that it was a nice place. Residents are looking forward to the parties to be held over the Christmas period and seeing and hearing the carol singers that visit the home. An outing is planned for a group of residents to see the Christmas lights, followed by a fish and chip supper. Residents are able to observe their religious practices and a priest visits the home on a monthly basis and Catholic residents and holds a mass. There is also an Anglican service that is held in the care home on a regular basis. Volunteers from the church organise and operate a trolley that visits each unit so that residents can buy small personal items. Residents told us that their visitors were made welcome when they arrived at the home and that residents could either entertain visitors in their own room or in the communal areas. They confirmed that visitors are offered refreshments. Residents in Harbour Lodge (the learning disabilities unit) are being encouraged to take a more active part in the running of the unit and have chosen the colours to be used in the redecoration of the communal parts of the unit. A resident said that living here is better than in hospital and was pleased that the kitchen is not locked now at certain times. He said that he would like to go out more and a trip to Finchley is planned as he knew the area well during the war time. To spend more time in the community, with an escort, has implications for staffing levels. (See Staffing section of the report). Two residents confirmed that they could choose when to get up in the morning or when to go to bed but said that it might depend on whether a resident was able to do this by themselves or whether they needed assistance from a carer. During the inspection we visited the kitchen to see the preparation of the midday meal. Fried fish or steamed fish was being prepared with chips. Seven alternative meals had been requested. These consisted of 2 omelets, 1 vegetable curry with rice, 2 salads, 1 jacket potato and 1 fish cake. The dessert was bread and butter pudding although again, alternatives were available. Two of the heated trolleys were out of use and so units were doubling up. Residents expressed satisfaction with the meals served in the home and a resident told us that the menu changed every day. He confirmed that the menu included his Care Homes for Older People Page 18 of 37 Evidence: favourite meals and he said that the evening meal was not too bad. Another resident said that the meals were fine. They said that there was always something to eat and that the staff didnt rush her. One resident confirmed that alternatives to the main meal were available and told us that she had ordered an omelet instead of having lamb. We saw that the home has a rolling menu and that Week 4 was in use during the inspection. The meals listed on the menu provided a varied and wholesome diet. The home has been awarded a 5 stars score on the door by the local authority environmental health department for its food hygiene standards. Care Homes for Older People Page 19 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A complaints procedure was in place to protect the interests of the residents. Protection of vulnerable adults training for staff and familiarity with the homes procedure and with the whistle blowing procedure contribute towards the safety of residents. Evidence: There is a feedback policy and guidelines in place, which includes timescales for the complaints procedure and makes reference to the regulatory body, with contact details. A Regulation 26 report identified that no complaints had been recorded for the period November 2008 to September 2009. Since September 2009 3 complaints have been recorded and it is unlikely that during a 9 month period no complaints will have been made. The 3 most recent complaints that have been recorded have been investigated and 1 was upheld. When we spoke with residents one person said that if they had a complaint they knew that they could air it and that it would be dealt with. They gave an example of bringing something to the attention of the carer providing support and that this had resolved the matter. Since the last key inspection a safeguarding alert was made to the Social Services department by a health care professional. This has resulted in an action plan for staff to implement in the event of a suspected head injury. Both the acting manager and Care Homes for Older People Page 20 of 37 Evidence: the deputy manager have been trained to deliver training in respect of safe guarding adults to people working in the home. When we spoke with residents they told us that if you want anything you just ask. A resident said that they could talk to staff if they had a problem and can always go to anyone. Another resident said that he would talk to the young man (referring to the deputy manager) if he had a problem. Two other residents referred to speaking to Jan (the manager) if they were unhappy about something and they said that she visited the unit every day. When we spoke with carers they confirmed that they had attended safe guarding training and were able to explain their responsibilities in the event of an allegation of incident of abuse. They referred to the whistle blowing procedure. Care Homes for Older People Page 21 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a care home that provides comfortable and homely surroundings. Bedrooms with an en suite facility were appreciated by residents. However, lapses in odour control affect the residents overall enjoyment of their surroundings. Evidence: The building is large and consists of 3 floors, ground, first and second. Nine of the 10 units are known by a number but the unit for residents with learning disabilities has been named Harbour Lodge. The name was suggested by a resident and then chosen by the residents. There are 2 units on the 2nd floor, 4 units on the 1st floor and 4 units on the ground floor. Although there is a reception area and desk no one is working there and so at times we noticed that people at the front door had to wait after ringing the bell to gain admittance. We noted that areas were comfortably furnished and provided a homely environment for the residents. Although clean and tidy, there was an odour of urine in the activities room in Unit 2, there was also an odour in one of the rooms in Unit 7 and the chairs in the lounge where smoking is permitted were worn and stained. The manager said that it was planned to replace the chairs with furniture from Harbour Lodge, when they received new items of furniture for Harbour Lodge. Residents expressed satisfaction with their bedrooms and a resident said that their Care Homes for Older People Page 22 of 37 Evidence: room was big. They were pleased to have an en suite toilet. Another resident said that they liked their room, which was nice and clean. During the site inspection we saw the laundry facilities in the home. The home has 4 commercial washing machines and 3 commercial tumble dryers. A new system of marking clothing has been introduced. All main clothing has what looks like a small button attached. The buttons come in 2 different colours so that they tone with the colours of the garment and they are attached in a discreet position. A device reads the button at the end of the laundry process and the name of the resident whose clothing the button has been attached to appears on the screen. This has resolved the problem of laundry being returned to the wrong person. Training in infection control procedures forms part of the in house training programme for carers. Care Homes for Older People Page 23 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Keeping staffing levels under review would assure residents that there are sufficient carers on duty to meet their needs and to enable residents to take part in activities outside the home. Residents benefit from staff that have developed their understanding and awareness through NVQ training. Recruitment procedures are thorough and this promotes the safety and welfare of residents. Members of staff have access to a programme of training to develop their understanding and skills. Evidence: This is a very large care home, 108 beds, and we were pleased to see that the acting manager and deputy manager are to be supported by an assistant manager. However, this appointment is for a period of 6 months and then a review is to be carried out. With a home of this size the management structure needs to be robust and be sufficient to carry out all the duties encompassed by providing a service on this scale. We saw the staffing rota for week commencing the 2nd November and discussed this with the deputy manager. We were told that staffing levels have improved with the recruitment of staff to vacant posts. He said that a review of the skills mix had taken place to ensure that the number of seniors on duty each day was more evenly spread throughout the week. We were told that each unit had dedicated staff and that the number of staff during the day ranged from 1 person to 3 persons, depending on the Care Homes for Older People Page 24 of 37 Evidence: size of the unit. At night 1 senior and 7 carers are on duty. At night the dementia care units are each allocated a carer while other units may share a carer. Minimum staffing levels are in operation with carers working across more than 1 unit, in some instances. Residents must have opportunities to enjoy activities in the community and this wish was expressed during the inspection. Rotas need to provide enough members of staff on duty to meet the needs of the residents, to respond to requests for assistance without unnecessary delay and to provide support for residents wishing to take part in activities, either as part of a group or on an individual basis. We checked the progress of carers achieving an NVQ level 2 qualification. The statistics provided from the data base held gave a total of 58 of care staff working in the home with an NVQ level 2, or higher, qualification. In addition there are 5 additional members of staff that are currently working towards obtaining an NVQ level 2 qualification. Six members of staff are in house assessors and the company has its own NVQ assessment centre. The home has met the requirement of 50 of carers holding an NVQ level 2 qualification. We examined 7 staff files to check recruitment practices in the home. We noted that each file contained an application form and that the applicant completed a declaration regarding any cautions or convictions. Proof of identity had been established and the right to reside and to work in the UK, if necessary. Files contained satisfactory references and a statement of fitness to work. Each file contained evidence of an enhanced CRB disclosure. Both the manager and the deputy manager have been trained to deliver training to members of staff in respect of safe guarding, food handling, infection control and manual handling. Members of staff also have access to training courses that give them an understanding of the needs of the residents living in the home. There was evidence on file of new members of staff having an induction programme. Care Homes for Older People Page 25 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The day to day management of the home provides residents with an environment where their needs are recognised. However, residents need to be assured that when regulations have been breached there is evidence to demonstrate that service provision is thoroughly monitored. A programme of supervision of carers assures residents that care practices are checked. Training for staff in safe working practice topics promotes the health and safety of residents, staff and visitors to the home. However, training must be refreshed according to recommended intervals to assure residents that the people supporting them are aware of current best practice. The testing/servicing of equipment in the home assures residents that it is safe to use. Evidence: The registered manager resigned in April 2009. We met the Acting Manager that had been appointed in July 2009. Prior to this she had been a registered manager working in one of the companys residential care homes in Buckinghamshire. She is currently undertaking the Management and Leadership (NVQ level 4) qualification. We were informed that interviews for the post of manager are due to take place in November. Care Homes for Older People Page 26 of 37 Evidence: Subsequent to the inspection we were told that the acting managers application had been successful and that she had been appointed to the permanent post. During the key inspection compliance with a Statutory Requirement Notice (SRN) issued in October 2009, in respect of medication, was checked. We are concerned that the service had not complied with the notice although an improvement plan that was sent to the CQC following an SRN that was issued in July 2009 said that compliance would be achieved by a date in September, which preceded the date of this inspection. We are also concerned that when the Regulation 26 monthly inspections (part of quality assurance systems in place in the home) were carried out after receipt of the SRN issued in July and the SRn issued in October the information in the report of the inspections did not demonstrate that careful monitoring of standards in relation to medication, where breaches of the regulations had taken place, was being carried out. The reports for July and October did not tick the area of medication as one of those checked and while the report for August did have a tick against medication there was insuficient detail to confirm that implementation of the improvement plan was checked or to inform the other trustees that compliance had been achieved. Residents finances were not examined during this inspection We discussed the supervision of carers and the manager said that there is now a programme in place for individual sessions between the carer and the group coordinator to take place on a 4-8 week basis. Group coordinators are trained to carry out this task. When we looked at the supervision records on 2 staff files we noted that 1 file contained the minutes of 3 meetings that had taken place in 2009, (the most recent having taken place in September) and the other file contained the minutes of 2 meetings that had taken place in 2009 (the most recent that had taken place in March). Both files contained a copy of a developmental review (annual appraisal) that had taken place in 2009. General staff meetings take place twice a year although the home is hoping to introduce a system of group meetings to be held on a monthly basis. A group meeting is to be managed by a group coordinator and will take place with the members of staff from 2 units. Staff working in the kitchen are supervised by the chef manager and domestic staff are supervised by the facilities manager. When we spoke with carers during the inspection a carer told us that the manager and deputy manager visits the units a lot and that the carer had individual supervision sessions with a manager. We spoke with the person who has responsibility for health and safety and for ensuring that the maintenance of the home and of the equipment in the home is carried out. In order to help him keep track of when servicing is due etc he uses a Care Homes for Older People Page 27 of 37 Evidence: yearly planner and monthly lists. There was evidence that the lifts are serviced and checked on a regular basis and we were told that a representative of the insurance company visits the home to ensure that the lifts and hoists are inspected and serviced on a regular basis. The fire precautionary systems and equipment in the home are also checked and serviced. There is an inspection certificate for the electrical installation, the gas appliances, the testing of the portable appliances, testing the water supply for Legionella and for the fire extinguishers. The fire alarm system is tested on a weekly basis and the last fire drill to be carried out took place on the 9/7/09. The care home has a fire risk assessment and fire safety training is given to members of staff on an annual basis. Senior staff have undertaken first aid training. When we looked at staff files we noted that 1 of the carers did not have an up to date manual training certificate as the date on the last certificate was 2006. When we asked the carer about the training they had attended they confirmed that they had not attended manual handling training recently. Care Homes for Older People Page 28 of 37 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 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. 2 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 not been complied with. To ensure better outcomes for people who use the service. 3 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. Care Homes for Older People Page 29 of 37 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, Care Homes 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 4 15 Contact must be made with the local authority again to request copies of the minutes of the review meetings that were held in March 2009 for residents of the Harbour Lodge unit. This will ensure that the development of the service for residents with learning disabilities builds upon agreements and recommendations arising from their review meetings. 01/01/2010 2 4 18 A programme of dementia 01/04/2010 care training, that builds on the basic awareness training given during induction, must be included in the annual programme of training. This will enable carers to offer support based on a greater understanding and knowledge of the needs of residents with dementia. Care Homes for Older People Page 30 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 3 7 15 The registered person must 01/01/2010 ensure that when changes in the likes or dislikes of a client are noticed the care plan must be updated. This will assure residents that changes in their needs are identified, recorded and acted upon. 4 7 12 The registered person must ensure that the new care plan format is implemented in the care home, after training for carers in the content and usage. This will assure residents that the format of the care plan is person centred, detailed and comprehensive so that all their individual needs are identified, recorded and addressed. 01/02/2010 5 7 14 The registered person must 01/04/2010 ensure that mental capacity assessments are carried out as required and are recorded with a copy kept on the residents case file. This will assure residents that an assessment of capacity has informed the support needed by the resident. Care Homes for Older People Page 31 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 6 9 13 The registered person must 10/12/2009 ensure that a system is put in place to ensure all residents of Apthorp Lodge are given their medication at the time and in the dose as prescribed. A Statutory Requirement Notice has been issued. This will safeguard residents because failure to adhere to safe medication practices puts them at risk. 7 9 13 The registered person must 10/12/2009 ensure a system is put in place to ensure medication administration records (MAR charts) are completed at the time of administering the medication and are accurate at all times. A reason for non administration of the medication must be recorded should that be the case. A Statutory Requirement Notice has been issued. This will safeguard residents because failure to adhere to safe medication practices puts them at risk. 8 9 13 The registered person must make arrangements for the recording, handling, safekeeping, safe 10/12/2009 Care Homes for Older People Page 32 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 administration and disposal of medicines received into the care home. A Statutory Requirement notice has been issued. This will safeguard residents because failure to adhere to safe medication practices puts them at risk. 9 12 12 The registered person must ensure that activities appropriate to the understanding of and suitable for the participation in by residents with dementia are provided. The post of activities coordinator for the dementia care units must be filled. This will assure all residents of opportunities for a stimulating and enjoyable lifestyle. 10 16 22 The registered person must ensure that a comprehensive record of complaints is maintained. This will assure residents, and their representatives that their concerns are listened to and acted upon. 11 19 16 A review of access to the 01/02/2010 building must be carried out. 01/01/2010 01/04/2010 Care Homes for Older People Page 33 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 This will assure visitors to the care home that they do not have to wait to gain entry for longer than is necessary. 12 19 23 The chairs in the lounge where smoking is permitted that are worn and stained must be replaced. This will assure residents that all lounge areas provide clean and smart seating. 13 26 16 Odour control systems must be effective in all parts of the home. This will assure residents of a pleasant environment that is free from offensive odours. 14 27 18 A system of regular reviews of staffing levels must be in place to check that they match dependency levels of residents and allow residents to take part in activities outside the home. Adjustments must be made to staffing levels as required. This will assure residents that there are sufficient members of staff on duty to meet their needs and to 15/01/2010 01/01/2010 01/02/2010 Care Homes for Older People Page 34 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 respond to calls for assistance in a timely manner. 15 27 18 When the review of management levels in the home takes place the layout of the home, the complexity of needs of the residents, the size of the staff team and the number of tasks associated with the day to day running of the home must be taken into account. This will assure residents that the management structure supports the smooth and effficient running of the home. 16 33 26 The format of the Regulation 01/01/2010 26 report must be reviewed and a more comprehensive format developed. This will enable the care home to keep a comprehensive record of the areas inspected and of the findings so that this report informs the trustees of how well the home is operating and whether it is achieving the standards required by regulation. 17 36 18 The registered manager must ensure that carers receive individual 01/01/2009 01/06/2010 Care Homes for Older People Page 35 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 supervision sessions which are recorded and which take place a minimum of 6 times per year. This will assure residents that members of staff are supported and that their work is monitored and kept under review. 18 38 13 The registered manager 01/01/2010 must ensure that training in safe working practice topics is refreshed when necessary e.g. manual handling training to be undertaken on an annual basis. This will assure residents that the way in which members of staff carry out their duties promotes the safety of the residents. 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 36 of 37 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 37 of 37 - 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!