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Care Home: Appleton Lodge

  • Lingard Lane Bredbury Stockport Cheshire SK6 2QT
  • Tel: 0161-4306479
  • Fax: 01614941158
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Appleton Lodge is one of the care homes owned and run by Southern Cross Healthcare. The home is located in a semi-industrial and residential area. Public transport is convenient and enables visitors and more able residents to travel to local shopping areas. Appleton Lodge is purpose built and stands in its own grounds, along with another home owned by the company. Appleton Lodge offers residents single bedroom accommodation, all with en-suite facilities. Accommodation is provided on two floors. Residents have the opportunity of sitting in various communal seating areas, one of which is designated for residents who prefer to smoke. The home has wide corridors and is able to support residents who use manual and electric wheelchairs. Fees for accommodation and care at the home vary between £340 and £573.03 per week. A service user guide is available on request.

  • Latitude: 53.428001403809
    Longitude: -2.125
  • Manager: Dawn Haughton-Tarmey
  • Price p/w: ~
  • UK
  • Total Capacity: 30
  • Type: Care home only
  • Provider: Southern Cross Healthcare Services Ltd
  • Ownership: Private
  • Care Home ID: 1825
Residents Needs:
Dementia, Old age, not falling within any other category, Physical disability

Latest Inspection

This is the latest available inspection report for this service, carried out on 27th May 2008. CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

For extracts, read the latest CQC inspection for Appleton Lodge.

What the care home does well Residents and relatives expressed great satisfaction with the manager, saying she was approachable and good at her job. Comments included "Dawn (the manager) always encourages an open door policy, this works well and I have full confidence in her", "always willing to listen and improve", "Dawn keeps me very well informed about everything and if I am unsure she always makes time to help. I think she is excellent" and "(the home) has a good manager who keeps very close to her team and her residents".The atmosphere in the home was friendly and relaxed. One relative who returned a survey wrote, "There is always a happy atmosphere. There is always something going on and X takes part in everything". The GP who returned a survey thought there was a "friendly supportive environment". Routines seemed to be fairly flexible; residents could choose to stay in their rooms or join other residents in the lounges. Visitors said they were made to feel welcome. One relative wrote, "I have been made to feel at home at Appleton as I visit quite often". Most residents liked the food provided at the home and said there was a choice. We sampled some of the food during our site visit and thought it was tasty and appetising. The manager positively views constructive feedback and uses it to develop and improve the service. Since the last inspection, one complaint has been made known to us and Social Services, who liaised with the manager about the concerns raised, reported that the manager took the matter very seriously, investigated it thoroughly and provided a full response. What has improved since the last inspection? More staff have undertaken NVQ training since the last inspection and a total of 62% have now successfully achieved this qualification. At the last inspection we had some feedback that staff did not always act as professionally as they should have done and we saw some instances where staff were not as helpful or responsive to residents as they could have been. Feedback from residents and relatives at this inspection indicated that this had improved and the manager reported that she had spent a lot of time talking to staff about their attitude and staff had attended "customer care" training. Since the last inspection an activities organiser has been appointed specifically for Appleton Lodge (previously someone was employed to work at the Lodge and the adjacent Appleton Manor). Staff, residents and relatives felt that having their own designated activities organiser had made a difference to the amount of social events being offered. The manager had a lot of ideas for further development in this area. Menus have been reviewed (although they are in the process of being reviewed again), and residents are now able to order and receive a cooked breakfast if they choose. CARE HOMES FOR OLDER PEOPLE Appleton Lodge Lingard Lane Bredbury Stockport Cheshire SK6 2QT Lead Inspector Mrs Fiona Bryan Unannounced Inspection 27th May 2008 09:00 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 Appleton Lodge DS0000008536.V363621.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. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Appleton Lodge Address Lingard Lane Bredbury Stockport Cheshire SK6 2QT 0161-430 6479 0161 494 1158 appletonlodge@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd 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) Dawn Haughton-Tarmey Care Home 30 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (10) Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Maximum number registered - 30. Services users to include up to 30 (OP), up to 3 (DE)(E) and up to 10 PD(E). 18th July 2007 Date of last inspection Brief Description of the Service: Appleton Lodge is one of the care homes owned and run by Southern Cross Healthcare. The home is located in a semi-industrial and residential area. Public transport is convenient and enables visitors and more able residents to travel to local shopping areas. Appleton Lodge is purpose built and stands in its own grounds, along with another home owned by the company. Appleton Lodge offers residents single bedroom accommodation, all with en-suite facilities. Accommodation is provided on two floors. Residents have the opportunity of sitting in various communal seating areas, one of which is designated for residents who prefer to smoke. The home has wide corridors and is able to support residents who use manual and electric wheelchairs. Fees for accommodation and care at the home vary between £340 and £573.03 per week. A service user guide is available on request. Appleton Lodge DS0000008536.V363621.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 star. This means the people who use this service experience good quality outcomes. This key unannounced inspection, which included a site visit, took place on Tuesday, 27th May 2008. The staff at the home did not know this visit was going to take place. We looked around parts of the building, checked the records kept on service users to make sure staff were looking after them properly, as well as looking at how the medication was given out. The files of three members of staff were also checked to make sure the home was doing all the right checks before they let the staff start work. In order to obtain as much information as possible about how well the home looks after the residents, staff and residents were spoken with. Before the inspection, surveys were sent out to residents, staff, relatives and other healthcare professionals asking what they thought about the care at the home. Ten residents, three relatives, seven staff, one GP and one District Nurse filled the surveys in and returned them to the Commission for Social Care Inspection (CSCI) and this information has also been used in the report. Before the inspection, we also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. The form was returned on time and we felt that the manager had tried hard to be objective about how the home was performing. What the service does well: Residents and relatives expressed great satisfaction with the manager, saying she was approachable and good at her job. Comments included “Dawn (the manager) always encourages an open door policy, this works well and I have full confidence in her”, “always willing to listen and improve”, “Dawn keeps me very well informed about everything and if I am unsure she always makes time to help. I think she is excellent” and “(the home) has a good manager who keeps very close to her team and her residents”. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 6 The atmosphere in the home was friendly and relaxed. One relative who returned a survey wrote, “There is always a happy atmosphere. There is always something going on and X takes part in everything”. The GP who returned a survey thought there was a “friendly supportive environment”. Routines seemed to be fairly flexible; residents could choose to stay in their rooms or join other residents in the lounges. Visitors said they were made to feel welcome. One relative wrote, “I have been made to feel at home at Appleton as I visit quite often”. Most residents liked the food provided at the home and said there was a choice. We sampled some of the food during our site visit and thought it was tasty and appetising. The manager positively views constructive feedback and uses it to develop and improve the service. Since the last inspection, one complaint has been made known to us and Social Services, who liaised with the manager about the concerns raised, reported that the manager took the matter very seriously, investigated it thoroughly and provided a full response. What has improved since the last inspection? More staff have undertaken NVQ training since the last inspection and a total of 62 have now successfully achieved this qualification. At the last inspection we had some feedback that staff did not always act as professionally as they should have done and we saw some instances where staff were not as helpful or responsive to residents as they could have been. Feedback from residents and relatives at this inspection indicated that this had improved and the manager reported that she had spent a lot of time talking to staff about their attitude and staff had attended “customer care” training. Since the last inspection an activities organiser has been appointed specifically for Appleton Lodge (previously someone was employed to work at the Lodge and the adjacent Appleton Manor). Staff, residents and relatives felt that having their own designated activities organiser had made a difference to the amount of social events being offered. The manager had a lot of ideas for further development in this area. Menus have been reviewed (although they are in the process of being reviewed again), and residents are now able to order and receive a cooked breakfast if they choose. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 7 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. Appleton Lodge DS0000008536.V363621.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 Appleton Lodge DS0000008536.V363621.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): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents were assessed before coming to live at the home to make sure their needs would be able to be met. EVIDENCE: A service user guide is displayed in the reception area of the home and is also provided in each resident’s room. One resident who was quite new to the home said she had read it and felt it gave accurate information about the services the home offered. Another resident said they had not seen the guide, but as their eyesight was quite poor, it was uncertain as to whether they would be able to read it. The manager said a member of staff (possibly the key worker) should have sat and explained the guide to the resident. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 10 Three residents were case tracked. Two residents had been admitted as emergencies. Assessments and care plans from Social Services had been obtained by fax prior to their admission. The manager said that, following this, each resident was assessed on admission as staff wrote their care plans. One of the residents said staff had asked her what she was able to do for herself and what she needed help with. The other resident, whose admission had been planned, had been assessed prior to admission. Assessments included risk assessments for moving and handling, falls, nutrition and pressure areas, as well as risk assessments for specific issues related to individual residents, for example, use of bed rails. Appleton Lodge DS0000008536.V363621.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): 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 arrangements in place ensure that residents’ healthcare and personal needs are well met. EVIDENCE: Three residents were case tracked. One resident lived at the home permanently and the other two residents had been admitted as emergencies for short stays. Care plans and risk assessments for the permanent resident were detailed and had been reviewed monthly. Two reviews had taken place since his admission and he had been asked if he was satisfied with the care he was receiving. This was recorded in his care file. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 12 The two residents who were admitted as emergencies and who were staying at the home on a short-term basis, had short term care plans written for them, which were kept in plastic wallets. However, staff were still having to use parts of the documentation used for permanent residents and this resulted in lots of loose papers, which were not in order and therefore difficult to extract information from. One resident had been seen by the district nurse who had identified problems with their pressure areas and ordered a pressure relieving mattress and cushion; however staff had not written a care plan to address what care they needed to give and how the resident would be monitored until nearly a week later. The manager agreed that the way in which records were kept for short stay residents presented a risk that some care needs would be overlooked and not monitored properly. In several of the files, gaps were noted in the daily records, although there had been generally one entry in every 24-hour period. The daily records, particularly for the short stay residents, were often written on separate pieces of paper and were not in chronological order. Again, this made it difficult to extract relevant information about their progress since entering the home. Two different scales for calculating the pressure risk to residents were in use (Waterlow and Braden), which was confusing and inexplicable even to the manager. Residents’ nutritional status was assessed using the MUST tool; however, staff did not appear to be fully aware of how to use it and in a number of cases it had been calculated incorrectly. Despite the shortfalls in record keeping, the residents appeared well cared for and content, and staff were aware of and able to describe their needs and preferences. One staff member who returned a survey wrote, “My manager always tries to keep us up to date with what is going on and also if we receive new residents”. Records showed that residents had seen other health care professionals, such as their GP, district nurses, chiropodists and opticians. One resident said staff had requested a dental visit for her and she was waiting for that. The medicine records and medicine stocks for the residents that were case tracked were examined. A number of errors were identified. All staff had signed the administration record for over two weeks stating that they had administered a medicine when they had not. The dose had been increased and they had been administering the correct dose and signing for that, whilst still signing that they had administered the lower dose as well, which had not been deleted from the record. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 13 One medicine for another resident had not been administered in the mornings, as prescribed, although the dose at night had been given. The manager investigated this and reported that the resident was choosing not to take the morning dose due to side effects of the medication. Changes to the dosage of prescribed medicines must be sanctioned and amended by the doctor. One resident was prescribed a topical ointment but there were no signatures on the record to indicate it had been applied. We asked the carer administering medicines that morning if the ointment was in the resident’s room and she said, “as far as I know – the carers are supposed to be putting it on” – but she had signed to say it had been applied. Staff should only sign to say that medicines have been administered if they know it has. The same resident was prescribed a controlled medicine, which had been given that morning and signed for on the MAR chart but not in the controlled drugs book. The carer who was responsible for administering medicines that morning had not undertaken any training in the safe handling of medicines whilst working at Appleton Lodge, although she had received some training in her previous job in approximately 2002. This staff member said she acted up as senior carer when the other seniors were on holiday or off sick. If she is going to do this, she must have up to date training in specific skills she needs to safely perform the role. This carer did not have an NVQ qualification either. The manager said that she undertook medicine audits every month and produced written evidence of this. The errors identified on the day of the site visit were recent ones and would not have been apparent at the last audit. We were satisfied that the manager would have identified them herself at the next audit. Residents said staff knew what help they needed with their personal care and commented that, in the main, staff attitude was good, with staff being kind and respectful. One resident said, “I am very happy here. Everyone is very helpful and kind”. This resident knew who her key worker was, although she was vague as to what the role entailed, saying that she did “whatever I ask her to do but I don’t ask much”. A staff member was overheard in residents’ rooms chatting with them in a friendly and pleasant manner and showing a good rapport with residents. All the relatives who returned surveys stated that residents always or usually got the care they needed to meet their needs, they were kept up to date with important issues and staff had the right skills and experience to support the residents. Comments included “My mother’s needs have increased now and the home has always reacted to accommodate changing needs” and “Care standards are generally very good – a few blips but these are addressed once communicated”. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 14 All the residents who returned surveys also said they always or usually got the care and support they needed, staff listened and acted on what they said and they got the medical support they needed. One resident wrote, “I haven’t needed medical support but I have needed first aid and the staff have been very good”. One GP who visits residents at the home returned a survey writing, “Friendly supportive environment, staff are very caring towards patients and provide a high level of care. Staff appropriately encourage patients to be more active when this is needed”. In response to the question “What does the home do well?” the GP replied “end of life care – one resident recently died and her daughter commented how well the staff cared for her mother, the staff are genuinely caring towards the residents – this is clearly manifest in the care they provide. I would be happy for a relative of mine to be cared for there”. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 15 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): 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. Residents were encouraged and supported to exercise choice in their daily routines in relation to lifestyle and to maintain contact with their relatives. The appointment of an activities organiser means that the range and variety of social opportunities can be explored and developed. EVIDENCE: Since the last inspection an Activities Organiser has been employed specifically for Appleton Lodge and works 15 hours per week. She works flexibly to fit in with arrangements that have been made for the residents. The activities organiser had only worked at the home since February 2008, so was still finding out what residents liked and did not like. Unfortunately, she was not on duty at the time of the site visit so we were unable to talk to her about her future plans for development in this area. The manager showed us some work she had been doing with residents, recording their interests and personal histories and memories; the manager said the activities organiser planned to extend this and work with individuals to create their own record of social preferences and expectations. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 16 There were some details in the care file for the permanent resident that was case tracked, about their social care needs and history. There were few details recorded for the residents that had been admitted as emergencies. The manager said this was because, on admission, staff concentrated on identifying and meeting their immediate health and personal care needs. If residents stayed at the home for longer or their residency became permanent, social care needs would be explored further. Residents said they were able to plan their daily routine, getting up and going to bed when they chose and spending the day in their own rooms or in the communal rooms as they wished. Staff adapted the routine to meet residents’ expectations, for example, one resident liked to get up very early and was hungry before the chef came on duty, so staff gave him some toast and tea when he got up and later, when the chef came in, he liked to have a cooked breakfast. Residents said their visitors were made welcome and several went out sometimes with them. Some people said they had also been out on trips organised by the home, for example, they had been to a hotel for lunch at Christmas. The manager said they had also arranged for entertainers to come and sing and perform for the residents and the activities organiser had been working hard at forging links with the local community. Line dancers had given a demonstration and the home had hosted a religious rock festival, which was really successful. Planning could be better to meet residents’ more diverse needs. For example, one resident had very poor eyesight but still liked to read, using a magnifying glass. There was no care plan in place to address the resident’s visual problems, this had not been discussed with her and no reading material had been provided. However, this resident was quite new to the home and the relative of another resident with diverse needs who had lived there longer wrote in a survey “X has been treated the same as anyone else, so much so that she calls Appleton Lodge her home. She just loves being there”. This relative went on to write “If you could see X now you would not believe the difference - she has so much more confidence due to the fact that she has care at night and a wonderful social life during the day”. Of ten residents that returned surveys, six said there were always or usually activities provided, three said there sometimes were and one said there never was. One resident wrote, “I am not much of a social person I’m afraid but I know there are plenty of activities”. The manager was aware of the shortfalls that still exist in the current arrangements for social activities and is working with the new organiser to expand and develop the service provided. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 17 Most residents spoken to were mainly complimentary about the food provided at the home. Comments included “The food is fine. If I don’t want the main choice I can have sandwiches”, “The food is very nice – it’s sometimes a bit cold” and “it’s like a hotel here – what more could you want”. One resident said that although the soup was always very nice, they did not always know what it was, as it said on the menu “Soup of the day”. Of ten residents that returned surveys, eight said they always or usually liked the food, whilst two said they sometimes did. Residents said there was a choice at each mealtime and staff came round the day before to ask what they would like to order from the menu. One relative who returned a survey did comment that people who had problems with communication often seemed to be served sandwiches at teatime, although a hot alternative was available. They suggested that staff could discuss the following week’s menu with close family or friends if they were willing, as they would be able to advise staff of residents’ preferences. Lunch on the day of the site visit was chicken curry or gammon and pineapple. Most residents had the gammon and several, who we asked, said it was tasty and enjoyable. We sampled the curry and found it to be appetising and flavoursome. The lunchtime routine on the ground floor was observed. The atmosphere was pleasant, with music playing in the background, tables nicely set with cloths, flowers and napkins and staff assisting where needed. The manager reported that menus were being reviewed at the present time. Since the last inspection, arrangements had been made to ensure that residents were able to order and receive a cooked breakfast. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 18 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents and their relatives were confident that their complaints would be listened to, taken seriously and acted upon and procedures in place protected residents from abuse. EVIDENCE: The service user guide and statement of purpose contained a copy of the home’s complaints procedure. Of ten resident surveys received before the site visit, eight residents said they knew how to make a complaint, whilst one wrote, “I can’t remember although I believe I was told” and another wrote, “Not been made aware of whom to speak to”. One new resident who had not seen the service user guide had not seen the complaints policy either. Another new resident had. All three relatives who returned surveys said they knew how to make a complaint. Two said the manager had responded appropriately to concerns they had raised, whilst one said they had never had to make a complaint. One relative wrote, “I have had some issues – these have without fail been listened to, acted upon and addressed. Dawn (the manager) always encourages an open door policy, this works well and I have full confidence in her” and another wrote the manager was “always willing to listen and improve”. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 19 The manager confirmed in the AQAA that the complaints system was used as a positive, quality assurance system and reported that an open door policy was in place for residents, relatives or staff to discuss any area of concern with her. The monthly home audit incorporates a complaint audit and all complaints are reported to the Divisional Office of Southern Cross Healthcare Limited. A record of complaints received had been kept. The record was incomplete in that it detailed the nature of the complaint and recorded when it had been responded to, but did not give information about how the complaint was investigated or what the response was. The manager said these details were kept separately for reasons of confidentiality, as the complaints book was not kept securely. It was advised to keep the record secure and use it to keep a full record of all complaints and the details of them. The CSCI was aware of one complaint that was made to the home through Social Services. The social worker liaising with the manager about the complaint commented that the manager took the matter very seriously, investigated the concerns raised thoroughly and provided a full response. Training records showed that staff had received training in safeguarding adults and staff spoken to were aware of the procedures to follow. The manager confirmed in the AQAA that the policy for safeguarding adults was understood and accessible to all members of staff from induction onwards and a whistle blowing policy was included. Since the last inspection, one referral has been made to the safeguarding team and a member of staff was dismissed. A relative of the resident involved in this incident wrote, “The handling of this has been professional and thorough”. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 20 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): 19, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The standard of cleanliness was good but the décor and maintenance of some parts of the home still need improvement so all residents have a comfortable and homely environment to live in. EVIDENCE: A tour of the home was conducted. The home was clean and tidy, whilst many residents’ rooms were homely and personalised with ornaments, furniture and mementos. However, some of the rooms used for residents that were only staying for a short time were quite sparse. Consideration should be given to adding additional “finishing touches” to these rooms to make them more appealing and hospitable. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 21 Nine of the ten residents who returned surveys said that the home was always fresh and clean and one said it sometimes was. No bad smells were noticed whilst we were on our site visit. Since the last inspection the redecoration programme has continued, bedrooms being decorated when they become vacant. The first floor reception area had been redecorated and it was reported that residents had had an input with regards to the choice of colour scheme. The ground floor reception area and lounge/dining room had been redecorated and new armchairs had been purchased. Co-ordinating curtains had been ordered and were due for delivery. Some double-glazing units around the home had “blown” and need to be replaced; it was recommended at the last inspection that these were replaced but the work has still not been done. One relative who returned a survey stated that the window frames in her relative’s room badly needed replacing, as they were often cold in their room, even with the radiator turned up full. This window must be replaced. The first floor lounge/dining room needs refurbishment; several residents and relatives commented that the décor was “jaded”. The manager said this was in hand. Several residents also commented that their laundry sometimes went missing. This was discussed with the manager. A full-time maintenance person is employed who divides his time between Appleton Lodge and Appleton Manor. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home was usually adequately staffed to meet the needs of the residents but lapses in recruitment practice could place residents at risk. EVIDENCE: Of ten residents that returned surveys, nine said there were always or usually enough staff available to meet their needs. Of seven staff that returned surveys, one said there were always enough staff, three said there usually were and two said there sometimes were (one did not answer the question). Residents spoken to on the day of the site visit generally thought staffing levels were satisfactory. Examination of staff duty rotas for the weeks commencing 18/5/08 and 25/5/08 showed that, in the main, there were enough staff on duty to meet the needs of the residents. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 23 Three staff personnel files were examined. Two provided all the documents to show that the necessary checks had been made before the staff started work at the home, although the employment history for one was very brief and had not been explored with the staff member during their interview. The third employee had also only provided a very recent employment history and there was no further information to say if they had worked in the preceding years. A poor verbal reference had been provided from this person’s last employer and they had declined to provide a written reference. A personal testimonial was available but it was not clear what the referee’s relationship to the applicant was. Training records showed that new employees had received induction training that covered the Common Induction Standards. A new employee said they felt the induction they received had provided enough support for them to understand their role and settle into working at the home. Staff had also undertaken training in customer care, dealing with challenging behaviour, COSHH, safeguarding, dementia awareness and mandatory training, such as fire safety, moving and handling, and food hygiene. As stated previously in this report, one staff member was acting up as senior carer and was responsible for administering medicines but had no recent training in the safe management of medicines. Staff must have training that is relevant to their role and responsibility. Records of staff supervision showed that the manager had discussed topics such as the role of the key worker with staff and was using supervision as a developmental tool. Information obtained from the AQAA showed that out of a team of 16 care staff, ten had successfully obtained an NVQ level 2 or above qualification. This meant the home had achieved 62 of trained staff. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 24 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): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The manager has the skills and knowledge to properly manage the home and systems in place create an open and consultative atmosphere, promoting active involvement from people living at the home to build a positive home for people to live in. EVIDENCE: Feedback about the manager from residents, relatives and staff was, without exception, very positive. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 25 Comments included “Dawn keeps me very well informed about everything and if I am unsure, she always makes time to help. I think she is excellent”, “(the home) has a good manager who keeps very close to her team and her residents” and “I have no complaints about my manager Dawn. She always makes sure her staff and residents’ needs are met. She is easy to talk to and you can go to her with any worries you have, also concerns about residents and she will always listen to you and take time to explain things. She is an excellent manager, the best I’ve seen. She really looks after us and her residents and also she is very good at dealing with any issues you have more or less straight away and if she says to you I will sort it out you can be assured she will do her best to do so”. It was clear from talking to the manager that she had a sense of ownership about the home and a strong vision of the direction she wanted to move in to continue improvements in the home. From her comments in the AQAA she was able to demonstrate that she was aware that the home wasn’t perfect but she was enthusiastic and committed to continuing to improve and develop services for the residents. The manager confirmed she was careful to keep up to date with current legislation and attended in-house training on various subjects to keep abreast of changes. Residents said they saw the manager frequently around the home and she always stopped and had a chat with them. Records of residents’ meetings were available that showed that residents had been asked to give their opinions and suggestions about the home. We suggested that the minutes of the last meeting were reviewed at the following one, so there was a record of how residents were updated about what action had been taken as a result of their feedback. Southern Cross Healthcare has a policy regarding quality monitoring by which the manager is required to undertake monthly internal audits, looking at areas such as home presentation, medicine management, documentation, pressure ulcer monitoring, complaints management, administration and finance. The procedures in place for handling residents’ money were satisfactory. Maintenance records showed that the building and equipment were checked and serviced frequently in accordance with health and safety guidelines. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 26 A fire risk assessment was available for each resident regarding his/her abilities and vacating the building and staff had taken part in fire drills. Since the last inspection, the manager reported an incident to us in which staff failed to respond appropriately when a toaster set the fire alarm off. The Fire Service was called to the home and were concerned that staff had not evacuated residents from the affected area, which was filled with smoke. Detailed information was provided by the manager regarding the actions taken to improve the response by staff. Staff said there was enough equipment within the home to enable them to carry out their jobs safely and staff were seen to be working using safe working practices. The manager is good at notifying us about things that happen at the home, such as accidents, and since the last inspection regular visits by a representative of the registered provider have taken place. Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 27 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 X 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 X 18 3 2 X X X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 3 X 3 Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 28 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. 1 Standard OP9 Regulation 13 Requirement All medicines must be administered by appropriately trained staff who have been assessed to confirm their competency in handling, recording and administering medicines. All staff must follow the policies and procedures laid down for the management of medicines to ensure that errors do not occur. Changes to the directions for administration of prescribed medicines must be sanctioned and amended by a doctor. The administration of Controlled Drugs must be witnessed and recorded by another appropriately trained member of staff. The window identified during the inspection must be replaced. Staff must not be employed to work at the home until all the required checks have been undertaken in order to ensure the safety of the people living at the home. This includes the exploration of any gaps in a person’s employment history. DS0000008536.V363621.R01.S.doc Timescale for action 15/06/08 2 3 OP25 OP29 23 19 30/08/08 15/06/08 Appleton Lodge Version 5.2 Page 29 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 2 Refer to Standard OP7 OP7 Good Practice Recommendations Care plans should provide staff with information about how a resident’s progress must be monitored. The format of documentation for people receiving short term care at the home should be reviewed to ensure it is easy for staff to use, understand and extract up to date information from. Further staff training should be provided for staff that have a responsibility to undertake risk assessments to ensure they are fully competent in using the tools. The registered person should ensure that blown double glazing units are replaced. 3 4 OP7 OP25 Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Appleton Lodge DS0000008536.V363621.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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