Care Home: Appleby Lodge

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What the care home does well The people who live at Appleby Lodge are very happy with the service they receive. They told us that the care, food and service provided was very good. No complaints were forthcoming. We found that the staff working at Appleby Lodge had been employed there for a number of years, and were very happy in their work. This means that staff and residents have got to know each other very well. People trust the staff and Manager. Appleby Lodge is well laid out and the lack of steps means that people are able to move freely around any part of the home and out into the garden. The house is clean and there are no unpleasant smells. The meals are well cooked from fresh ingredients, cakes are baked every day, and the smell of good cooking pervades the home. People enjoy the food. Most people feel that they have enough to do; there are some planned activities. Some of the people at Appleby Lodge also enjoy the bar that is the corner of the lounge, and they are happy to stay up late with a drink watching special events such as football matches on the TV. People get up and go to bed when they please. The home is well managed and people feel confident in being able to raise concerns with the Manager or staff. There are sufficient staff who have received regular updates in their training. What has improved since the last inspection? The last inspection report listed eight statutory requirements. It is pleasing to note that all of these have now been complied with. One new resident has moved into the home and evidence of pre-admission assessment was evident. Care plans have been updated and a new system put in place. New medication storage facilities have been purchased and these now comply with requirements. The administration of medication has also been reviewed and improved. A complete new fire detection system has been installed as detailed in this report. These improvements show a willingness on behalf of management to comply with requirements and improve standards. What the care home could do better: We have made the following recommendations as a result of this inspection. Regulation 26 reports compiled by the Registered Providers should be available for inspection in the home. We recommend that all records pertaining to an individual, resident or staff member, are, where possible ,kept in a single master file. The temperature of hot water at outlets in bedrooms should be risk assessed and automatic control valves fitted if deemed necessary. Key inspection report Care homes for older people Name: Address: Appleby Lodge 157 Launceston Road Kelly Bray Callington Cornwall PL17 8DU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michael Dennis     Date: 2 3 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Appleby Lodge 157 Launceston Road Kelly Bray Callington Cornwall PL17 8DU 01579383979 01579383108 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Appleby Rest Homes Limited care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Appleby Lodge offers accommodation and personal care for eighteen older people. The single storey, purpose built home is situated in Kelly Bray, one mile away from the town of Callington. It is reached via a driveway that leads off from the main road. Car parking is available at the end of the driveway. A public house, post office, shop and Methodist Chapel are all within easy reach. The accommodation comprises of 18 single bedrooms, 2 bathrooms, 5 separate WCs, an office, a well-equipped kitchen, an outside laundry area and a lounge/dining room with access to the patio and large wellkept garden via French doors. The garden is wheelchair accessible. The home has a no smoking policy. A variety of activities are offered to the service users and visitors are encouraged with no restrictions on visiting times. Appleby Lodge is fully wheelchair accessible. Copies of information about the home (the Statement of Purpose and Service User Guide) are available from the office. The fees for the home are 364.50 to 378.50, this fee does not include personal items such as toiletries, clothes, Care Homes for Older People Page 4 of 25 Over 65 18 0 Brief description of the care home chiropody, or hairdressing. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was unannounced and included a visit to Appleby Lodge. The visit took place on 23rd June 2009 between 9.20am and 3.30 pm. As part of this visit we looked around the home, talked with people who lived in the home, and looked at the care provided to three of the people. We looked at records of care and observed medication practices. We also looked at staff records and other records relating to safety. We spoke with a number of the care staff and spoke with the cook. The Manager, Jan Rider, was in the home during this inspection. We also considered the information supplied in the Annual Quality Assurance Assessment document which was returned to us. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: We have made the following recommendations as a result of this inspection. Regulation 26 reports compiled by the Registered Providers should be available for inspection in the home. We recommend that all records pertaining to an individual, resident or staff member, are, where possible ,kept in a single master file. The temperature of hot water at outlets in bedrooms should be risk assessed and Care Homes for Older People Page 7 of 25 automatic control valves fitted if deemed necessary. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with the information they need. Prospective residents care needs are assessed prior to admission. Evidence: The manager visits prospective residents and completes a needs assessment. A standard format for assessment and care planning is now used. When completed in sufficient detail, this record covers the assessment issues specified in the standard and the diverse needs of prospective residents. The residents records case tracked, for the one new admission, contained completed and comprehensive needs assessments. The homes staff carry out an assessment for both private purchasers and those commissioned by the local authority. The homes assessments state who was present at the assessment. They are dated and signed. Prospective service users and their relatives are issued with the Statement of Purpose and Service User Guide prior to admission. These documents contain all relevant Care Homes for Older People Page 10 of 25 Evidence: information as required by the standard and enable people to make an informed decision about the home before committing to it. Recorded evidence indicated that that people have visited the home prior to making the decision to take up residency. All persons living at the home have been issued with contracts or statements of terms and conditions. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have a plan of care. Residents have access to other healthcare professionals. Medicines are being administered in adherence to pharmaceutical guidelines. Residents are treated with respect and their privacy is upheld. Evidence: There has been a marked improvement in the quality of the care plans, which now provide clear instruction to care staff as to the interventions needed to meet the care needs and capabilities of the residents. All of the care plans case tracked complied with the National Minimum Standards. There was evidence to indicate that these plans are reviewed at regular intervals. They are signed and dated and the majority include who was present or consulted at the time of inception. The care documentation and discussions with staff and residents confirm that external health professionals are used and available. Each resident is registered with a GP, and has access to specialist services. Significant improvement is noted with regard to all aspects of medication practices. Care Homes for Older People Page 12 of 25 Evidence: The administration of medication was seen to be appropriately conducted with suitable records kept. An audit of the Controlled Drugs proved correct. Storage and the prompt return of unwanted drugs has also improved. Residents were observed to be treated with respect when staff interacted with them. Staff were seen to knock before entering residents rooms, and the residents spoken with confirmed that staff are respectful of their privacy. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people at Appleby lodge are treated with respect, feel valued and enjoy the company of staff and other people at the home. Meals are well cooked, from fresh ingredients. Relatives and visitors are welcome, and kept well informed of things they need to know about. Evidence: Many of the people at Appleby Lodge maintain a degree of independence and it was apparent that many of the residents were friends and able to share activities and interests. People visited each other, and initiated activities. There is a bar in the corner of the lounge and we were told that people enjoy a drink and snack whilst they watch TV together. Residents told us that there were no rules, and it was clear from the banter that took place between people that this was a home where people enjoyed each others company. On the day of the inspection someone visited the home to Facilitate a sing along session, and we were told that other activity sessions were planned, as well as a trip out. The homes documentation and discussions with staff and residents confirm that Care Homes for Older People Page 14 of 25 Evidence: visiting is open and unrestricted We met with the cook and saw that all food in the home is cooked fresh each day. At lunchtime the plates that went back to the kitchen were all empty. Staff also said that they ate and enjoyed the same food as the residents. There is information about what each person does and does not like, and the cook said she tried to make sure that people do not ever get given something they dont like. It was noticeable that when you entered this home there was a very pleasant smell of good food cooking. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Appleby Lodge feel confident in being able to raise any concerns, and are protected from abuse by trained and knowledgeable staff. Evidence: There is a copy of the complaints procedure in the hallways and this information is also contained in the Service User Guide, a document given to people when they move to the home. We found that the complaints procedure had been up dated and referred to the latest contact details of the Commission. The Manager said that she had not received any concerns in the last year. Residents said they were able to make complaints but felt this need was unlikely. We talked with staff about recognising abuse, and they knew what to do if they had concerns. The manager confirmed that all staff, apart from the cooks, had received training in relation to recognising and reporting suspected abuse. The manager and a senior care worker have attended courses on the Mental Incapacity Act and Deprivation of Liberty. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people at Appleby Lodge live in a pleasant, well-maintained home that is comfortable and clean. Evidence: As part of this inspection we looked around Appleby Lodge. The house was clean and there were no unpleasant odours. Many of the people had chosen to bring items of their own furniture into their bedrooms. Bedrooms were individually personalised to suit their occupants taste. The communal areas are spacious, and the lounge area looks out on to a patio area. Many of the bedrooms look out on to the large garden, others look out on to the entrance drive and car park. The Manager said that some people like to look out at the entrance as they can see who is coming and going. There is level access throughout the home and the design of the home is such that the lounge and dining area are at the centre of the house. A considerable improvement to the fire prevention equipment has been achieved in the past year. A new fire detection system is in place and all the old heat detectors have been replaced with smoke detectors as required. Fire doors now have intermiscent Strips and vision panels. All bedroom doors are fitted with auto holders to allow residents the choice of having their doors left open at certain times of the day. The kitchen was seen to be spotlessly clean. The Environmental Health Officer visited Care Homes for Older People Page 17 of 25 Evidence: on the 17th.June 2009. No recommendations were made as the inspection was entirely satisfactory. We noted that a copy of the Statement of Purpose was available in each residents bedroom. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Appleby Lodge are supported by competent and well-trained staff, who enjoy working at the home. Evidence: No new staff have been recruited to work at Appleby Lodge since the last inspection. The manager told us that she was aware of the need to ensure that checks are made on any new staff recruited to the home in the future. We discussed the recruitment process in some detail and the manager demonstrated that her knowledge in this area was up to date. Staff spoken to had worked at the home for many years, and were clearly very happy in their work. This level of continuity in staff teams is now unusual in care homes. We looked at training plans for staff and found that all staff had received training in relations to areas such as first aid, moving and handling and fire. Many of the staff had also received training in relation to dementia and the Mental Capacity Act. We were told that there are two care staff on at all times, in addition is an additional member of staff on duty between 9am and 11 am on week days. In addition there is a cook on each day, and a cleaner during the week. Staff said that there was usually enough staff on duty. At night there are two staff on duty, one awake and the other sleeping and available if additional support is needed. Care Homes for Older People Page 19 of 25 Evidence: One of the most impressive things that came across from staff spoken with during this inspection was how well they worked together. There was a record of the supervision that the Manager provides to all of the staff. Staff said that the manager is always available, and the Manager confirmed that she is available at all times when she is not in the home. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appleby Lodge is well managed by Jan Rider. The Service Users benefit from the ethos, leadership and management of the home. Evidence: Ms Jan Rider, Registered Manager, has the Registered Managers Award and an NVQ 4 in care. Ms Rider has worked at the home for a number of years. It is a reflection of Ms Riders competence as a Manager that the staff team at the home are not only competent and provide a high quality service, but clearly enjoy their work and have chosen to stay at the home for a number of years. The Manager said that she felt it was important to show staff she was prepared to be involved in providing care, and was not just in the office. An annual quality assurance survey is conducted and we were able to see the current questionnaires, already in the envelopes, ready to be sent out. Care Homes for Older People Page 21 of 25 Evidence: The Manager confirmed that the Registered Provider visited the home every month to check that it was being run properly. We asked to see copies of the reports of these visits, but were told that they had not been sent to the home. Copies of the reports of these visits should be available to be inspected. The manager said we hold regular appraisals and supervision and records were produced to support this. The current method of supervision involves the manager observing practice, giving advice and completing a supervision record. We would suggest that this process be expanded to include a one to one meeting, at least six times a year. Financial records were not inspected at this time, though they were satisfactory at the previous inspection. Records required by legislation are kept and now considered to be of a satisfactory standard. Policies and procedures have and are being reviewed and brought up to date. With regard to record keeping we recommend that all records pertaining to an individual, resident or staff member, are, where possible ,kept in a single master file. This will help to ensure compliance with the Data Protection Act. There is relevant health and safety information at the home, and practices have improved to comply with these policies. One area of concern relates to the temperature of hot water. Hot water should be delivered from domestic taps at no more than 43 degrees centigrade. It was found that after allowing the taps to run, in bedrooms, for a prolonged period of time the water exceeded the required temperature. We recommend that risk assessments are undertaken for each room and the occupant and warning signs, Hot Water, are put in place. Management may also wish to consider the installation of automatic control valves as fitted to the communal bathing facilities. It is recognised that management have made considerable improvement to the environment and fire safety arrangements since the last inspection. Care Homes for Older People Page 22 of 25 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 37 we recommend that all records pertaining to an individual, resident or staff member, are, where possible ,kept in a single master file. Regulation 26 reports compiled by the Registered Providers should be available for inspection in the home. The temperature of hot water at outlets in bedrooms should be risk assessed and automatic control valves fitted if deemed necessary. 2 3 37 38 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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