Care Home: Appleby Care Home

What the care home does well There are good links with health professionals and care plans are implemented for short term health issues. The meals served were good and people said they enjoyed the food, which was wellcooked. Staff support was on hand. The tables were nicely set and lunch was seen as a social occasion. Hot and cold drinks were readily available. The cook is part of the staff team and was available to residents for comments and requests. They had good knowledge of the individual dietary needs of residents and of the nutritional needs of older people. The service provides good support to enable some residents to enjoy a range of social activities. The home was clean, comfortable and homely with good evidence of personalisation. What the care home could do better: Ensure that all information relating to individuals care is current, kept under review and recorded in full, to ensure that peoples holistic needs are met. Ensure that residents and their representatives are involved in the implementation and review of their plans. This will help plans to be more person centred. Ensure that people who have specialised health care needs have access to appropriate care and treatment and equipment that is used correctly. Ensure that all residents are given the opportunity for meaningful social activities and choice in their daily routines. This will improve their health and wellbeing. Ensure that all residents have a pleasant dining experience and receive sufficient staff support at all mealtimes. Make sure that suitably trained and supervised staff are available in sufficient numbers to meet the full needs of people living at the home. Have in place a programme of cleaning for all areas of the home to ensure that the home is free from mal odours at all times. Random inspection report Care homes for older people Name: Address: Appleby Care Home Military Road North Shields Tyne And Wear NE30 2AB two star good service 01/07/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Mary Blake Date: 2 4 0 6 2 0 1 0 Information about the care home Name of care home: Address: Appleby Care Home Military Road North Shields Tyne And Wear NE30 2AB 01912579444 01912708226 Appleby@schealthcare.co.uk www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ashbourne (Eton) Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 55 Number of places (if applicable): Under 65 Over 65 0 dementia Conditions of registration: 55 The maximum number of service users who can be accommodated is 55. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Dementia Code DE, maximum number of places: 55 Date of last inspection Brief description of the care home Appleby is a 55 bed care home with nursing. It provides care for older people with enduring mental health problems. The home is owned and managed by Southern Cross Healthcare Limited a large national provider of services for vulnerable client groups. Care in the home is provided by Registered Nurses supported by care staff. The home Care Homes for Older People Page 2 of 11 0 1 0 7 2 0 0 9 Brief description of the care home is situated in North Shields in North Tyneside close to local shops and good public transport links. The building is comprised of two floors with 55 single bedrooms all with en-suite facilities. Each floor has separate lounge, dining areas, bathrooms and additional toilet facilities. The home also has a kitchen and laundry room. There is a garden and patio area to the rear of the home. Information about the homes services, philosophy of care, service brochures and Inspection reports are displayed in the homes entrance area. Care Homes for Older People Page 3 of 11 What we found: The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. The quality rating of the home was not under review at this inspection. We have reviewed our practice when making requirements. Some requirements from previous inspection reports may have been deleted or carried forward to this report as recommendations. This will only happen when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The last key unannounced inspection of the home was in July 2009. This inspection was carried out to ensure that the service had met the requirements/recommendations set at that inspection. Before the visit we looked at information we received since the last visit to the home. This includes how the service dealt with any complaints, changes to how the home is run, the views of people who use the service and the managers views of how well they care for people. During the visit we talked with people who use the service, some staff and the acting manager. We focused mostly on the personal and health care of people who use the service and checked staffs understanding of the care required by the people living in the home. We also looked at the previous requirements and recommendations to see if these had been met. The home is currently occupied with 45 residents. We looked at the records relating to the most recent admission to the home from hospital. Assessments of those people returning to the home after a period in hospital were being carried out to make sure that they could meet their needs on their return and a full assessment was carried out on admission back to the home. The pre-admission information had been transferred into the care plans which contained sufficient information to ensure that the home could meet the overall needs of the resident. We looked at some of the occupied bedrooms and communal areas. The majority of residents were up and about. Some were in the lounge area and others were in their rooms. The residents generally looked well, clean and comfortable. Four care plans were examined and two were case tracked. This means that we spoke to the individual residents or observed their care and then matched our observations to what was written in the care plan. Care Homes for Older People Page 4 of 11 When we examined the care plans we found the plan identified a range of areas requiring support and the plans were based on the daily activities of life. Nutritional risk assessments were in place and residents had nutritional care plans. Monthly nutritional risk assessment evaluations were completed but not consistently and we found that fluid/food intake charts were inadequately detailed and failed to provide a clear picture of exactly what and how much residents had eaten. In addition weight recordings were inconsistent. Fluid balance records were not consistently completed. Peoples nutritional needs were monitored and records for individuals who had been identified as being nutritionally at risk were in place. Although staff were entering the information of people intake, they were not always completed in sufficient detail to show that they were receiving enough fluid over the period of the day. We saw pressure ulcer risk assessments were reviewed monthly and that care plans were adequately detailed with regular evaluations undertaken for these problems. The staff had managed residents pressure damage with good support from the Tissue Viability Nurse. The care plan identified a range of areas requiring support and the care plans were based on the daily activities of life. Whilst there were details within the care plan around residents mental health needs, there was insufficient information about dementia needs. We examined four sets of resident plans and found that the quality of recording was variable and there were some areas that were inadequate and incomplete. The recorded information was inconsistent. There was inadequate emphasis on residents strengths and abilities and what staff should do to maintain these and very little on the social or spiritual needs of residents. There was very little involvement of the residents and their relatives. Physical and mental health needs were addressed in care plans and records showed people living at the home access a range of health care health care professionals. The local gp visits weekly and has rounds/clinic to address individual concerns and changes. Moving and handling practices observed were appropriate and staff assisted to provide a safe transfer, hoists were used as necessary. There was good evidence of social activities happening in some of the home. We observed some flexible routines such as people choosing to get up later and being offered breakfast and medication throughout the morning. Personal choices and support with making decisions was offered to some extent however some limitations are placed on this when there are reduced numbers of staff or when the staff are from another home or agency and they are unfamiliar with the people living in the home or staff who have limited communication skills. The meals served were good and people said they enjoyed the food, which was well cooked. Staff support was on hand. The tables were nicely set and lunch was seen as a social occasion. Hot and cold drinks were readily available. The cook is part of the staff Care Homes for Older People Page 5 of 11 team and was available to residents for comments and requests. They had good knowledge of the individual dietary needs of residents and of the nutritional needs of older people. Those residents identified as needing additional fluids and observation of food intake appeared to be getting good support during the inspection. One to one assistance was given to these people but due to the distractions the staff did not always remain with the resident for them to complete the meal. Upstairs the tables were not well laid, limited cutlery, no condiments, napkins, some drinks available with good support for fluids. Staff were observed not to communicate clearly with residents and some had limited english. Residents were seen to get agitated and hit out at staff and other residents with minimal distraction or intervention by staff. Not all staff sat with residents and mealtimes were a lengthy disorganised event. The mealtime was not well organised for those people on the upper floor. Complaints and safeguarding issues had been appropriately managed. Records examined had evidence of a mental capacity assessment being carried out and a care plan to address restrictions relating to deprivation of liberty. There was an odour of urine on the first floor both on the corridor and in the bedrooms viewed. This floor mainly accommodates those people needing nursing care and more support than the other areas of the home which were odour free. Recruitment and selection records were looked at for two staff. The necessary checks were in place including proof of identity, application form, two written references a Criminal Record Bureau disclosure confirmation an interview checklist and necessary Southern Cross documentation to comply with the policies and procedures. The staffing levels at the time of the visit were satisfactory. The staffing training matrix indicated that the staff had not undertaken training in a number of areas this included infection control, POVA, nutrition and dementia. The home has a new manager who has been at the home for three weeks. He is an experienced manager, appeared competent and had good knowledge on the operation of the home and service users needs. There was a very detailed audit carried out by the company and an action plan has been developed from this. Accident overview, actions identified and implemented within care plans. A detailed audit carried out by the provider and an action plan was in place. The manger was aware of the content. The manager was aware of the issues during the feedback and although he was disappointed at the issues we found he was confident that he was able to address them as part of his management of the home. What the care home does well: There are good links with health professionals and care plans are implemented for short term health issues. The meals served were good and people said they enjoyed the food, which was well Care Homes for Older People Page 6 of 11 cooked. Staff support was on hand. The tables were nicely set and lunch was seen as a social occasion. Hot and cold drinks were readily available. The cook is part of the staff team and was available to residents for comments and requests. They had good knowledge of the individual dietary needs of residents and of the nutritional needs of older people. The service provides good support to enable some residents to enjoy a range of social activities. The home was clean, comfortable and homely with good evidence of personalisation. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Ensure that care plans are kept under review and where appropriate and, unless it is impracticable after consultation with the service user or his representative of his, revised to reflect service users changing health and welfare needs. This will ensure that service users and their representatives are fully aware and involved with the plan of their care 16/08/2010 2 8 12 Ensure residents are 16/08/2010 weighed, nutritional risk assessments are undertaken and that fluid and nutritional records are kept for those at risk This will ensure that accurate records are kept of residents weights and nutritional and fluid intake. Provide to CQC a programme of cleaning and 16/08/2010 3 19 16 Care Homes for Older People Page 9 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action refurbishment for the home to ensure that the home is free from malodours, clean and with suitable furnishings To ensure that residents live in an environment that is safe and comfortable. 4 28 18 Staff that have received 16/09/2010 appropriate training must be available in sufficient numbers to meet the needs of the residents living at the home at any time to provide skilled and trained staff to meet the needs 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 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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