Care Home: Appleby Court

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What the care home does well Most morning routines were flexible and positive, allowing the wishes and choices of individual residents to be respected. What the care home could do better: Better care records would help staff know residents` preferred night time routines and also help staff stop or reduce the chance of residents` becoming aggressive or agitated (and know how to help them if they do). Check night-time routines to make sure they help residents get a good, restful nights sleep. Random inspection report Care homes for older people Name: Address: Appleby Court Ellesmere Road Pemberton Wigan Lancashire WN5 9LA two star good service 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: Sarah Tomlinson Date: 2 6 0 6 2 0 0 9 Information about the care home Name of care home: Address: Appleby Court Ellesmere Road Pemberton Wigan Lancashire WN5 9LA 01942215000 01942215000 sheenathompson@cuerden.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Keith Lowe care home 80 Number of places (if applicable): Under 65 Over 65 0 80 0 mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 80 0 80 The registered person may provide the following category 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: Mental disorder, excluding learning disability or dementia - Code MD Physical disability - Code PD Old age, not falling within any other category - Code OP The maximum number of people who can be accommodated is: 80. Date of last inspection Care Homes for Older People Page 2 of 8 Brief description of the care home Appleby Court is a large private care home. It is registered with us (the Care Quality Commission) to provide nursing and personal (residential) care for up to 80 older people. Mr Keith Lowe owns the home, plus 3 others in the north west (2 in Wigan and 1 in Preston). Appleby Court is purpose built, on 2 floors, with a lift. It is divided into 4 separate units - Bluebell Walk (nursing) and Daisy Villas (residential) on the ground floor, and Orchid Mews (nursing) and Tulip Row (residential) on the first floor. There are 20 single bedrooms on each, all with en-suite toilets. Each unit also has its own lounge, dining room and bathrooms. The home is on a main road, with local shops nearby and bus routes into Wigan town centre. The entrance is at the rear, where there is a car park and a small outdoor seating/garden area. At the last main (key) inspection, fees ranged from £360.51 to £540.00 (hairdressing, dry cleaning and toiletries were extra). Care Homes for Older People Page 3 of 8 What we found: We did this random inspection because of a complaint about the morning routine in the home. The complainant told us residents were often woken up early for the convenience of staff, with night staff expected to help a certain number of residents get up (e.g. washed, dressed and then put back on their beds) before day staff started work. Our inspection visit, which the home was not told about beforehand, took place one morning (starting at 6.30am and finishing at 10.15am). It was carried out by one inspector. (References to we and our in this report mean the Care Quality Commission). During our visit we spoke with several residents and 9 of the 10 night staff on duty (plus the home manager when she came on duty later). We also visited and walked around the four units (all initially by 7.05am and then each again later), and looked at staff rotas and care records. We found no evidence of residents being woken early and being got up for staff convenience. On one unit (Tulip Row), 5 residents were up, dressed and sitting in the lounge, on another unit (Daisy Villas) two residents. On the remaining two units, one or two residents were also up and dressed, either walking around the unit or watching television in their bedrooms. On all four units, several further residents were in the process of getting up. We saw no evidence of residents being washed, dressed and then laid back on top of their beds. Some bedroom doors were left open during the night, due to residents preference or to manage a high risk of falling. This allowed us to discreetly observe these residents, who were all in bed and wearing night clothes. Staff explained all the residents who were up or getting up had woken early or had needed help with intimate personal care (e.g. they had been incontinent) and had wished to then get up. Staff did explain when some residents needed help with intimate personal care (after approximately 6am) they wanted to then wear their day clothes, whilst others would want to get dressed in clean night clothes and go back to bed. Staff confirmed if somebody wanted to get dressed in their day clothes they would be helped to then sit in the lounge or in an easy chair in their room. There was general confirmation from staff that they were under no pressure to get residents up, with residents allowed to wake naturally. However, we saw many bedroom curtains open on one unit (Orchid Mews) despite residents in these rooms being asleep (e.g. at 6.35am). Staff said they were told to do this. We advised this was unacceptable, as it was likely to disturb residents (causing them to wake). The manager agreed and said she would ensure this practice stopped. We also advised thicker, lined curtains should be considered, particularly for those residents with a broken sleep pattern. Care files contained a night care plan. We looked at 7 of these. A pre-printed, general form was used. Sections relevant to the resident were highlighted. There were occasional additional handwritten entries. We advised the night care plan should be reviewed, with Care Homes for Older People Page 4 of 8 more helpful information added. For example, whilst residents usual retiring times were written, there was no information about preferred rising times. The manager said this information used to be detailed. We advised this was restarted. We also advised if a resident is regularly restless or agitated during the night, there should be clear, helpful guidance for staff about how to provide support and help (e.g. what helps to calm and settle a person when they start calling out). The need to have this clear, personalised guidance for staff had been previously identified at the last main (key) inspection. Practical details about whether the resident preferred their bedroom door open or closed should also be consistently detailed. Plus other information that would be helpful for night staff, e.g. if the resident prefers a night light left on; window open; spectacles on their bedside table. We also looked at a care plan regarding verbal and physical aggression. We advised more information was needed to help and guide staff with this high risk issue, e.g. type of physical aggression; to whom (staff, other residents); frequency; when last occurred; any known triggers; and how to manage and minimise the residents distress. The manager had recently discussed morning routines with staff, confirming unless a resident expressed a clear wish to do so, night staff should not help residents to get up before 7am. Staff and meeting minutes confirmed this. A meeting between the manager and the team of 4 night nurses was also planned to discuss this further. Staff rotas confirmed adequate staffing levels during the night and day. Finally, we saw staff making drinks for residents who had woken early. For those who chose to get up particularly early, a light snack should also be considered as breakfast was not served until 9am/9.30am. What the care home does well: 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 5 of 8 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 12 (1) (a), 15 To ensure residents receive 30/06/2008 (1) the care they need, care records must include all relevant information (and be of sufficient detail to guide staff). Care Homes for Older People Page 6 of 8 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 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 1 2 7 7 Night time routines should be reviewed to ensure they benefit residents (helping them get a restful nights sleep). To guide staff and minimise the occurrence of aggression and agitation for residents, relevant care plans should contain more guidance and information (e.g. about possible triggers, behaviour patterns, frequency and helping strategies). To guide staff and ensure residents night time and early morning routines and preferences are known, night time care plans should contain more practical, personalised information (including usual prefered rising time). 3 14 Care Homes for Older People Page 7 of 8 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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