Inspection on 04/12/07 for Apthorp Lodge

This inspection was carried out on 4th December 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Apthorp Lodge 09/03/10

Apthorp Lodge 21/01/10

Apthorp Lodge 03/11/09

Apthorp Lodge 17/08/09

Apthorp Lodge 19/06/09

Apthorp Lodge 11/06/08

Apthorp Lodge 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 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 4th December 2007 9:00 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.V354265.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.V354265.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Apthorp Lodge Address Nurserymans Road off Brunswick Park Road London N11 1EQ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8211 4000 020 8211 4109 admin@fremantletrust.org The Fremantle Trust Mrs Irene S Rondell Care Home 108 Category(ies) of Dementia - over 65 years of age (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.V354265.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. 22nd May 2007 Date of last inspection Brief Description of the Service: Apthorp Lodge is a care home, which was first registered in August 2003 to provide personal care for 54 people, some of whom had dementia and a learning disability. Following the closure of two other homes, which were also managed by Fremantle Trust, a further 54 places were commissioned in October 2004, bringing the total capacity of the home to 108 residents. In December 2006 the registration for the service was amended to enable it to offer care to more people with dementia. The home can now accommodate up to 50 people with dementia, 52 older people and 6 people with a learning disability. The home is a large detached three-storey building. It is purpose built and organised on three levels, with lift access to all floors. It is divided into ten units or flats. Four units are dedicated to residents who have dementia and one unit to service users who have learning disabilities. The remaining five units are for mainstream services for older people. People with dementia can also be accommodated in the mainstream units if this is where their needs can most appropriately be met. There is a kitchen, lounge and dining room in each flat. All bedrooms are single with en-suite facilities. There is also an additional assisted bathroom in each unit. There is a car park to the side of the building and gardens to the side and rear, which are partly paved and accessible to the residents. The home is situated off Brunswick Park Road. It is well served with community services and facilities located along Russell Lane and East Barnet Road. The home has a day centre, which provides services to twenty-six service users specifically from the outside community. Apthorp Lodge DS0000051441.V354265.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.V354265.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 4 December 2007 and was unannounced. The inspection took seven and a half hours to complete. On the day of the inspection there were 97 residents in the home of whom one was receiving respite care and one step down care. The inspector spent the majority of the inspection focusing on four of the ten flats. In each flat the inspector spoke at length to some of the residents. The inspector also interviewed four members of the care staff as well as speaking to other care staff who were working at the time. The inspector also looked at eight care plans and the medication systems in four of the flats. The inspector also looked at all the relevant records including service user finance records, staff files and health and safety information. The home also prepared a self–assessment (AQAA) and this was submitted to the Commission for Social Care Inspection prior to the inspection. The inspector also received 40 completed surveys, 19 from staff, 10 from relatives and friends and 10 from residents and one from a health care professional. The inspection is the second annual key inspection and the aim is to look at how well the service is meeting the key National Minimum Standards for Older People and progress with meeting requirements from the last key inspection. The inspector would like to thank the residents 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 “The care here is very good, it really is very good”. The feedback from residents and relatives is very positive and one person said in their questionnaire “the experienced staff give loving and thorough care beyond the call of duty”. There was a very warm and friendly atmosphere in the home and it was observed that the staff related very positively to the residents. One relative said in her questionnaire that, “the staff are excellent and always friendly”. Apthorp Lodge DS0000051441.V354265.R01.S.doc Version 5.2 Page 7 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 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 physical environment throughout the home was clean and comfortable and the bedrooms are personalized and homely. The Christmas decorations were very jolly and helped to create a seasonal atmosphere. 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 person centred and reflected the needs of each individual. These showed that the home works closely with other healthcare professionals when this is needed. The policies and procedures were in place to maintain health and safety in the home. What has improved since the last inspection? At the last inspection there were fourteen requirements and six recommendations. The manager and the team at Apthorp Lodge have worked hard to make progress in addressing these requirements. Since this time the people living in the home have been supported to complete a contract between themselves and the home, have been able to receive a dental check, have appropriate care plans and risk assessments to prevent the development of a pressure sore if they are at risk of this happening and all have the correct medication available. Also healthcare appointments are being fully recorded, there is evidence that people are being supported to have a bath or shower as often as they wish and the residents meetings are discussing a wider range of topics. The staff numbers have increased in the afternoon and two staff are working in the units. Also active staff recruitment has been taking place although more is still needed. The staff all have a copy of their ID in their staff record and training has either taken place or is booked on food hygiene, infection control, safeguarding adults and a few have been trained on specialist topics such as diabetes care. The dishwasher has been replaced in the kitchen. The fire safety risk assessment is complete and the fire drills have taken place. Apthorp Lodge DS0000051441.V354265.R01.S.doc Version 5.2 Page 8 In addition a number of other areas of improvement were observed including the homes participation in the NHS Apprenticeship Scheme which has improved the skills of some staff, the appointment of the facilities manager that has improved the maintenance of the building and support functions in the home and a group of volunteers are providing a weekly trolley service in the home, which is very popular with the residents. What they could do better: 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.V354265.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.V354265.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. People using this service experience good outcomes in this area. 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 in caring for the people in the home particularly people with dementia, although further training on a number of specialist areas would be helpful. EVIDENCE: At the time of the inspection the home was reviewing the service user guide and when complete this will be a very comprehensive document that is user friendly and includes photos of senior staff. Apthorp Lodge DS0000051441.V354265.R01.S.doc Version 5.2 Page 11 I looked at the assessments completed for seven people living in the home. They all had a detailed assessment prepared by the home covering all their individual needs. This also included information such as their preferred routine and their life story. Since the last inspection three people have moved to Apthorp Lodge from another home. I discussed the process of moving to the home with the care staff. They explained that the staff from Apthorp Lodge had spent time with the residents at their previous home to get to know them better prior to their move. They had also been provided with detailed written information. The surveys completed by the service users showed that nine out of ten of them felt they had received enough information about the home before their arrival. I looked at the contracts between the home and the residents for four people living in the home. All these documents had been completed and signed appropriately and a copy was available in their case notes. 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 had been trained on how to work with people who have dementia, which was reflected in the good practice observed in the units. At the previous inspection it was identified that staff would benefit from training on pressure care and diabetes. The manager explained that three staff had attended training on arthritis and Parkinsons. Three other staff were also attending ongoing training on palliative care. Training is also planned in the next few months for four staff on nutritional care, two staff on continence care, and a group of staff on diabetes. This training needs to be shared across the staff team. The ten surveys completed by residents showed that people said they always receive the care and support they need. The relatives and friends said that the home always or usually met the needs of their relative for example one person said that, “the home takes my father to his medical appointments and supports him with his bathing and dressing”. Apthorp Lodge DS0000051441.V354265.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. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and wellbeing of the people living in the home is well maintained. Risks are assessed and residents treated with respect and their privacy protected. Medication is generally well managed although medication profiles need to be updated. 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 person’s healthcare and support needs but also looked at their emotional needs including significant relationships. The care plans had been reviewed on a monthly basis. Each care plan included an individual risk assessment that always included a moving and handling assessment. Other areas of risk were Apthorp Lodge DS0000051441.V354265.R01.S.doc Version 5.2 Page 13 also covered such as wandering, nutritional needs, fire safety or complex behaviours. It was however noted in the learning disability service that one resident has particularly complex needs and would benefit from having his risk assessment and care plan further developed. The home operates a key-working system and the staff and residents who were interviewed showed a good understanding of the key-working role. The residents said they appreciated their key-worker. 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. These included all the primary healthcare input including the optician, GP and chiropody. Significant progress has been made since the last inspection in supporting people to have dental checks. In addition people are referred for specialist input as required according to their individual healthcare needs. The district nurses support a number of the residents in the home on a regular basis. The recording of healthcare appointments appeared to be up to date and accurate. Each person had a nutritional assessment and had been supported to have their weight checked on a monthly basis. The manager explained that at the time of the inspection none of the residents had a pressure sore, although a number of residents were at risk of developing a pressure sore. In one of the units I inspected the care plan for a resident who had been assessed as being at risk of developing a pressure sore. The care plan and risk assessment reflected the action to be taken by the staff to address this issue. I also spoke to a member of staff working on the unit and she had a good understanding of what steps the staff needed to take to prevent a pressure sore developing and the importance of closely observing skin integrity. 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 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 two areas for improvement relate to the administration of creams which just say to “use as directed” rather then explaining where and how they need to be applied and some of the medication profiles were slightly out of date where medication had been changed. All medication received and returned is recorded on the administration records and so there is a clear audit trail available of the Apthorp Lodge DS0000051441.V354265.R01.S.doc Version 5.2 Page 14 medication. I checked the medication for one resident in each of the four units and all the drugs were available. All of the surveys completed by residents said that the staff always listen and act on what they say and one said, “my speech can be hard to understand but the staff who know me can understand”. I observed that all the personal care was given in a manner that preserved the privacy and dignity of the people living in the home. This was assisted by all the bedrooms having en-suite facilities. Everyone was appropriately dressed and were able to access the hairdresser who visits the home weekly. The staff were observed to be friendly and able to share a joke, whilst treating people in a respectful manner. One relative said in the survey “I have been pleased and relieved to see the care my relative has received and particularly impressed by the staff who are hardworking and cheerful”. I spoke to a number of residents about personal care and they all said that they are supported mainly by their key-worker to have a bath or shower when they wish this to take place. Apthorp Lodge DS0000051441.V354265.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. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home 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 activities for people with dementia are not currently meeting their specific needs and have to be developed further. 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 Apthorp Lodge DS0000051441.V354265.R01.S.doc Version 5.2 Page 16 which everyone can attend. On the day of the inspection a game of indoor bowls was being enjoyed by a number of residents. The programme of Christmas entertainment was displayed and includes a number of parties, entertainers and involvement from the local community such as school choirs visiting the home as well as shopping trips and a visit to the Christmas lights. The residents spoken to said they enjoyed the activities offered in the home. They were also happy with the new weekly activity where volunteers visit the home and take a trolley round the flats so residents can purchase confectionary and other items. The surveys showed that residents feel there are usually enough activities although one person said they would like more opportunities to go out. One relative also commented that, “the activity coordinator is great but there are many residents with different needs to accommodate”. The manager said there is a recognition that there needs to be more activities for people with dementia and proposals are in place to address this shortfall. The home strives to meet people’s religious and cultural needs in line with their individual wishes. The staff spoken to explained how they supported the residents to attend religious services and arranged for their specific dietary preferences to be met. It was also observed that the programme of activities included the different religious festivals taking place in December. One resident who has recently moved to the home speaks Parsee and one member of staff who speaks the same language helps to communicate with her. In addition the staff have written out some key phases phonetically. Relatives were observed visiting the home throughout the inspection and were able to spend time with people in the lounge or their bedrooms. One person said he felt welcome in the home and this was also reflected in the relative’s surveys. One resident told me how she moved to the home with her husband and they have been offered two bedrooms next to each other and they use one as a shared bedroom and the other as a private lounge. 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 discussed a wider range of issues than at the previous inspection including matters relating to the building and staffing. The home follows a four-week rolling menu and I was able to see the lunch being served. This was a home cooked meal and included plenty of fresh fruit and vegetables. Almost all of the relative’s surveys said they always or usually enjoyed the meals. Only one relative said he thought the evening supper was not as good as it used to be. The manager said that the evening menu had not changed apart from the introduction of soup. Apthorp Lodge DS0000051441.V354265.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. People using this service experience good outcomes in this area. 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. The home has an effective safeguarding vulnerable adults procedure and most staff have received appropriate training with further training planned. EVIDENCE: I looked at the record of complaints and in the last six months there have been six complaints. It was evident that all the complaints were appropriately investigated and the outcomes were recorded. The residents spoken to said that if they had any concerns they would speak to their key-worker or the manager. The surveys showed that all the residents said they would know who to speak to if they had a complaint. All the relatives also said that they knew how to make a complaint and that where they have raised issues the service has responded appropriately. One relative said “staff have always been very helpful if I have raised any concerns and have sorted things out straight away”. The home has an appropriate policy and procedure in place for the protection of vulnerable adults. The staff training records showed that most staff had Apthorp Lodge DS0000051441.V354265.R01.S.doc Version 5.2 Page 18 completed training on safeguarding vulnerable adults and further training was planned later in the month. Since the last inspection there has been one safeguarding vulnerable adults strategy meeting regarding the care of a resident who passed away in the learning disability unit. This did identify some areas for improvement particularly for the senior carers in the home and the manager has addressed these matters. The previous inspection highlighted a specific issue in relation to the protection of resident’s monies in the learning disability service. This has been addressed and resident’s monies are being appropriately safeguarded. Apthorp Lodge DS0000051441.V354265.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. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Apthorp Lodge is a purpose built service and overall provides a comfortable and safe environment for the people who live in the home. One flat needs to be brought up to the standard of the rest of 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.V354265.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. The only significant exception to this was the decoration and flooring in flat 10, where improvements are needed but no date is available for this work to take place. It was also observed that the paintwork in communal areas is in need of attention. 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. The premises were clean and tidy throughout. The laundry was appropriately equipped and suitable arrangements were in place for the washing of foul laundry. The kitchen was also appropriately equipped and a new dishwasher has been provided since the last inspection. There were a couple of areas where there were unpleasant odours. In one area the carpet was being steam cleaned and in another area the manager explained the carpet is being replaced. Apthorp Lodge DS0000051441.V354265.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. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are looked after by staff who are trained and committed to meeting their needs. The number of staff vacancies whilst being addressed is still a cause for concern as it results in the ongoing use of agency staff who may not know the residents well. EVIDENCE: I looked at the staff rotas, spent time on four flats, spoke to staff and relatives and noted the comments in the surveys 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 540 vacant care staff hours, which is an improvement of 95 hours from the last inspection. A recruitment campaign has taken place and 299 of these hours have been offered to applicants and recruitment checks are now taking place. Large numbers of agency hours had still been used in the last four weeks ranging from 600 to 350 hours a week, but again was an improvement from the last inspection. The manager explained that whilst new staff have come into post a number of staff have also left and so the overall gain in permanent staff has remained low. A Apthorp Lodge DS0000051441.V354265.R01.S.doc Version 5.2 Page 22 number of recruitment days had taken place and senior managers are interviewing more staff later in the week to support the home managers with the ongoing task of recruitment. The use of agency or inexperienced care staff is clearly the issue of greatest concern to relatives, residents and staff as was shown in a number of the surveys. One resident said, “the staff who are real carers and experienced are very good and fine but I do not agree with the unqualified agency staff who are a waste of money”. Since the last inspection the shift system had been altered and there are now two staff working in all the flats in the afternoon. The self-assessment completed by the home showed that over 50 of the staff have completed the NVQ in care. I looked at the recruitment checks for four new members of staff. They all had an application form, two written references, ID and a CRB check. All the staff had completed and signed contracts of employment. I looked at the training records for the whole staff team. They have recently been collated and still need to include details of some of the training that took place within the last two years so there is an accurate assessment of the staff teams training needs. The home had not yet received the corporate training programme for next year in order to start applying for staff to attend the training. The manager had however arranged some local mandatory training and worked with the local PCT to plan specialist training. It was however recognised that since the last inspection a significant amount of training had taken place in the home and several of the staff surveys said the training was very good. Apthorp Lodge DS0000051441.V354265.R01.S.doc Version 5.2 Page 23 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 31,32,33,36 and 38 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in this home benefit from the service being well managed. They also have an opportunity to contribute their point of view through the quality assurance process. Health and safety measures are in place. Staff supervision still needs to take place regularly to maintain standards of staff performance. EVIDENCE: The registered manager has extensive skills and experience and is working towards the NVQ level 4. Apthorp Lodge DS0000051441.V354265.R01.S.doc Version 5.2 Page 24 The manager during the inspection demonstrated an excellent knowledge of all aspects of the service she manages and was observed to be very organised and able to give clear direction to the staff team. A couple of the staff surveys said they did not feel the manager was very supportive, whilst others said there was good team working and effective communication in the home. It was observed that there is a clear management structure in the home and that this is very necessary as the manager cannot be expected in a service of that size to be available to all the staff. I looked at the quality assurance exercise that had just been completed in August 2007. 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. The results and comments received had been collated into an action plan. This exercise takes place on an annual basis. In addition monthly regulation 26 visits by senior managers take place to monitor the home. I looked at the record of supervisions for the whole staff team. Whilst the number of supervisions has increased since the last inspection, these are still not taking place regularly, especially for the senior carers. Since the previous inspection the fire safety risk assessment had been completed and two fire drills had taken place during the day and the night. The maintenance certificates for the electrical installations, lifts, hoists, gas, portable electrical appliances and water system check for legionnaires were all in place as confirmed in the homes self assessment. The staff training records for health and safety were inspected. The food hygiene and infection control training that was identified as being needed at the last inspection had now been booked. The staff training records need to be completed to ensure outstanding health and safety training is identified and planned. Apthorp Lodge DS0000051441.V354265.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x 2 x 2 Apthorp Lodge DS0000051441.V354265.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 18(1)(c) Requirement Timescale for action 31/03/08 2. OP19 23(2)(b) 3. OP27 18(1)(b) 4. OP30 18(1)(c) The registered person must ensure that where senior staff attend training to support them to meet the specialist needs of the residents on topics such as diabetes, pressure care, Parkinsons, strokes and arthritis that this training is shared with other members of the staff team. The registered person must 31/03/08 ensure that flat 10 is redecorated and new flooring provided. The registered provider must 31/03/08 ensure permanent staff continue to come into post and the use of agency staff reduces. This requirement is amended and restated from the previous inspection. Previous timescale of the 30/06/07 was unmet. The registered person must 28/02/08 complete the training needs assessment for the whole staff team and ensure an ongoing training programme is in place to meet the identified training needs of the staff in the home. DS0000051441.V354265.R01.S.doc Version 5.2 Apthorp Lodge Page 27 5. OP36 18(2) 6. OP38 13(4) This requirement is amended and restated from the previous inspection. Previous timescale of the 31/07/07 was unmet. The registered person must ensure all the staff receive regular individual supervision. This requirement is amended and restated from the previous inspection. Previous timescale of the 15/08/07 was unmet. The registered person must ensure all the staff have up to date health and safety training including fire safety and that seniors have current first aid training. 28/02/08 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP9 OP12 Good Practice Recommendations The registered person should review the risk assessment and care plan for the resident on the learning disability unit to address his changing and complex needs. The registered person should ensure that there are clear directions for the administration of creams and that each persons medication profile is up to date. The registered person should provide activities specifically designed to meet the needs of people with dementia. Apthorp Lodge DS0000051441.V354265.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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.V354265.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!