Care Home: Appledale Cottage Residential Home

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What the care home does well This home has an admissions procedure that is designed to ensure that an individual`s needs can be met. The people who work in the home identify the health needs and preferences of all of the people who live there. They make sure that should someone need medical attention they receive it promptly and should they require medication they also receive that when they should. The home provides an environment, both indoors and out, that is pleasant for people to be. One lady told us, "Its nice here; very comfy." The people who live in this home tell us that they find the staff to be friendly and caring and we saw how they are properly screened before being allowed to start work and receive training when they do. What has improved since the last inspection? No requirements were made as a result of the last inspection. What the care home could do better: Two specific recommendations have been made as a result of this inspection. One is that the home should record, in writing, when they either receive or give back monies that they are storing for people so that the process is open and transparent. The other is that they should record that they have periodically checked the temperatures of the hot water coming from the taps so that they can show that they are trying to ensure that nobody scalds themselves. It would also be easier to check to see if the home is meeting the social needs of the people who live there if they were to more formally identify their interests and note each occasion that the person has taken part in an activity that they say they enjoy. Key inspection report Care homes for older people Name: Address: Appledale Cottage Residential Home Appledale Cottage Residential Home Bagley Marsh Ellesmere Shropshire SY12 9BP     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 Moloney     Date: 2 4 1 1 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: Appledale Cottage Residential Home Appledale Cottage Residential Home Bagley Marsh Ellesmere Shropshire SY12 9BP 01939270374 F/P01939270374 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Pauline Hodgson,Mr Adrian Douglas Hodgson care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 9 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 9 Dementia (DE) 9 Date of last inspection Brief description of the care home Appledale Cottage is a small residential Care Home, recently approved to provide care for 9 older persons requiring Residential care, including a number requiring Dementia care. Care is provided within the family home of the Proprietors, Mr and Mrs Hodgson, who are both involved as full-time carers. The Home is situated in a quiet, rural area, near to the centre of the Village of Bagley Marsh, approximately five miles from the Town of Ellesmere in North Shropshire. Set in attractive, extensive, and Care Homes for Older People Page 4 of 25 Over 65 0 9 9 0 Brief description of the care home accessible grounds and gardens, the Home offers accommodation comprising 9 ensuite bedrooms, a large combined lounge/dining room, which benefits from the addition of a conservatory at one end. People who live there can also enjoy the added interest and stimulation from the Proprietors collection of animals that include dogs, cats, a pony, a donkey and chickens. The homes fees are currently £465 to £500 per week. 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: A range of evidence was used to make judgements about this service. This includes: information from the provider which included a self assessment document that they are required by law to complete and notifications that have been received by the Care Quality Commission form the home about incidents, bereavements and other incidents that affect the welfare of the people who live in the home. The visit was unannounced with the purpose of carrying out a Key Inspection which is where the homes performance is measured against a set of standards identified by the Department of Health. No other visits had been made by Care Quality Commission staff since the last Key Inspection. This inspection was undertaken by one inspectors, Mike Moloney, and lasted four hours. On this occasion we did not involve an Expert by Experience which is someone who has experienced the care provided by this type of service and is asked by the Care Care Homes for Older People Page 6 of 25 Quality Commission to assist and give their views during an inspection.. During that time we Case Tracked a number of the people who live in this home. This means that we talked to them and/or their relatives, where this was practical, to find out their views of the care that was being provided to them. This also enabled us to see if the records that identified peoples needs such as the care plans that are provided for the staff to follow were accurate and covered each individuals personal issues. We also talked to members of the staff team to check that they were aware of the identified needs of the people who live in this home were and whether or not they had the approach and training required to meet them. The standards set out by the Department of Health are in seven different groups. Each group can be judged as being either poor, adequate, good or excellent. The inspectors reach their judgement by following the guidelines laid down in the document known as the Key Lines Of Regulatory Assessment (KLORA) which is available on the Care Quality Commission web-site: www.cqc.org.uk Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? 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 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. People looking to live in the home and their representatives have the information needed to choose a home which will meet their needs They have their needs assessed and a contract which clearly tells them about the service they will receive. Evidence: We looked at the records of one of the people who had been admitted into the home in the last few months. We saw that the home had carried out their own assessment about whether or not they could meet that persons needs. We saw that the assessment that was carried out looked at how well that person could care for their own personal hygiene, use the toilet, dress themselves, move around and talk as well as how aware they were of where they were. We also looked at the documentation that was available to people who were Care Homes for Older People Page 10 of 25 Evidence: considering living in the home and this contained the information that they would need in making an informed choice. 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. The health and personal care that a person living in this home receives is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: We looked at the records of two of the people who live in this home. We saw that they contained details about their life history and this included the details of their medical history. We also saw documents that identified where the person might be at risk of harm and also how the risk could be reduced. We talked to the staff and they showed that they knew what those documents said. One of the risk assessments was about moving around the house whilst the owners dogs were there. We talked to a number of the people who live in the home who said that they liked seeing the dogs and would miss them if they were not there and therefore measures to reduce the risk of such things as tripping over them was more appropriate than removing them. Care Homes for Older People Page 12 of 25 Evidence: We talked with a District Nurse who was visiting one of the people who live in the home. She told us that that either she or one of her colleagues visited about once a week to do such things as monitor peoples skin condition or blood sugar levels. We saw that both she and the staff carried out such personal care either in peoples own bedrooms or the bathrooms. We saw that the nurses notes were kept in the privacy of each persons bedroom and that the home had notes in their own records that said who had been seen for what and when. We talked with a number of the people who live in the home and their relatives and they all said that they found the staff to be friendly and caring. We looked at the way the home manages peoples medication. We saw that they have a purpose built steel cabinet to store the medication in the area between the kitchen and the office. At the time of the inspection there were no Controlled Drugs in the home but they did have the storage and recording facilities in place should they need them. We also looked at the way that the home records the administration of the medicines and saw that those records were accurate and up to date. 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. People who live in this home are able to choose their life style, social activity and keep in contact with family and friends. Social, cultural and recreational activities meet their expectations. They receive a healthy, varied diet according to their assessed requirement and choice. Evidence: We looked at the records of two of the people who live in this home. We saw that there were limited records about the activities that each person had taken part in. The longest entry in the Daily Report book for one person during November was, Other two daughters came. I settling well. Bonfire night we all watched a firework display from the conservatory. It was therefore not easy to gauge from the records whether or not people where taking part in any activities of their choice. We talked with the staff who told us that there were various board games for people to take part in and we saw one of the people who live in the home playing Patience and another reading a book. We also spoke to some other people who told us that they occasionally play gentle ball games to keep them mobile. When we asked one lady about activities she said, No, dont want to be rushing around. Another lady said, Its nice here; comfy. Care Homes for Older People Page 14 of 25 Evidence: We have also received a report from a social worker which says that the owner often sits with the people who live in the home and chats to them. One of the people who live in the home and a visiting relative confirmed this. We looked at the records of the meals that had been served to the people who live in this home and these showed that such things as stew and dumplings and other traditional foods were available. All of the people spoken to said that they liked the food that was offered to them. One told us that she was looking forward to her favourite which was sausage and mash. The meal served on the day of the visit, sausage and mash, was seen to be well presented and the menus seen for the previous month was well balance and nutritious. We talked to the staff and established that they could cater for people who required special diets because of such things as diabetes. The staff also told us that should any of the people who live in the home need to be taken out the owner would usually transport them in his own car. We saw that peoples bedrooms were lockable and a key was available to the person should they wish it. 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 in this home have access to a robust and effective complaints procedure, are protected from abuse and have their legal rights protected. Evidence: The self assessment completed by the manager of the home prior to the inspection told us that they had received no complaints and the staff on duty confirmed this. There had been one allegation of abuse, which was not upheld, and records provided by the Local Authority, who investigate such matters, showed that the home had cooperated fully with their investigations and accepted any lessons to be learned from it. We also saw records that showed that the staff had received training in the identification and reporting of such issues. We talked to the staff on duty and they confirmed this. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home gives anyone living there a safe, wellmaintained and comfortable environment which encourages independence. Evidence: Appledale Cottage is set in a rural part of Shropshire to the northwest of the county town of Shrewsbury. It is set in its extensive grounds which are home to a number of animals such as dogs, cats, chickens and ponies many of which could be seen from the conservatory where most people choose to sit. We saw that the home is all on one level and that access to the garden is level and therefore easy for people with mobility problems to move around. There was one communal area for the people who live in the home to gather. This was divided into two areas with one part being the dining area and the other being the sitting area in the conservatory style extension. We watched people moving around the home and they were able to move freely from one area to another and chat to each other as they went. Each person had their own bedroom and each room had its own en-suite toilet facilities. Care Homes for Older People Page 17 of 25 Evidence: We saw that the home was well maintained, clean and odour free throughout. The staff showed us the homes laundry and explained that the equipment in it was designed to keep peoples clothing and bedding clean even if it had been heavily soiled. One lady said, Its nice here; very comfy. 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. Staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing needs of people who live in this home. Evidence: We spoke to the staff on duty and they explained that there were always at least two people available to meet the needs of the people living in the home. They also told us that on some occasions there are more so that more activities can take place. We looked at the homes staffing rota and it confirmed this. The staff also told us that only one new member of staff had been recruited since the last inspection. We looked at that persons records and these showed that all of the background checks that ensure that a person is fit to work with vulnerable people had been carried out. We also saw records that showed that the newly recruited person had undergone an induction training programme that was appropriate for someone with her experience within the care industry. We looked at the records of all of the staff and these showed that they had undertaken training such as dementia care, infection control and moving and handling that would help them meet the needs of those people that they care for . We also saw Care Homes for Older People Page 19 of 25 Evidence: records that showed that most of the staff had undertaken National Vocational Training in care to at least level 2 which is the minimum level that it is considered to be appropriate for someone working in this type of service. We spoke to the staff and they confirmed that they had undertaken this training. During the inspection a lot of conversations between people who live in the home and staff were seen and heard. The staff were always professional, clear and polite when they spoke. When we spoke to those living in the home as well as their relatives they were very complimentary about the staff 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. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. Evidence: The manager/proprietor was not present during this inspection. We spoke to the staff and they told us she works in the home providing hands on care, on a day to day basis and looking at the staffing rota confirmed this. They also told us that this is a family run business and the majority of the staff are family members enabling them, as the owners, to be able to monitor closely how well their service is meeting the needs of the people that they provide care for. We saw the records of the monthly meetings held by the manager with the people who live in the home which enables her to discuss any problems or issues that they may have so that they can be resolved. Care Homes for Older People Page 21 of 25 Evidence: We saw the managers certificate that shows she had achieved National Vocational Qualification Level 4 in care which is a qualification that is considered to be appropriate for someone who runs a service such as this. The staff showed us how some monies were stored by the home on behalf of some of the people who live in the home. However, they could not show us any records of receipt or payment that would prove that the cash was being monitored in an open and transparent way. Various records were seen that monitored systems and the environment in order to make sure the people living in the home safe such as the checking of the fire alarm system. We saw that most were kept up to date but records of the checks on bath water temperatures that would show that care is being taken to avoid people being scalded were not carried out regularly. Hazardous materials such as some cleaning fluids were seen to be kept securely and instructions about how they should be used safely were also available. 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 35 Written records of any monies or valuables held for safekeeping on behalf of anyone living in the home should be kept so that they can be fully accounted for. Hot water temperatures should be monitored on a regular basis to reduce the risk of people being scalded. 2 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. 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. 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