Care Home: Applegarth Nursing Home

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What the care home does well People living in the home and their relatives gave positive feedback on the service and the care provided. One relative said, "I enjoy coming to visit, the staff are very good". Admissions only take place if the service is sure it can meet the assessed needs of the prospective resident. Care planning and care practice supports people`s choice and independence. The service does regular audit work across systems in the home to monitor the quality of the service and makes changes if needed. The management has a clear vision of what they are trying to achieve for residents through continuing improvements in the environment and in their improved person centred care planning. The environment is homely, clean, fresh smelling and comfortable and people living there are able to bring in their own things from home such as pictures, ornaments and suitable items of furniture to make their rooms more homely and personal. Work is underway to improve and extend the home and residents are kept informed on progress at their meetings. There is a good standard of catering and the home has built a new spacious kitchen to further develop this for residents. People told us that they liked the food provided and that they have a choice. There are good systems for handling medication to make sure that people`s medicines are managed safely and that residents receive the correct treatment. There is good communication with residents` doctors so that health care needs are met promptly. Training and staff development is well established and supported in the home to try to make sure staff are up to date and aware of how to fulfil their roles and give people the care they need as they prefer it delivered. Staff are aware of the needs of residents and work well with relevant health care professionals to maintain an appropriate service for residents. The service has robust recruitment systems to ensure they get the right staff and promote the safety and wellbeing of people living there. What has improved since the last inspection? The Statement of purpose is being updated as changes take place in the home but it is now easily accessible and in the foyer and there are information files for people to keep and refer to in their bedrooms. This included information on how to make a complaint and this information is generally more accessible. Information on advocacy services is in place and we saw evidence of this service being used so improving support for individual`s rights and give information for those residents who need this. Since the last inspection the service has reviewed and revised its assessment tools to develop a more comprehensive and holistic view of people`s needs on admission. The care planning process is now much more focused on the individual and their views and feelings as well as their personal and clinical nursing needs. As part of a more person centred approach to planning, individuals have detailed personal profiles and clear indications about what they expect and what is important to them. This has been very useful in making sure people take part in social activities that suit them. The addition of a computer with Internet access should help improve people`s opportunities for following their interests and to keep in touch with people. Personal care is being recorded and weights monitored and psychological and individual needs are made clear Records for receipt, administration and disposal of medicines were being well kept and showed that people received the correct treatment. Medications systems and monitoring has been improved and audits done and acted upon and consequently records are accurate and signed by the appropriate staff and medicines are given as prescribed and not allowed to run out. This helps protect people`s health and make sure they get the right treatment. The service audits all residents` monies now and two people to help protect resident`s financial interests witness all transactions. Refurbishment, improvement and extension of the premises is continuing as well as general maintenance to improve the facilities in the long term for all people living and working there. We saw that disinfecting substances were no longer left out and that the sluicing disinfection equipment needed to promote good infection control is being kept in working order for use by staff to maintain safety and good hygiene for people. The manager and provider have clearly acted effectively to improve those areas identified at the last inspection and improve the services they offer and outcomes for people living there. CARE HOMES FOR OLDER PEOPLE Applegarth Nursing Home 243 Newtown Road Carlisle Cumbria CA2 7LT Lead Inspector Marian Whittam Unannounced Inspection 10th July 2008 09.30:0 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Applegarth Nursing Home Address 243 Newtown Road Carlisle Cumbria CA2 7LT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01228 810103 01228 538777 Mrs Julie Robb Mrs Caroline Mary Whitehead Care Home 36 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (36), Physical of places disability (36) Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 36 service users to include: up to 36 service users in the category of OP (Old age, not falling within any other category) up to 36 service users in the category of PD (Physical disabilities under 65 years of age) 1 named service user in the category of LD (Learning disabilities under 65 years of age) may be accommodated within the overall number of registered places. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 12th July 2007 2. Date of last inspection Brief Description of the Service: Applegarth care home is registered to provide nursing care for up to 36 older people and up to the same number who may have physical disabilities. Applegarth is an adapted Victorian house in a residential area of Carlisle. The home is on a main road with easy transport links to the town and local amenities and the bus route into Carlisle goes past the home. Accommodation is provided on two floors with access to the second floor of the home via a passenger lift or stairs. Some information is available on request from the manager in a combined statement of purpose and service user guide but this is not on display. The fees charged by the service ranges from £450.00 to £980.00 (including a nursing contribution) according to information provided during the visit. Fees do not include personal toiletries, personal newspapers, and magazines, trips out and hairdressing. Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This site visit to Applegarth Nursing Home forms part of a key inspection. It took place on10.07.08 and we (The Commission for Social Care Inspection, CSCI) were in the home for five and a half hours. The CSCI pharmacist inspector also visited on the same day and assessed the handling of medicines through inspection of relevant documents, storage and meeting with the nursing staff and residents. The pharmacy inspection took four and a half hours. Information about the service was gathered in different ways: • Annual Quality Assurance Assessment document completed by the manager identifying what the service does well and what could be improved. This was returned to CSCI before the visit. • The service history. • Interviews with residents and staff on the day of the visit. • Observations made by us in the home during the visit. Also a ‘short observation framework for inspectors’ (SOFI) was carried out. This observational tool is used to observe interaction between residents and staff and gain information and insight into how well people’s needs are being met. • Completed questionnaire survey forms from people living in the home. During the visit we spent time with people living in the home and talking to them about their experiences. We looked at care planning documentation and assessments to ensure the level of care provided met the individual needs of those living in the home. We made a tour of the building to inspect the environmental standards. Staff personnel and training files were examined and a selection of the service’s records required by regulation. What the service does well: People living in the home and their relatives gave positive feedback on the service and the care provided. One relative said, “I enjoy coming to visit, the staff are very good”. Admissions only take place if the service is sure it can meet the assessed needs of the prospective resident. Care planning and care practice supports people’s choice and independence. Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 6 The service does regular audit work across systems in the home to monitor the quality of the service and makes changes if needed. The management has a clear vision of what they are trying to achieve for residents through continuing improvements in the environment and in their improved person centred care planning. The environment is homely, clean, fresh smelling and comfortable and people living there are able to bring in their own things from home such as pictures, ornaments and suitable items of furniture to make their rooms more homely and personal. Work is underway to improve and extend the home and residents are kept informed on progress at their meetings. There is a good standard of catering and the home has built a new spacious kitchen to further develop this for residents. People told us that they liked the food provided and that they have a choice. There are good systems for handling medication to make sure that people’s medicines are managed safely and that residents receive the correct treatment. There is good communication with residents’ doctors so that health care needs are met promptly. Training and staff development is well established and supported in the home to try to make sure staff are up to date and aware of how to fulfil their roles and give people the care they need as they prefer it delivered. Staff are aware of the needs of residents and work well with relevant health care professionals to maintain an appropriate service for residents. The service has robust recruitment systems to ensure they get the right staff and promote the safety and wellbeing of people living there. What has improved since the last inspection? The Statement of purpose is being updated as changes take place in the home but it is now easily accessible and in the foyer and there are information files for people to keep and refer to in their bedrooms. This included information on how to make a complaint and this information is generally more accessible. Information on advocacy services is in place and we saw evidence of this service being used so improving support for individual’s rights and give information for those residents who need this. Since the last inspection the service has reviewed and revised its assessment tools to develop a more comprehensive and holistic view of people’s needs on admission. The care planning process is now much more focused on the individual and their views and feelings as well as their personal and clinical nursing needs. As part of a more person centred approach to planning, individuals have detailed personal profiles and clear indications about what they expect and what is important to them. This has been very useful in making sure people take part in social activities that suit them. The addition of a computer with Internet access should help improve people’s opportunities for following their interests and to keep in touch with people. Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 7 Personal care is being recorded and weights monitored and psychological and individual needs are made clear Records for receipt, administration and disposal of medicines were being well kept and showed that people received the correct treatment. Medications systems and monitoring has been improved and audits done and acted upon and consequently records are accurate and signed by the appropriate staff and medicines are given as prescribed and not allowed to run out. This helps protect people’s health and make sure they get the right treatment. The service audits all residents’ monies now and two people to help protect resident’s financial interests witness all transactions. Refurbishment, improvement and extension of the premises is continuing as well as general maintenance to improve the facilities in the long term for all people living and working there. We saw that disinfecting substances were no longer left out and that the sluicing disinfection equipment needed to promote good infection control is being kept in working order for use by staff to maintain safety and good hygiene for people. The manager and provider have clearly acted effectively to improve those areas identified at the last inspection and improve the services they offer and outcomes for people living there. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1,2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A detailed assessment of people’s needs is done before they come to live in the home to make sure they can be met and relevant information is provided to help people make an informed decision about living there. EVIDENCE: The home has developed a statement of purpose and combined service user guide that can be provided to anyone thinking of using the service to help them in making a decision about living there. It was on display in the home on the day of the visit and also the last inspection report. The notice board in the foyer of the home also gives information of what is going on in the home, information on advocacy services and support organisations as well as general information and staff training. Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 10 Currently these documents are being updated so that it gives up to date information about the services being offered with the new extension. There are also information packs for people in their bedrooms with useful information on daily life there such as meal times, identifying staff and complaints. No one is admitted to the home until a full needs assessment has been done. The manager does the pre admission assessments and nursing staff told us that it had been discussed at their staff meeting that nursing staff should accompany the manager to do assessments so that they gained more experience in this for their professional development. We looked at four people’s pre admission assessments that had been done to make sure the home was able to meet an individual’s needs before they came to live there. The pre admission assessments we looked at contained the relevant information from which to develop an individual’s care plan. The assessments covered the personal, social and health care needs of people so individual needs can be identified and the home can assure people it can meet them before they come in. This information ensures the staff are aware of the level of care required to meet the different needs. Since the last inspection the service has reviewed and revised its assessment tools to develop a more comprehensive and holistic view of people’s needs on admission. The process is now much more focused on the individual and their views and feelings as well. Residents we spoke to felt they had sufficient information provided on the home and had been given contracts. This was supported by the survey responses we received as well. The service does not provide intermediate care. Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care which people using this service receive is based on their individual needs. Privacy, dignity and personal choice are promoted. EVIDENCE: All residents have an individual care plan, based on initial detailed assessments and risk assessments, setting out health, social and personal care needs and these are being reviewed and updated. The care plans are clearly set out and easy to follow. The information provided covered areas such as a person’s mobility, dietary needs and preferences, health needs and medical history, personal care, communication needs and people’s social and religious preferences. Appropriate equipment to prevent pressure sores following assessment is in use, individual’s mental health and behaviour is being monitored and effective nutritional screening is being done and weights recorded. The care plans have Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 12 continued to be developed and improved since the last inspection and this is evident in the new ‘person centred’ documentation that underpins care approaches. We looked at three care plans where this had been started and found them to present more clearly what is important to the individual, what they feel they need to support them and what they felt their emotional as well as physical needs were and what made them anxious. There were detailed social and individual plans in place with a section all about the individual and how that person wanted to be supported. The new plans gave a clearer insight into the lives of individuals and what was important to them to help staff support them. We spoke to nursing staff that had clearly been putting a lot of time and effort into this improvement in care planning. We looked at records for receipt, administration and disposal of medicines and these were very well kept and showed that people received the correct treatment. We checked a sample of medicines against records and these were in order. The manager also did regular checks of medication to look for discrepancies that could be dealt with promptly to keep people safe. We found some good systems in place for managing high-risk medication. The management of a blood thinning medicine had been reviewed and the service had introduced a system for recording blood tests. We found that results were followed-up and dosage changes were implemented promptly to make sure people got safe and effective treatment. However, the way the dosage was recorded on the medicines administration chart was ambiguous and the service should review this to reduce the risk of errors although no mistakes were found. The service had improved the systems for ordering medicines to prevent them running out. Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are able to make choices about their lifestyle and are supported to maintain their independence. EVIDENCE: Activities and recreational preferences are included in the individual care plans and records of what people enjoy and what they like to do Social assessments contain a lot of detail about people’s interests and what is important to them to do and be involved in. We spoke with people and looked at their activities plans and expectations to see if they were accurate and they did give a good picture of their hobbies and interests. This was evident for a younger person staying in the home who was being well supported to do the things they wanted and follow the lifestyle they chose. Activities that people want are discussed at resident’s meeting along with menus. The home has just changed its menus after consulting with people living there. Observations made using the ‘short observation framework for inspectors (SOFI) indicated good staff and resident interaction with a high level of positive Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 14 well being observed amongst residents using one of the lounges. Residents engaged with each other to a good level and no negative interactions were observed. The home’s ‘Lifestyle and leisure co-ordinator’, who is responsible for planning both group and individual activities with people living there, has recently left but recruitment is well advanced for a replacement. People we spoke to enjoyed the activities they took part in including local community events such as Harvest Festivals and Seasonal events, attending religious services, singing, going out to see friends and relatives, artwork, and musical entertainments. We spoke with one person who was taking a taxi out to visit relatives and they also told us about the drawing they did and enjoyed. People living there have access to religious services and pastoral support from clergy. Recently some people have visited a neighbouring home for afternoon tea and so extend their opportunities for social interaction. Some people told us they chose not to attend some activities and were not made to feel they had to. The service has recently installed a computer with Internet access in one of the lounges and they are encouraging residents to use this service. A choice of meals is offered each day from the four weekly menu and any residents that don’t like the daily choices are offered alternatives. The menus we looked at offered nutritious meals with choice and variety. We spoke with the cook who was aware of the different dietary needs of residents and could cater for special diets. The cooking staff make the meals on the premises from fresh ingredients and one person told us “ The food is very good, we have a choice of meals and I like some better than others but I am always asked what I want”. We were told that the chef “pops in and asks if everything is alright” and one person said “ I asked for bacon and egg for my breakfast and they brought it”. People we spoke to told us that they enjoyed their meals and we saw staff offering drinks through out the day and providing people with their own jugs of juice. Surveys we received also commented positively on the standard of catering. We saw the spacious new kitchen that was nearing completion as part of the premises extension and improvement and when complete should improve the catering facilities considerably to benefit people living there. The meals seen on the day of inspection were well presented and the residents appeared to enjoy them. There were staff available at lunchtime to help support residents if needed in the lounge or bedrooms. Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has complaint and adult protection procedures in place to protect people using the service. EVIDENCE: There are suitable policies and procedures in place for dealing with complaints and concerns. The complaints policy and procedure is part of the guide for the people using this service and there was also a copy on display in the foyer along with a suggestion box. Information on advocacy is also displayed in the foyer. The home is a member of an advocacy service. We spoke with one person who is using the advocacy services to support them in aspects of their life to uphold their rights. Residents are encouraged to use their right to vote and help is given to fill out forms for postal voting for those who want to. The service has not received any complaints made since the last inspection but we saw that there is system in place for recording and investigating any complaints that are made about the service. The Commission for Social Care inspection (CSCI) have not received any concerns or complaints about the service. The residents we spoke with during the visit were all aware of the procedure and what they would do to should they need to use it and survey results supported this. Staff we spoke with were aware of how a complaint should be handled and also any allegations of abuse and who needed to be Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 16 informed. Staff we talked to told us that if they had any problems they would speak to the home if they had any concerns about the care of the residents or any other issues. The service had clear procedures for safeguarding vulnerable adults and has internal policies and procedures for the Protection of Vulnerable Adults (POVA). Staff records show that all staff have enhanced Criminal Records Bureau (CRB) checks before they start work to protect residents. Nursing and care staff have had mandatory training on recognising abuse and the adult protection procedures. This subject is also covered in National Vocational Qualification (NVQ) training, which over 70 of staff have done. The manager has attended awareness training on ‘Deprivation of Liberty’ and equipment used for restraint such as bedrails is used within a risk assessment framework and with consent obtained. Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19, 20, 21, 22, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment within the home is of a consistent standard providing resident’s with a well equipped, clean and homely place to live. EVIDENCE: The home is well maintained decoratively by the maintenance staff and there are ongoing internal improvements to furnishings and bedrooms. The home is clean and safety precautions are being observed whilst building is going on. Residents told us that they are kept informed on the progress of the work on the extension and improvements. The new extension to the home, that will merge with the existing building, is almost complete and that will provide additional facilities that residents will be able to use including a café area, hot tub and recreational therapy rooms. This should improve communal areas as Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 18 at present there are not separate dining rooms and people have their meals in their rooms or the lounges. The lounges are to be upgraded as part of the planned work and work has begun on one lounge and the roof garden. We looked at bedrooms that had been refurbished and this was done to a high standard and had involved residents in their preferences for decoration and floor covering. We looked around the new kitchen that is is almost complete and when operational should be a great improvement on the existing facilities. Work has been done to enlarge narrow corridors on the first floor to improve access by the lift area. All bedrooms are single occupancy and the work being done has also added en suite facilities to improve faciities for people living there. Improvements have been made to the nurses station so there is ample room and security for information and files and it is easily accessible. The service has policies and procedures on infection control and staff are given training on this at induction and annually. Some staff have done a 12 week infection control course and there are sluice and disunfecting equipment in good order to reduce the risk of cross infection. The service undertakes hygiene audits to monitor its effectiveness. There is a range of equipment, nursing beds, bathing aids and adaptations to help residents make the most of their independence and to get about the home and call bells are accessible in areas used by residents. The new extension will have a new laundry to improve the facilities for residents as the present one is small. Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has robust recruitment processes and sufficient nursing and care staff to provide a consistent level of individual care. Training programmes ensure that staff have the skills and knowledge to give a good standard of care to people living there. EVIDENCE: Staffing levels are, overall, satisfactory for the number and dependancy level of residents presently in the home. We looked at staff rotas and observation during the visit indicated that the home has sufficient staff on duty with a range of skills and experience to provide a consistent level of individual care for the number of people currently living in the home. We discussed with the nurse in charge the need to monitor occupancy and as it goes up they will need to re assess staffing against dependency and individual needs to maintain that consistent level of care. Nursing staff were aware of the need to do this and that this was discussed with the manager. The off duty records show that generally there are 2 registered nurses (RGN) on duty during the busy morning period, 1 in the afternoon and 1 at night, with 6 carers on duty in the morning plus one giving 1 to 1 support for one resident. There are 3 carers on duty in the afternoon and 2 at night. The Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 20 morning shift has good staff coverage and the skill mix remains satisfactory during the day. People living there spoke well of the staff, one person told us “They spoil me and look after me well”. The home has a high percentage of care staff with NVQ Level 2 in care or above and health care assistants undertake the ‘Skills for Care’ Induction programme. Staff training has a separate budget and training beyond the mandatory subjects is encouraged and care assistants are supported to develop their role and receive appropriate training to do this, such as in care plans. Additional training has included care planning, bereavement awareness, emergency actions and continence awareness, all relevant to the needs of people living there. Training is booked on dementia awareness and one member of staff is attending training on the new Mental Capacity Act. Three members of staff have completed Learning and Disability Award Framework (LADF) accredited training to provide additional skills to support some of the people living there. Staff files were examined and confirmed the home has effective and robust recruitment procedures and follows good practice guidelines with regard to the recruitment of staff. Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks have been done for staff before starting work. Staff files were clear and up to date and had records of all necessary documentation and references taken up prior to starting work. Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 32, 33, 34, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Effective management and quality monitoring help safeguard people using the service and procedures are in place to safeguard resident’s interests and promote their health and safety. EVIDENCE: The service has a well qualified and experienced registered manager, Caroline Whitehead, who maintains her professional development through relevant training. This includes the Registered Managers Award (RMA) and learning disability training (LDAF) as well as ongoing training to fulfil the requirements of her professional nursing body. The manager is currently doing a management performance training programme. Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 22 The manager undertakes quality assurance and reviews procedures, systems and practices in the home and works with nursing and care staff to identify areas to focus on and has taken advice and implemented improvements and changes such as those in care planning, activities and medication, that are having positive outcomes for the people living there. Systems are in place to do audits and a range of satisfaction surveys for those using and coming into contact with the service. Regular staff meetings are being held with staff contributing to the agenda. This allows staff feedback and new ideas to be introduced by nursing staff as well as internal reviews of policies and procedures and information sharing. There are also residents’ meetings to get feedback from those using the service and their ideas. The service also does its own quality monitoring across all areas of the service using audits. There is adequate insurance cover in place for the service. We spoke with nursing and care staff who confirmed they felt supported in their work and that the manager and senior staff discussed their work with them. Staff turnover is low and staff morale appeared good from what staff said to us. Supervision is being given to staff and this was recorded. The registered nurses do this with care staff and also work along side them on a 1 to 1 basis to support their practice. Records and servicing contracts indicate that the home has systems in operation and training to promote resident health and safety including moving and handling and infection control. Fire training is being done by the manager and up to date. The provider has a bacterial water analysis done annually to promote safety in this respect. There are systems in place to safeguard resident’s finances and these are audited and transactions now witnessed by 2 people. From what we saw during the visit records required by regulation are being kept and information is being kept securely to promote confidentiality. Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 2 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that the service review the way that the dosage of the blood thinning medicine warfarin is recorded on medicines administration charts to reduce the risk of errors. Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Applegarth Nursing Home DS0000010110.V365103.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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