Care Home: Apple Court Care Home

What the care home does well Apple Court provides a safe environment for older people with a range of facilities for residents. There is a well maintained environment with all residents having single en suite accommodation. All areas were cleaned to a good standard. The health and safety of residents and staff is maintained by equipment to aid mobility and health being provided. Prospective residents have a full assessment prior to moving in. Residents are helped and encouraged to maintain contact with friends and family and visitors are welcome at any reasonable time. The staff are friendly and approachable. Care is of a good standard and relatives` and health and social care professionals` comments support this. What has improved since the last inspection? The recruitment of staff had improved so residents were protected from harm.The testing of fire equipment had improved so residents and staff were protected from the risk of fire. The level of staff with NVQ level 2 qualifications had improved so residents received care and support from a skilled workforce. What the care home could do better: Residents support plans should contain more personal information about residents` decisions, choices and routines around health and social care so they reflect individualised person centred care. Residents lifestyle and recreational choices should be detailed in their care plans so activities are structured around their wishes, promote their independence and meet their expectations so residents participate in activities appropriate to their needs. The living environment should be changed to assist residents to recognise where they live so they remain independent and can find facilities appropriate to their needs. The numbers and deployment of staff should be reviewed so staff are available to promote residents` independence, offer them flexibility around their lifestyle choices and provide care based on residents` routines so residents receive individualised person centred care. CARE HOMES FOR OLDER PEOPLE Apple Court Care Home Apple Court Mental Nursing Home 76 Church Street Warrington Cheshire WA1 2TH Lead Inspector Anthony Cliffe Key Unannounced Inspection 09:30 18 and 19th December 2007 th 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 Apple Court Care Home DS0000046209.V348257.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. Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Apple Court Care Home Address Apple Court Mental Nursing Home 76 Church Street Warrington Cheshire WA1 2TH 01925 240245 01925 240123 applecourt@hallmarkhealthcare.co.uk 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) Hallmark Healthcare (Warrington) Limited Mrs Helen Sellars Care Home 67 Category(ies) of Dementia (67) registration, with number of places Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with Nursing - code N, to people of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Dementia over 55 years of age - Code DE The maximum number of people who can be accommodated is: 67 Date of last inspection 3rd October 2006 Brief Description of the Service: Apple Court is a 67-bedded care home providing nursing and personal care to older people diagnosed with dementia and is operated by Hallmark Healthcare. The home is located in Warrington town centre and is on a main bus route and close to all local amenities and facilities. The home is a purpose built twostorey building. Each floor has two living areas that have been combined to provide one larger living group and facilitate the support of a larger group of staff, with a minimum of two registered nurses on duty at any one time. Each floor has two lounges, two dining rooms and recreational areas. Each resident had their own single bedroom with en-suite facilities. Fees range from £513 to £700 per week. Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on the 18th and 19th of December 2007 and lasted fourteen and half hours. A Regulatory Inspector carried out the visit. Someone who had experience of using a social care service ‘an expert by experience assisted the inspector for part of the site visit’. The expert by experience was an independent member of the public used by the CSCI to get first hand experience of living in a care home by spending time with residents for a couple of hours during a regular part of the day. This visit was just one part of the inspection. Other information received was also looked at. Before the visit the home manager was also asked to complete a questionnaire to provide up to date information about services provided. Questionnaires were provided for residents, families, and health and social care professionals to find out their views. During the visit various records and the premises were looked at. A number of residents, staff and visitors were also spoken with and they gave their views about the service. What the service does well: What has improved since the last inspection? The recruitment of staff had improved so residents were protected from harm. Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 6 The testing of fire equipment had improved so residents and staff were protected from the risk of fire. The level of staff with NVQ level 2 qualifications had improved so residents received care and support from a skilled workforce. 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. Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 7 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 Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 8 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available for residents and their representatives so they can make a choice about where they live. Residents’ needs are assessed prior to moving in so appropriate care can be provided to them. EVIDENCE: Apple Court accommodates mainly people from Warrington and is welcoming to anyone from outside the area or with a disability, different ethnic or cultural needs or sexual orientation. Residents where possible or their relatives were provided with a copy of the service users’ guide and statement of purpose on request and copies of this and the most recent inspection report were available. Service user guides were not put in each bedroom. Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 9 The statement of purpose was not available in large print or different formats but the manager said this could be done on request. The manager said copies of the statement of purpose were sent out routinely with a welcome pack giving details on the facilities available. Though two of the three residents’ survey forms returned prior to the site visit said information had not been received or a contract in place. The other survey said information had been provided and a contract in place. When looking at financial arrangements there was information that residents were buying scented sprays for their bedrooms and facial wipes to wash their face and hands. The manager said that flannels were provided and rooms cleaned and scented sprays used but the additional sprays were at the request of relatives for ‘odour control’. The manager agreed to amend the service users’ guide so residents and relatives were clear that room sprays and facial wipes were available for purchase and not in addition to payments for care and services. Records were examined of two residents who recently moved into Apple Court. The manager or deputy manager had assessed the residents and gathered information on them but the person that completed them did not sign some of the forms used to gather information. Appropriate care plans and risk assessments were in place for one resident and the other resident had just moved in and these were being written. Additional information had been obtained from the local council social services department or NHS service involved with the residents’ care, which arranged for the residents to live at Apple Court. Details of residents’ life histories were completed on both residents and contained within their care plans. Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Completed records of care, liaison with health and social care professionals and good medicine management is consistent so residents’ health and welfare needs are met. EVIDENCE: The personal files of four residents were examined. Each care plan had a pre admission assessment and an assessment completed by staff from Apple Court and additional information from social workers or NHS services involved in their care. From looking at surveys received from residents, relatives and health and social care professionals. Reading residents’ care plans, observing staff working practices and talking with residents, staff and visitors, residents’ needs were met. There were good examples of care plans in place that monitored residents’ health. Care plans were in place to monitor eating and drinking, risk of developing pressure ulcers and assistance with personal care. Care plans described how to approach and communicate with residents. Each residents’ care plan had information about their physical and mental health needs. These generally identified residents’ needs and contained Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 11 guidance for staff to follow on providing support, help and care to them. There were good examples of appropriate care being provided. A resident that had a large pressure ulcer had been treated for this and it had healed. Records referred to contact with a tissue viability specialist who had reviewed the wound. The care plan for this demonstrated it was dressed regularly and tested for infection and it had nearly healed. Though residents support plans were informative they were not written from the residents’ perspective of their care or recorded how residents wished to be cared for. They reflected person centred thinking but did not use a person centred plan reflecting residents’ lifestyle choices and promoting their dignity, choice and independence. They were very task orientated in how staff were to provide residents with help and support. For example a resident’s care plan to assist his social and personal care contained limited information around his routines and preferences but did not reflect personal preferences. There was information on his preferred name and that staff were to encourage him to make decisions but no information about how he wished his care to be arranged. Another resident’s care plan for communicating used quite long jargon, which the resident or a relative might not understand. The plan was positive in how staff was to communicate with the resident did not describe her methods of communication or understanding. Some residents’ health had deteriorated and a General Practitioner saw them. If they were not expected to recover they were placed on the Liverpool Care Pathway for end of life care. Agreements were sought with their family about the care of their relative. A visitor confirmed she did not want her relative to be moved form Apple Court to an NHS hospital if her health deteriorated and said, “things could not be any better with her care it’s wonderful and always has been. The staff are great and mum and I wouldn’t want her to be anywhere else. I have always requested she is not taken to hospital and I have written this after talking with the doctor”. Two General Practitioners and a General Practitioners’ surgery returned health professional survey forms prior to the site visit. They said that staff always or usually sought advice and acted upon it. A General practitioner said in a survey that Apple Court, ‘worked through the nursing liaison service to inform the practice of patients’ needs and also the concerns of the family. Apple Court offer good care and seek medical advice when appropriate’. Medicines management and administration was examined. The home continued to use a monitored dosage system to manage residents’ medicines. No residents at Apple Court managed their own medicines. Minor errors were noted on medicine administration records. Stocks of medicines were replaced monthly. Receipts of supplied medicines were recorded. Where medicines were supplied in original packages and not supplied each month the stocks of these were transferred from one month to the next so staff knew when to reorder Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 12 medicines. Records were maintained for the destruction of medicines. Controlled drugs records were checked on one unit and no errors found. The manager and deputy manager audited medicines as part of the quality assurance system. Where as required medicines were used for medicines prescribed to treat conditions arising as a result of mental health. The home did not routinely use a plan to monitor when and why as required medicines were being used and in what circumstances they were being used or what the maximum times in 24 hours they could be used. The manager gave assurances that this mater would be addressed. Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are not sufficiently supported in making choices about their lifestyle and activities could be more individualised to match residents’ expectations and preferences so they are encouraged to be more independent have more choice and control over their lives. EVIDENCE: White dry wipe boards in the dining rooms displayed information about the menu, staff on duty and day and date to provide residents with information. Apple Court is a member of the National Association of Provision of Activities for older people. There was a full time activities coordinator employed whose hours had only recently been increased when the other activities coordinator left. A quarterly newsletter for residents and visitors was produced with information about planned and forthcoming events. The activities organiser said her main enjoyment was working on a 1 to 1 or in small groups with residents. She said she found motivating some residents difficult and others were very good. She said she found difficulty dealing with the memory difficulties and concentration levels of residents when doing activities. Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 14 She said she had the National Association of Providers of Activities (NAPA) guidance on activities but had not read it. She said she also had a DVD to watch on what appropriate activities to do from the manager and this was produced by NAPA but she had not watched it. She said the manager was very supportive and keen to help her develop. She said the company had regular meetings between the activities organisers to share ideas but she had not been to one of the meetings yet. She said that she felt staff was very supportive of her but as she was employed as the activities organiser they expected her to do all the activities. Her weekly planned events included arts and crafts, board games, exercise, beauty therapy and baking. She said, “When I’m not doing things residents will be sat around sleeping. I see residents sleeping a lot. Residents will have time when staff will sit and talk to them but they don’t do beauty therapy or hand massage with them”. She said she was keen to develop and there was always monies and materials to do activities available. The expert by experience chatted to residents and said some of them could not remember taking part in activities but seemed content. She spoke to the activities coordinator who assured her activities were available but most of the residents refuse to take part or cannot remember if they had. One resident said he liked to watch television in his bedroom but his seat was so far away it was difficult to see the TV. This was brought to the attention of staff. A cheese and wine party had been held recently and a small group had been taken out the previous week, but the residents involved couldn’t remember going out. Preparations for a Christmas party were going on during the day of the site visit. Entertainers were booked and relatives and friends had been invited. In walking around the units and observing staff practice staff would be sat in the communal lounges talking with one or two residents. The majority of other resident were sleeping for quite long periods and there was not always other members of staff around that sat and talked with residents. Staff seemed busy helping other residents with personal care. During mid morning and mid afternoon no activities were seen on the units. Staff was on breaks and again one member of staff was sat in the communal lounge. If more than one staff member was sat they talked to residents but the others mainly slept. The television was on in all the units and when speaking to a relative she said that residents were brainwashed with the television as it was on all the time. She said, “ I have been visiting for four years and see new residents who are able to care for themselves and are independent but because staff don’t have the time to spend keeping them independent and doing things for themselves they deteriorate very quickly. I don’t see staff doing things or activities taking place that keeps people fit and mentally active”. Another relative said that her mother had moved from another home where there were activities going on all day but she did not see activities provided to Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 15 the same level at Apple Court. Another visitor said that more could be done to keep people independent and relatives’ surveys made similar comments. Relatives said they felt welcomed, supported and received a warm welcome. Relatives said they were involved in their relatives care. Relatives said that residents’ personal care needs were generally cared for. The expert by experience shared a meal with residents and had lunch with a small group of residents and said it was reasonable. There was a choice of sausage mash peas and gravy or fish fingers and chips followed by jelly and ice cream. Two members of staff gave those residents that were unable to eat by themselves help. She said large portions were served and there was a choice offered. Residents didn’t remember what they had chosen so staff reminded them of the choice available. She didn’t see residents offered the choice of washing their hands before or after their meal. A relatives survey said the satellite kitchens on the units were not cleaned but this was not seen during the site visit. However a staff member assisting a resident to clean up was not observed to wash their hands and use the same cloth to wipe the floor and resident’s hands. These matters were brought to the attention of the manager. A relative said that some residents’ meals were left to go cold because they needed reminding or encouragement with eating. This was due to staff being busy assisting other residents with their meals and by the time they received help their meals were cold. This was not seen during the site visit but dining rooms seemed cluttered and busy. Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and concerns were acted on so they were taken seriously. The staff group understood safeguarding procedures so residents were protected from abuse. EVIDENCE: There were two recorded complaints since the last site visit. These had been investigated using the Hallmark complaints procedure. There were detailed records demonstrating a full investigation of the concerns raised. The complainants were involved throughout the complaints process. The manager used a variety of methods to assist the complainants to confirm their concerns and the complaints could be substantiated and were acknowledged. The manager had referred a number of concerns to the local council under the vulnerable adults procedure. The manager had cooperated with the local council, police and CSCI into the investigation of these concerns. Staff was suspended pending investigation of the allegations. The Hallmark induction programme for new staff included training in awareness of indicators of adult abuse but the records of two recently employed staff did not confirm they had completed this. The manager said that training records were not up to date and demonstrated that staff had completed the training by use of E learning. Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a well maintained home, which is clean and hygienic and so safe to live in. EVIDENCE: All communal areas and some bedrooms were seen. In the ground floor corridors the carpets and low level lighting give a sense of being closed in. Signage on all the units for residents to recognise their bedrooms was poor. Corridors were not colour coded to help residents recognise the different areas of the building. The expert by experience also said that signage on residents’ bedrooms was poor and some bedrooms had only the number on and a few had the residents’ names on. She said that bathrooms and toilet doors were indistinguishable from bedroom doors. Dinning rooms seemed cluttered at mealtimes with space a premium. In the corridors the borders and wallpaper had been ripped of the wall and not repaired. Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 18 Bedrooms were personalised with items of the occupants’ furniture, electrical equipment and family photographs. The interior and exterior of the building was otherwise maintained to a good standard. Outside a sensory garden had been created. Residents and relatives surveys said the home was always clean but the satellite kitchens were identified as needing regular attention especially replacement of bins to provide ones without swing lids. The home was clean and free from odours during the site visit. Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff are adequate to meet residents’ needs but staff deployment needs to improve so residents’ independence is encouraged and promoted and they retain their ability to make choices and determine their care. EVIDENCE: During the site visit it was noted that residents were left unsupervised in communal lounges. In walking around the units and observing staff practice staff would be sat in the communal lounges talking with one or two residents. The majority of other resident were sleeping for quite long periods and there was not always other members of staff around that sat and talked with them. Staff seemed busy helping other residents with personal care. During mid morning and mid afternoon Staff were on breaks and again one member of staff was sat in the communal lounge. Comments received from the expert by experience were that residents were seen sleeping throughout the duration of her visit. Relatives commented that care staff was not routinely seen promoting residents opportunities to be independent and exercise choice. However staff was praised for their skills in communicating with residents especially in maintaining eye contact when talking to them, holding their hands when sitting with them and talking and anticipating their needs and offering assistance with personal care. Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 20 The home had accessed through the local council an organisation called Migrant Workers Northwest. This organisation works with employers to ensure that staff that did not originate from outside the UK had access to training. For staff at Apple Court this may help support staff that are qualified nurses that are not registered with the Nursing and Midwifery Council to register to practice within the United Kingdom. The manager provided information on the number of staff that held NVQ qualifications both on the Annual Quality Assurance Assessment and during the site visit. Thirty-five care staff was employed and twenty-three had an NVQ level 2 qualification and three were undertaking NVQ level 2 qualifications. Staff recruitment records for six new staff were examined. Records confirmed that all appropriate documentation was in place including a Criminal Records Bureau Check (CRB) and POVA First check was completed. Staff had the required references but two staff had supplied referees that had supplied to ‘whom it may concern’ references and the referees where different form those on their application form. The administrator said these were additional references when referees had not responded to requests to supply a reference from a previous employer. Details of staff training were provided during the site visit. Recently appointed staff had completed induction training through E learning. This was also used for staff to update their mandatory training. Staff had completed training in fire awareness, moving and handling, Control of Substances Hazardous to Health (CoSHH), abuse awareness, infection control, food hygiene, health and safety and first aid. All staff completed fire training in August 2007. The home used a training matrix to record all staff training that had taken place. The manager said this was not up to date. Two recently appointed staff had no abuse awareness training on record, which the manager said reflected that records had not been updated. Only five of a staff group of over forty registered nurses and care assistants had completed training in dementia care in 2007. The manager had purchased a training package for dementia care based on NVQ level national occupational standards called ‘Understanding Dementia’. This had not yet been introduced. The ‘L Box’ was the E learning package used by the provider for all induction and mandatory training. The induction training included health and safety, abuse awareness, CoSHH, infection control, first aid, food hygiene, risk assessment and fire. It covered the Skills for Care induction standards. The manager confirmed the ‘L box’ reminded staff when repeated mandatory training was due. Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 21 Two staff were qualified moving and handling facilitators. The deputy manager was completing the NVQ 4 registered managers’ award and a registered nurse was doing an NVQ level 4 qualification. Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Quality assurance systems that monitor the overall management of Apple Court are completed so residents’ welfare is promoted and they are protected. EVIDENCE: The home manager has been in post for almost two years. She was a registered mental nurse and held the registered manager award. A deputy manager had been appointed who was a registered mental nurse. A full time administrator supported the management team. The manager was seen as being important to the running of Apple Court. The home achieved the Investor’s In People award in September 2007. Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 23 Since the last site visit the number of complaints and safeguarding adults’ referrals had reduced. The manager had achieved registration as manager in January 2007. The manager was open about matters that were found during the site visit in relation to the provision of activities and staff deployment. She said Apple Court had moved in the right direction since the last site visit and now had a settled staff team that were more confident. She said staff provided a high level of care but the challenge was to challenge the culture that existed at Apple Court. She said that staff was task orientated in their approach and needed to promote residents’ independence and choice and lessen the impact of dementia upon them. She said the challenge was to help residents maintain their abilities and levels of personal skill to care for themselves. She said this would mean a change in how the staff team worked and would be achieved through training and support from the management team and Hallmark Healthcare. Relatives’ surveys and relatives present during the site visit said the manager listened to concerns and responded to them. The manager and staff team were described as supportive and good at keeping relatives informed about the care of residents. There was an established quality assurance process in place with monitoring of records and staff practice by the management team. The manager completed monthly audits of the internal quality assurance systems at Apple Court and the Operations Director of Hallmark Healthcare verified this. A number of quality assurance audits were completed as part of the providers’ quality assurance system. For example a health and safety audit had commenced In October 2006 and this was reviewed again in March 2007 and repeated again in October 2007. As a result of the audits advice was given throughout the year. For example the need for an emergency contingency plan to be developed in case of a major emergency. Quality assurance audits continued throughout the year and covered matters such as fire safety, health and safety of the building, including the kitchen and laundry. These were complimented by audits completed by the manager and deputy and included audits of residents; records, medicine administration, accidents and incidents. Medicine administration was audited weekly by staff on the units and each month the manager or deputy checked these as part of a larger audit. Hallmark Healthcare sent out satisfaction surveys to relatives annually. In 2007 fifteen questionnaires were sent to relatives of residents. All fifteen were returned and the finings published. Apple Court was seen as providing good/excellent care by ten relatives. Twelve of the fifteen said that residents were treated with respect. Eleven said that they were involved in residents care and this was good/excellent. Seven said activities were good/excellent and five said average/poor. Fourteen said they always felt welcomed and this was good/excellent. Eleven said menus were good/excellent. Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 24 No personal monies other than personal allowances were held on behalf of residents. Relatives were billed directly for additional services such as chiropody or hairdressing. Residents’ personal allowances were safely secured and records for credits and debits maintained. Information provided by the provider in the Annual Quality Assurance assessment and records held on site were examined. All the required maintenance and health and safety checks of the building and equipment had been completed. Apple Court Care Home DS0000046209.V348257.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 X X N/A 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 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Residents support plans should contain more personal information about residents’ decisions, choices and routines around health and social care so they reflect individualised person centred care. Residents lifestyle and recreational choices should be detailed in their care plans so activities are structured around their wishes, promote their independence and meet their expectations so residents participate in activities appropriate to their needs. The living environment should be changed to assist residents to recognise where they live so they remain independent and can find facilities appropriate to their needs The numbers and deployment of staff should be reviewed so staff are available to promote residents’ independence, offer them flexibility around their lifestyle choices and provide care based on residents’ routines so residents receive individualised person centred care. 2. OP12 OP14 3. OP19 4. OP27 Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Apple Court Care Home DS0000046209.V348257.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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